经颅多普勒脑血流动力学检测的临床价值

经颅多普勒检测脑血流动力学状态具有无创、可重复、连续监测等特点，本阐述脑血流动力学检测在临床颅内压监测、指导治疗、术中临测、评价疗效和评估预后等方面的研究进展，为进一步发挥脑血流动力学检测的临床作用提供依据。     

精神分裂症经颅彩色多普勒超声检测分析

目的 初步探讨精神分裂症患者的脑动脉血流动力学改变。方法 应用经颅彩色多普勒超声(TCD)检测108例精神分裂症患者,并与31例正常人TCD检测进行对照。结果 精神分裂症患者中有78例(72.2％)TCD诊断异常,对照组中有9例(29.0％)TCD诊断异常,两组异常率有显著性差异(P<0.001);TCD诊断异常主要表现为动脉的痉挛、痉挛伴扩张、弹性下降、硬化及供血不足等;这些异常多发生在大脑前动脉、颈总动脉、基底动脉、椎动脉和大脑中动脉等。结论 精神分裂症患者可能存在脑动脉血流动力学改变,因此造成脑部血流灌注量减少。初步认为,TCD对精神分裂症的病因、诊断和治疗研究可能具有一定的参考价值。     

经颅多普勒诊断血管性偏头痛的临床意义

目的 应用经颅多普勒超声(TCD)分析仪,检测脑血管血流动力学改变,对偏头痛患者的诊断及治疗提供客观依据。方法 采用以色列产彩色经颅多普勒分析仪,对108例偏头痛患者进行脑血流检测,经枕窗探测基底动脉及双侧椎动脉;经颞窗探测大脑中、前、后动脉,记录流速及搏动指数,同时观察频谱、频声等参数。结果 在108例偏头痛患者中48例脑血流速度加快,16例血流速度减慢,余44例脑血流速度不稳定及双侧脑血流速度不对称。结论 对脑血管进行TCD检测,为偏头痛患者的诊断及指导治疗提供客观依据。     

经颅多普勒动态检测脑血流变化对颅内动脉瘤患者手术时机选择的指导作用

目的探讨经颅多普勒动态检测脑血流变化对颅内动脉瘤患者手术时机选择的作用。方法选取我院2010-03—2014-05收治的动脉瘤患者152例为研究对象,均因动脉瘤破裂导致的蛛网膜下腔出血入院。按手术时间分为早期手术组、间期手术组和延期手术组。对患者基本病情资料、经颅多普勒动态监测血流情况、手术实施时间及术后恢复情况进行回顾性分析。结果早期手术组术前1~3d脑动脉血流速度(72.35±12.60)cm/s,间期手术组为(172.23±21.30)cm/s,延期手术组为(92.35±12.61)cm/s,早期组与间期组、间期组与延期组术前1~3d血流速度差异有统计学意义(t=16.342,P0.01;t=16.121,P0.01);早期、间期和延期患者术后预后良好率分别为91.23%、75.4%和90.5%,早期组与间期组、间期组和延期组预后良好率差异有统计学意义(χ~2=4.243,P0.05;χ~2=4.143,P0.05),而早期组和延期组的预后良好率差异无统计学意义(χ~2=2.123,P0.05)。结论通过TCD动态监测脑中动脉血流速度对选择合适的手术时机,协助判断术后预后有一定的指导意义。     

经颅多普勒超声观察甘露醇对脑出血患者脑血流的影响

目的用经颅多普勒超声观察甘露醇对急性期脑出血患者脑血流动力学的影响。方法以大脑中动脉(MCA)和颈内动脉颅外段(EICA)为靶血管,观察30例急性期脑出血患者脑血流变化的趋势及应用甘露醇前后各指标的变化。结果Ⅰ组静滴甘露醇前后MCA和EICA的收缩期峰流速(Vs)、舒张期流速(Vd)、平均流速(Vm)、脉动指数(PI)无明显变化(P>0.05);Ⅱ组用药后MCA的Vd、Vm、Vs增加,PI降低(P<0.05);EICA的Vd增加(P<0.05),Vs、Vm、PI无明显变化(P>0.05)。结论脑损害较轻的患者应用甘露醇可改善脑灌注,甘露醇对严重脑损伤患者难以发挥调节脑血流作用。     

