TCD检测系统性红斑狼疮患者脑血流动力学变化

目的：了解系统性红斑疮患者脑血流动力学状况,方法;利用经颅我镨勒（ＴＣＤ）测定纤斑疮患者和健康对照组脑血管收缩峰速度（Ｖｓ）、舒张期血流速度（Ｖｄ）、平均血流速度（Ｖｍ）、收缩／舒张比值（Ｓ／Ｄ）、血管搏动指数（ＰＩ）、阻力指数ＲＩ）。结果：红斑狼疮患者无Ｖｓ、Ｖｍ是否升高,各脑血管Ｖｄ均较对照组显著增快（Ｐ〈０．０１）,ＰＩ、ＲＩ显著降低（Ｐ〈０．０１）,突出表现为低的ＴＣＤ频谱改变。结论：红斑     

经颅多普勒检测儿童病毒性脑炎脑血流变化的临床研究

目的:观察儿童病毒性脑炎急性期脑血流变化特点,探讨脑血流速度变化与患儿病情严重程度和经颅多普勒检测结果与临床短期预后的关系。方法:设病毒性脑炎组和正常对照组。用经颅多普勒动态检测双侧大脑中动脉、前动脉、后动脉的收缩峰流速、舒张末流速、平均流速及动脉指数。将结果进行比较,并对脑炎组进行格拉斯格昏迷量表及按格拉斯格结局量表评分,分析脑血流速度变化与格拉斯格昏迷量表、格拉斯格结局量表和预后的关系。结果:在病情的不同阶段,病毒性脑炎组急性期各颅内大动脉脑血流变化不一致,较对照组相比,差异有显著性(P<0.05或P<0.01)。病毒性脑炎组双侧大脑中动脉-平均流速及大脑前动脉-脉动指数均与格拉斯格昏迷量表呈负相关(P<0.05)。病毒性脑炎组格拉斯昏迷与格拉斯格结局呈正相关(P<0.01)。双侧大脑中动脉-脉动脉指数与格拉斯结局成负相关。结论:采用经颅多普勒动态检测脑血流速度可作为判断病毒性脑炎病情严重程度的一种方法,经颅多普勒检测结果与病毒性脑炎短期预后有显著相关性。     

506例精神分裂症患者脑血流改变分析

目的：探讨精神分裂症患者的大脑血流特点。方法：应用经颅多普勒超声血流分析仪（TCD）对506名患者进行大脑血管血流测定，并与正常组进行对照比较分析。结果：精神分裂症的TCD血流异常占55.53%，基动脉的Vs,Vd，左大脑中动脉的Vs，两侧大脑后动脉的Vd增高；两侧椎动脉的Vs，左大脑前动脉的Vs,Vd，右大脑前动脉的Vs和两侧大脑后动脉的Vs减低。结论：精神分裂症的脑血流有异常，脑营养代谢药物的使用可能有助于此病的康复。     

TCD傅里叶分析对临床检测正常值确定的意义

ＴＣＤ傅里叶分析对临床检测正常值确定的意义李英秋①经颅多普勒超声（ＴＣＤ）能通过脑血流速度变化来间接反映脑血流量变化，但不能直接测量脑血管的横截面积。德国产ＴＣ－２０００彩色经颅多普勒超声诊断仪新增添了傅里叶分析软件系统，该系统能实时显现所测血管的相...     

降压治疗对高血压病患者脑血流的影响

高血压是脑卒中的主要病因之一 ,降压治疗对于预防脑卒中的价值已被肯定 ,为了观察降压治疗前后脑血流的变化 ,我们应用经颅彩色多普勒超声 (TCD)对 6 6例高血压患者降压治疗前后进行了检查 ,现将结果报道如下。1　对象与方法6 6例高血压病患者主要来自门诊患者 ,男 36例 ,女 30例 ,平均年龄 (5 2± 8)岁 ,平均病程 (7± 3)年 ,其中 期患者30例 , 期患者 2 1例 , 期 15例。每例入选的高血压病患者血压均高于正常 ,暂不予降压治疗并于当天下午行 TCD检查 ,之后开始给予口服卡托普利 12 .5～ 2 5 m g,每日 3次治疗 ,2周后复查 TCD;TCD检…     

脑震荡患者脑血流变化与临床意义

采用彩色三维经颅多普勒（３Ｄ－ＴＣＤ）检测９３例脑震荡患者伤后４８小时以内与治疗后１４４小时后脑血流平均峰流值，结果伤后４８小时以内脑血流平均峰流速度较治疗后差异显著（Ｐ＜０．０５）提示脑震荡早期脑血流增强，后期逐渐回落的病理过程。应用２０％甘露醇、脑复康注射液治疗后，随脑血流回落，脑震荡的临床表现趋于消失。     

TCD对颞浅动脉—大脑中动脉搭桥术前后脑血流的检测

目的：应用经颅多普勒超声（TCD）动态观察大脑中动脉（MCA）在颞浅动脉－大脑中动脉搭桥术（STA－MCA）前后脑血流的变化。方法：对MCA主干狭窄及颈内动脉（ICA）颅外段闭塞影响MCA远端供血障碍的患者行STA－MCA术。采用TCD对5例成功实施STA－MCA术患者术前、术后MCA血流变化进行检测。结果：术前4例MCA主干狭窄及1例ICA闭塞后MCA0远端血流明显减低,呈低搏动性改变。术后血流明显改变,吻合处血流方向逆转。结论：TCD可有效地检测脑血流变化,动态观察STA－MCA架桥术的治疗效果。     

TCD对腔隙性脑梗死早期脑血流动力学评价

目的探讨经颅多普勒(TCD)在腔隙性脑梗死患者脑血流动力学检测中的作用。方法对210例经CT确诊为腔隙性脑梗死患者进行TCD检测,并将结果结合临床资料进行相关性分析。结果210例腔隙性脑梗死患者的TCD检测结果显示193例脑血流异常,异常率达91．9l％。CT显示病灶位于颈内动脉供血区者,TCD则显示65．7％的病例该病灶区供血血管脑血流动力学异常。结论脑血流动力学异常在腔隙性脑梗死发病中起重要作用,TCD检测可反映腔隙性脑梗死患者的这种脑血流动力学异常。     

硫酸镁联合拉贝洛尔治疗妊高征的临床效果及对子宫动脉血流参数的影响

目的探讨硫酸镁联合拉贝洛尔治疗妊高征的临床效果及对子宫动脉血流参数的影响。方法将我院收治的120妊高征患者按随机数字表法分为观察组(60例,硫酸镁+拉贝洛尔)和对照组(60例,硫酸镁)。比较两组治疗前、后的妊高征相关指标、子宫动脉血流参数、胎儿心功能指标及不良妊娠结局发生情况。结果治疗后,观察组的SBP、DBP、24 h尿蛋白、AFP水平、RI、PI、S/D及胎儿左、右心室Tei指数均低于对照组(P<0.05)。观察组的不良妊娠结局总发生率低于对照组(P<0.05)。结论硫酸镁联合拉贝洛尔治疗妊高征可有效降低血压,改善子宫内动脉血流情况,提高胎儿心功能,优化妊娠结局。     

急性脑挫伤脑血流量变化的临床研究

目的通过本研究检测颅脑外伤后脑血流的分布及变化规律,为临床治疗提供依据.方法应用法国GK公司生产的四通道八分度经颅多普勒(TCD),于伤后2、8、12、24、72h连续检测其大脑前动脉(ACA)、中动脉(MCA)血管在不同时间的血流峰值(PACA、PMCA)、平均值(VmMCA、VmACA)及脉动指数(PI).结果伤后4 h内脑血流加速,表现为脑血管痉挛;8～24h血流速度持续升高;伤后72 h脑血流速度较伤后24h减慢;伤后对侧脑血流速度变化与伤侧相同,但变化相对较小;伤后PI逐渐升高,12、24、72 h均高于对照组.结论伤后72h内脑挫伤区供血血管血流量明显下降,伤后24 h下降最显著.     