59例不同年龄段偏头痛患者经颅多普勒超声探测脑血流变化的临床意义

目的 探讨经颅多普勒超声(TCD)对偏头痛的检测价值.方法 59例偏头痛患者,按不同年龄段分成5组,在急性发作期应用TCD检测血流速度.结果 偏头痛患者不同年龄段急性发作期脑血流速度和正常人血流速度与同名动脉比较,偏头痛患者和正常人血流速度差异有统计学意义(P<0.01).结论 TCD可敏感而准确地反映偏头痛患者在急性...     

经颅多普勒对脑死亡患者脑血流动力学的观察

脑死亡概念是现代临床医学进步的象征。本研究采用经颅多普勒（TCD）技术观察8例脑死亡患者的脑血流频谱，探讨脑死亡的脑血流动力学动态变化规律，对TCD诊断脑死亡研究作一些补充。     

经颅多普勒联合CT灌注成像对单侧颈内动脉重度狭窄或闭塞患者脑血流动力学评价

目的 经颅多普勒(TCD)联合CT灌注成像(CrP)对单侧颈内动脉(ICA)重度狭窄或闭塞患者脑血流动力学评价.方法 经TCD检测为单侧ICA重度狭窄或闭塞患者19例,分症状组(9例)及无症状组(10例),行头颅CT血管成像(CTA)和CTP检查.15例健康志愿者为对照组.比较症状组和无症状组患侧之间、症状组和无症状组患侧与对照组TCD及CTP参数.结果 TCD示症状组患侧大脑中动脉(MCA)平均血流速度(Vm)低于对照组(P＜0.001),而无症状组MCA Vm低于对照组,但差异无统计学意义(P＞0.05);症状组和无症状组MCA搏动指数(PI)均低于对照组(P＜0.05).症状组患侧MCA Vm明显低于无症状组(P ＜0.001),与颅内侧枝循环有关.症状组和无症状组与对照组CTP参数分析,症状组患侧脑血流量(CBF)减低(P＜0.05),而无症状组CBF无明显改变(P＞0.05);症状组和无症状组平均通过时间(MTI)及达峰时间(TIP)延长(P＜0.05),但两组脑血容量(CBV)与对照组比较差异无统计学意义(P＞0.05).结论 TCD与CTP结果有良好的一致性,二者联合应用可以综合评估单侧颈动脉狭窄或闭塞患者脑灌注情况,为临床选择有效治疗方案提供科学依据.     

儿童偏头痛发作期脑血流动力学变化特点分析

1资料与方法1.1一般资料头痛患儿选自2010-05—2012-03在我院神经内科门诊及病房就诊或住院患儿68例,主要症状为反复发作性头痛,年龄2.5～8岁,平均6岁;男30例,女38例;病程2个月以内11例,>2～6个月12例,>6个月～1a25例,>1～2a20例;发作频率不等,少则1个月左右发作1次,多则发作次;发作部位:全头痛例,单侧或双     

Right-to-left-shunts detected by transesophageal echocardiography and transcranial Doppler sonography

BACKGROUND: Transesophageal echocardiography (TEE) and transcranial Doppler sonography (TCD) can identify right-to-left-shunts that predispose to paradoxical embolism. In a large cohort we compared the results of both techniques. METHODS: 222 patients were investigated by both techniques using the contrast agent Echovist-300 and performing each test once without and once with the Valsalva maneuver (VM). RESULTS: TEE-proven right-to-left-shunts were detected by TCD with a high sensitivity of 94%. In addition, TCD revealed shunts not noted during TEE in about 20% of all patients studied. These shunts are in general smaller than those concordantly identified; however, 9% of the patients without a TEE-proven shunt presented with a shunt that allows a considerable amount of contrast medium to pass. There were 12% more microbubbles detected in the right middle cerebral artery than in the left middle cerebral artery during the TCD test performed with VM, but not during the TCD test performed without VM. CONCLUSIONS: Contrast-enhanced TEE and TCD are complementary methods in the assessment of stroke and stroke-prone patients. The side difference of microbubbles may indicate a selective streaming of cardiac emboli during VM.     