Doppler ultrasound measurement of cerebral blood flow in healthy pregnant women

Purpose To compare global cerebral blood supply in healthy pregnant women and nonpregnant women. Materials and Methods Flow volumes in the common, internal, and external carotid, arteries and the vertebral arteries were determined using color Doppler ultrasonography in 17 nonpregnant women, 55 healthy pregnant women at 10 to 40 weeks gestation, and 24 puerperal women within 1 week after spontaneous delivery. Global cerebral blood flow was defined as the sum of flow volumes in the bilateral internal carotid and vertebral arteries. Results In the nonpregnant group, mean flow volumes of the common, internal, and external carotid arteries and the vertebral arteries, and mean global cerebral blood flow volume were (mean±SD) 863±108 ml/min, 554 ±94 ml/min, 386±65 ml/min, 115±24 ml/min, and 669±104 ml/min, respectively. During the second trimester, flow volumes of the common and external carotid arteries increased significantly in the healthy pregnant women, to about 130 percent and 140 percent of the nonpregnant level, respectively. Global cerebral blood flow volume remained unchanged during pregnancy. Conclusion During pregnancy, increase in flow volumes in the common carotid arteries were accompanied by elevated flow volumes of the external carotid arteries but not the internal carotid arteries. This distribution would tend to regulate the volume of global cerebral blood flow throughout the period of pregnancy.     

Prediction of brain blood flow using pulsed Doppler ultrasonography in newborn lambs

The purpose of this study was to evaluate the ability of pulsed Doppler ultrasonography to predict brain blood flow by comparing measurements made in basal cerebral arteries using a pulsed Doppler system with measurements of brain blood flow using radioactive microspheres in lambs. We measured the instantaneous maximum velocity during peak systole and end diastole and the mean velocity over the pulse cycle in basal cerebral arteries, calculated Pourcelot's index of resistance and Gosling's pulsatility index, and used regression analysis to compare the pulsed Doppler measurements with brain blood flow measured with radioactive microspheres. Pulsed Doppler measurements of the peak systolic, end diastolic, and mean flow velocity in basal cerebral arteries were directly related to brain blood flow. In contrast, no linear relationship was detected between the resistance or pulsatility indices and brain blood flow measured by microspheres (p greater than 0.14). Prediction of brain blood flow for individual subjects lacks the quantitative precision necessary for use as a clinical tool. However, the direct relationship between brain blood flow and the peak systolic, end diastolic, and mean flow velocities in basal cerebral arteries supports the use of these measurements in clinical research for the qualitative assessment of change in brain blood flow.     

Computerized evaluation of the peripheral blood flow during maximal vasodilatation in humans using venous occlusion plethysmography

Summary. Forearm blood flow was studied with venous occlusion plethysmography after ischaemic exercise in 10 healthy volunteers and 10 hypertensive patients. The peak blood flow was calculated by three methods: the manual conventional graphic technique and by fitting of a tangent to the inflow curve with the help of a computer. In addition a computer-aided derivation of an exponential curve adapted to the initial part of the inflow curve was used for the calculation of the maximal blood flow. With the two tangential techniques the peak mean blood flow values did not differ significantly and were 58 ml min^-1 100 ml^-1 tissue while the exponential derivation procedure gave in both groups about 40% higher maximal flow values. The effect of venous occlusion on the linear velocity of the brachial arterial blood flow blood was studied with Ultrasound Doppler Flowmetry. The maximal flow velocity after ischaemic exercise decreased by about 18% during 50 mmHg venous occlusion; the influence of the venous stasis was least during the first heart beats after the onset of the venous occlusion. The effect of the venous stasis was similar but less pronounced in the hypertensive patients. In conclusion, forearm blood flow during maximal vasodilatation is reduced by venous occlusion and the best estimate of the flow is obtained from the earliest part of the venous occlusion inflow curve, as indicated by the use of the computer-aided exponential derivation technique.     