Cerebral hemodynamics during induced tachycardia in routine electrophysiologic studies: A transcranial Doppler study

Abstract

Supraventricular and ventricular tachyarrhythmia are established causes of syncope. We investigated the mean blood flow velocities (V_mean) of the middle cerebral arteries (MCA) during routine cardiac electrophysiologic studies in patients with supraventricular and ventricular tachyarrhythmias in order to evaluate the changes in cerebral hemodynamics associated with pre-syncopal and syncopal states. Thirtytwo patients with a history of supraventricular (n = 14) or ventricular (n = 18) tachyarrhythmias were investigated in the nonsedatedl post-absorptive state in supine position. V_mean was assessed in both MCAs by means of transcranial Doppler under resting conditionsl during atrial and ventricular pacing at constant rates (n = 28) and during induction of tachyarrhythmia (n = 4). Mean arterial blood pressure (MABP) and heart rate were also recorded. Seven patients suffered pre-syncope at a heart rate of 187 ± 45 bpm (mean ± SO) with an average drop of 44% in the V_mean MCAI and statistically insignificant changes in MABP. Five patients suffered syncope during tachyarrhythmia (mean heart rate 283 ± 42 bpm) with a reduction of 69% in the V_mean MCA. MABP could be assessed iii two of those patients and showed a drop of 15 and 43 mmHgl respectively. During tachyarrhythmia pre-syncope and syncope are associated with an average reduction in V_mean MCA by 44% and 69%1 respectively. The decrease in MCA blood flow velocity is a more important predictive factor for the development of pre-syncope and syncope than the MABP. [Neural Res 1998; 20: 504-508]     

Microembolization from a carotid mural thrombus detected by transcranial Doppler

Over the last few years, many authors have described the possibility of using transcranial Doppler to demonstrate the passage of microemboli in the cerebral arteries. We report the case of a 44-year-old woman with thrombotic diathesis and thrombocytosis who was admitted twice within a short period of time (one and a half months) to a neurological department because of multiple cerebral infarctions. On the occasion of the second admission, a colour-Doppler examination of the epiaortic vessels, which had previously been negative, showed a carotid lesion due to a mural thrombus and, on the same side as the carotid lesion, transcranial Doppler detected short-duration, high-intensity signals in the middle and anterior cerebral arteries, an expression of the passage of microemboli.As already described by other authors in similar clinical situations, our case confirms that transcranial Doppler can identify the passage of microemboli in the circle of Willis.

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Sommario Negli ultimi anni è stata descritta da molti autori la possibilità di dimostrare mediante Doppler transcranico il passaggio di microemboli nelle arterie cerebrali. Riportiamo il caso di una donna di 44 anni con diatesi trombotica e trombocitosi ricoverata per due volte, a breve distanza di tempo (un mese e mezzo), in ambiente neurologico per infarti cerebrali multipli. In occasione del secondo ricovero l'esame Color-Doppler dei vasi epiaortici, che era risultato negativo in precedenza, ha evidenziato una lesione carotidea riferibile a un trombo murale e al Doppler transcranico sono stati rilevati, omolateralmente alla lesione carotidea, segnali di breve durata ed alta intensità nelle arterie cerebrali media e anteriore, espressione di passaggio di microemboli.Come già descritto da alcuni autori in situazioni cliniche simili, il nostro caso conferma la possibilità di individuare, mediante Doppler transcranico, il passaggio di microemboli nel circolo cerebrale.

     

Emotionally evoked changes in cerebral hemodynamics measured by transcranial Doppler sonography

The cerebral representation of emotions has previously been investigated by the study of patients with local brain damage, experiments with selective stimulation of only one hemisphere, and more recently by imaging techniques such as positron-emission tomography or magnetic resonance imaging measuring local cerebral blood flow. We investigated the mean flow velocity (FV_mean) in the middle cerebral artery (MCA) by transcranial Doppler sonography during emotional stimulation with video scenes in 24 healthy test persons. The videos consisted of an erotic scene and a violent scene shown in contrast to a calming scene. Blood pressure, heart rate, and breathing frequency were monitored continuously by noninvasive measurement. FV_mean increased during the erotic scene to 108.5 ± 11.9% (P < 0.05) of the baseline value in the right MCA and to 109.0 ± 10.6% (n.s.) in the left MCA. During the violent scene FV_mean reached 109.0 ± 8.7% (P < 0.05) on the right side and 108.1 ± 13.0% (n.s.) on the left side. The FV_mean time course showed a close relationship to the video sequence. During scenes involving great tension FV_mean showed a plateaulike state and peaked during sudden actions. Blood pressure, heart rate, and respiratory rate showed no significant changes. However, we observed a tendency towards lower heart rates (lowest value 94.5 ± 13.6%) during the erotic scene and two peaks (103.2 ± 13.3%, 104.8 ± 16.8%) coinciding with sudden violent actions. The significant increase in FV_mean in the right MCA supports the theory of a right hemisphere dominance for the processing of emotions. Received: 12 March 1998 Received in revised form: 13 July 1998 Accepted: 24 July 1998     

TCD对小动脉病变为主的腔隙性脑梗死脑血流动力学评价

目的探讨以小动脉病变为主要发病机制的腔隙性脑梗死患者的血流动力学改变。方法利用颈部血管彩超和MRA等排除伴有显著大血管病变的患者后,利用TCD观察115例腔隙性脑梗死患者脑内主要动脉的血流动力学改变,并与年龄和动脉血压等进行相关分析。同时以同年龄阶段、头颅影像学检查正常的30例健康体检者作为对照。结果腔隙性脑梗死组大脑中、前、后动脉的平均血流速度均低于对照组、脉动指数均高于对照组[分别为(1．05±0．26)、(1．01±0．24)、(1．05±0．23)和(0．87±0．12)、(0．88±0．20)、(0．88±0．16),均P＜0．05]。其中大脑中、前、后动脉的脉动指数均与年龄呈正相关(r=0．394、0．299、0．352,均P＜0．05),大脑前动脉脉动指数与收缩压和脉压差呈正相关(r=0．338、0．353,P＜0．05),大脑中动脉脉动指数与脉压差呈正相关(r=0．220,P＜0．05)。结论以小动脉为主要发病机制的腔隙性脑梗死患者脑血流动力学表现为血流速度轻度减慢,脉动指数显著升高,其中脉动指数与年龄和动脉血压有一定的关系。     

Cerebral hemodynamics and the role of transcranial Doppler applications in the assessment and management of cerebral arteriovenous malformations

Dramatic hemodynamic changes occur following resection of brain arteriovenous malformations (AVM). Transcranial Doppler (TCD) records non-invasive velocity and pulsatility parameters. We undertook a systematic review to assess AVM hemodynamics including the time course of changes in velocity and pulsatility in patients undergoing AVM resection. The review employed the Embase and Medline databases. A search strategy was designed. An initial title search for clinical series on AVM and TCD was performed followed by a search for reports on AVM and TCD. A total of 283 publications were selected. Full text analysis produced 54 studies with extractable data regarding AVM, velocity and pulsatility. Two TCD techniques were utilized: conventional “blind” TCD (blind TCD); and transcranial color duplex Doppler (TCCD). Of these, 23 publications reported on blind TCD and seven on TCCD. The presence of high velocity and low pulsatility within AVM feeding arteries preoperatively followed by a postoperative decrease in velocity and subsequent increase in pulsatility of feeding arteries is established. The time sequence of hemodynamic changes following AVM resection using TCD remains uncertain, confounded by variations in methodology and timing of perioperative measurements. Of the two techniques, TCCD reported qualitative aspects including improved differentiation of feeding arteries from draining veins. However, there are a limited number of studies supporting this conclusion. Furthermore, none report reproducible changes with time from treatment. TCCD appears to be a useful technique to analyze the hemodynamic changes occurring following treatment of AVM, however little data is available. This is a field of research that is appropriate to pursue.