妊娠高血压综合征并发HELLP综合征的护理

笔总结了7例妊高征并发溶血、肝酶升高血小板下降（HELLP）综合征病人的护理。认为对妊高征并发HELLP综合征的病人,应加强护理和特殊病情的观察,及早发现异常情况,防止并发症的发生。积极主动配合医生,采取有效护理措施,及早诊治和抢救病人,适时终止妊娠。在降低孕产妇及围产儿病死率方面起到积极的作用。     

Aging and transmitral flow pattern in patients with systemic hypertension

Purpose Currently, the transmitral flow (TMF) pattern is routinely recorded as the first step in the assessment of left ventricular diastolic function. In young, healthy subjects, it is known that the early diastolic flow (E wave) of TMF is larger than the late diastolic flow (A wave). The E/A ratio then gradually decreases with age. This change in the pattern of TMF can be expected to occur earlier in patients with systemic hypertension than in healthy subjects. However, data pertaining to this matter are limited for Japanese patients. The purpose of this study was to investigate the changing pattern of TMF with age in Japanese patients with systemic hypertension. Methods A database of echocardiographic examination reports was surveyed. A total of 553 patients with systemic hypertension (HT group) and 394 patients without hypertension or organic heart disease (control group) were included in this study. The patients were subdivided according to age, after which the E/A ratio was compared for different patient categories and age groups. Results The E/A ratio gradually decreased with age in the control group, and the mean value of E/A was <1 in the sixth decade. On the other hand, the E/A ratio rapidly decreased and was <1 in the fifth decade in the HT group. Conclusion In patients in the HT group, the E/A ratio decreased about a decade earlier compared with patients in the control group.     

脐血流监测对妊娠期高血压疾病孕妇妊娠结局的意义探讨

目的探讨妊娠期高血压患者胎儿脐动脉血流阻力指标对围产儿结局的影响。方法用粘度仪检测正常妊娠孕妇及妊娠期高血压孕妇血浆粘度(PV);用离心机检测红细胞压积(HCT)等;统计分析其妊娠中期(20~27周)及妊娠晚期(28~36周),并测定收缩期最大血流速度和舒张期血流速度的比值(S/D)和脉搏指数(PI)、阻力指数(RI)。探讨血液流变学各值与胎儿脐动脉血流指标相关性。结果妊娠高血压组妊娠中、晚期S/D、PI及RI值与正常妊娠组比较均有统计学差异。随着病情进展,中度、重度妊娠高血压组RI、PI值逐渐升高。妊娠期高血压病患者血液HCT、PV等值与胎儿脐动脉血流阻力指标各值呈正相关。结论 HCT、PV对妊娠期高血压病的发生、发展、严重程度及脐动脉血流阻力指标可能有重要影响。多项指标监测妊娠期高血压病患者血液流变学及胎儿脐动脉血流动力学,可提高预测妊娠期高血压症发生、发展及严重程度及其对围产儿预后影响的准确性。     

Effect of hypertension and candesartan on the blood flow velocity of the extraocular vessels in hypertensive patients

OBJECTIVE: To define alterations in the blood flow velocities of the ophthalmic artery (OA), central retinal artery (CRA), posterior ciliary artery (PCA) in essential hypertension and to evaluate the effect of a new antihypertensive drug, candesartan which is an angiotensin II receptor antagonist, on the blood flow velocity in hypertensive patients. METHODS: Blood flow velocity and resistive index (RI) of the OA, CRA, and PCA were measured in 22 hypertensive patients off medication and 15 controls by color Doppler imaging. After treatment with candesartan, blood flow velocity and RI were again measured in the hypertensive patients. RESULTS: In controls (n=15), the OA had a mean peak systolic flow velocity (PSFV) of 48.1+/-2.6 cm/s, mean end diastolic flow velocity (EDFV) of 16+/-1.0 cm/s, and RI of 0.65+/-0.01; the CRA had a PSFV of 20.8+/-0.4 cm/s, EDFV of 9.4+/-0.3 cm/s, and RI of 0.54+/-0.01; the PCA had a PSFV of 23.6+/-0.7 cm/s, EDFV of 11.2+/-0.3 cm/s, and RI of 0.52+/-0.01. There was a significant decrease in the PSFV and EDFV of the vessels in the medication free hypertensive patients when compared with controls (P<0.05). In the hypertensive patients off medication (n=22), the OA had a PSFV of 29.4+/-1.2 cm/s, EDFV of 10.4+/-0.5 cm/s, and RI of 0.71+/-0.01; the CRA had a PSFV of 15.1+/-0.6 cm/s, EDFV of 5.4+/-0.3 cm/s, and RI of 0.65+/-0.02; the PCA had a PSFV of 17.2+/-0.6 cm/s, EDFV of 6.7+/-0.3 cm/s, and RI of 0.61+/-0.01. RI measured in the OA, CRA, PCA were significantly increased in the hypertensive patients when compared with the controls (P<0.05). In hypertensive patients after medication (n=22), OA had a PSFV of 38.3+/-2.5 cm/s, EDFV of 12.3+/-0.7 cm/s, and RI of 0.68+/-0.01; CRA had a PSFV of 19.2+/-0.5 cm/s, EDFV of 7.8+/-0.3 cm/s, and RI of 0.59+/-0.01; PCA had a PSFV of 20.8+/-0.8 cm/s, EDFV of 9.2+/-0.4 cm/s, and RI of 0.56+/-0.01. There was a significant increase in the blood flow velocities of the OA, CRA, PCA (P<0.05) and significant decrease in the RI values in the treated hypertensive patients when compared with the controls (P<0.05). But blood flow velocities and RI values did not reach the control level. CONCLUSION: The increase in the RI values and the decrease in the blood flow velocity of extraocular vessels in the hypertensive patients are thought to be caused by increased peripheral resistance in the vessels of the eye and orbit. Although, it increases blood flow velocity and decreases RI significantly, candesartan treatment in the hypertensive patients cannot increase blood flow velocity and decrease RI to the control level.     

The effects of left ventricular hypertrophy on the respiratory changes in transmitral Doppler flow patterns of hypertension patients

BACKGROUND: Left ventricular early diastolic fillings can be reduced by inspiration. However, the effects of left ventricular hypertrophy on such changes have not been studied before. This study was undertaken to investigate whether respiratory changes in transmitral Doppler flow were affected by left ventricular hypertrophy in hypertension patients. METHODS: Eighty-three patients (mean age 46 +/- 8 years, 49 males) with untreated essential hypertension were included in this study. Transmitral Doppler flow velocity was measured both at end-expiration and end-inspiration. Left ventricular mass was measured by M-mode echocardiography. We divided patients into two groups based on the presence of left ventricular hypertrophy or not. RESULTS: Twenty-one patients were diagnosed to have left ventricular hypertrophy. In patients without left ventricular hypertrophy, the peak early filling velocity decreased significantly (from 74 +/- 15 to 71 +/- 18 cm s(-1), P = 0.003), the peak atrial velocity increased significantly (from 65 +/- 17 to 74 +/- 15 cm s(-1), P < 0.001) and the early filling to atrial velocity ratio decreased significantly (from 1.2 +/- 0.3 to 1.1 +/- 0.3, P < 0.001) from end-expiration to end-inspiration. In patients with left ventricular hypertrophy, the parameters of transmitral Doppler flow pattern did not change during respiration. CONCLUSION: Respiratory changes in the transmitral Doppler flow velocity are blunted by left ventricular hypertrophy in hypertension patients. This phenomenon is probably contributed by the increased left ventricular wall stiffness in the left ventricular hypertrophy.