镰状细胞贫血患者中心静脉导管拔除继发脑空气栓塞

正中心静脉导管已经成为现代医疗技术操作不可缺少的一部分,随着临床应用的日益广泛,其并发症也越来越引起人们的注意,其中空气栓塞虽然少见,但有潜在致命危险,应当引起临床医师的足够重视。而有血液系统疾病的患者在拔除中心静脉导管后出现空气栓塞的风险性更高。现将我院近期一例镰状细胞贫血患者中心静脉导管拔除继发脑空气栓塞病例报告如下。     

Takayasu氏动脉炎的脑血流动力学改变

目的Takayasu氏动脉炎是主动脉及其主要分支的炎性血管病变,本研究用经颅超声多普勒(TCD)探测16例大动脉炎患者脑血流动力学的特征性改变。方法16例患者均行TCD检测,分析其收缩期血流速度(Vs)、舒张期血流速度(Vd)、脉动指数(PI)、频谱形态等改变,5例患者同时行主动脉造影。结果累及主动脉弓多支血管者,TCD表现为Willis环主干血管的Vd升高(P<0.05和P<0.01),PI均降低(P<0.001),频谱表现为波型衰减、波峰变钝、峰值后移,呈几乎无波动的频谱改变;累及主动脉弓单支血管者,TCD仅表现为锁骨下动脉狭窄伴颈内动脉及椎动脉、基底动脉分叉处狭窄。结论TCD检测显示颅内出现异常的血流动力学改变,即Vd升高、PI明显减低或锁骨下动脉狭窄、频谱出现特征性的改变等,结合临床即可诊断为Takayasu氏动脉炎。     

经颅多普勒对偏头痛患者间歇期的血液动力学检测

偏头痛目前被认为是颅内外血管舒缩功能障碍所致。经颅多普勒(TCD)能直接检测颅内主要动脉的血液动力学变化。较好地反映颅内血管的功能状态改变。为探讨偏头痛患者的脑血流变化的特点，我科自1998-10～2004-03对86例偏头痛患者进行了TED检测分析，报道如下。     

重视功能性疾病的脑血液动力学紊乱

相对于器质性疾病而言,功能性疾病是一组由大脑皮层功能紊乱引起自主神经功能失调而产生的一系列临床症状性疾病,无明显的器官和脏器的实质性病损.……     

颈内动脉扭曲的特点及其脑血流动力学变化

目的 研究颈内动脉(ICA)扭曲的特点及其脑血流动力学变化.方法 对223例缺血性脑血管病患者进行全脑血管造影和经颅多普勒超声检查.观察ICA扭曲的形态,将患者分为ICA扭曲组及正常组.比较两组的脑血流动力学参数.结果 全脑血管造影示ICA扭曲159例(ICA扭曲组),其中双侧扭曲127例(79.9％),单侧扭曲32例(20.1％);无扭曲64例(正常组).扭曲的类型以迂曲型最多(47.8％),折曲型次之(36.8％),盘曲型最少(5.3％);其中ICA左侧迂曲率(56.7％)显著高于右侧(43.3％)(P＜0.05).与正常组比较,ICA扭曲组及双侧折曲患者的大脑中动脉的收缩期峰速、舒张末期血流速度、平均血流速度、搏动指数及阻力指数明显降低(均P＜0.05);双侧迂曲患者各血流动力学参数的差异无统计学意义.结论 ICA扭曲以迂曲型和折曲型为主.ICA扭曲及其折曲型可引起脑血流动力明显降低,迂曲型则无显著改变.     

外伤性颈内动脉海绵窦瘘患者介入治疗的血液动力学分析

目的 应用经颅多普勒超声（TCD）观察外伤性颈内动脉海绵窦瘘（CCF）患者介入治疗（可脱式球囊栓塞术）前后的血液动力学变化。方法 回顾分析2000年2月至2007年10月间介入治疗的18例外伤性CCF患者的TCD结果,并将手术前后的TCD与数字减影血管造影术（DSA）的检查结果进行比较。结果 经DSA证实的18例CCF患者15例行可脱式球囊栓塞术,DSA证实手术一次成功;2例术中改为ICA闭塞术,术后DSA显示患侧ICA完全闭塞;另1例术中出现血管痉挛而被迫放弃手术。术前TCD检测：（1）17例患侧颈内动脉颅外段和（或）颈内动脉虹吸段血流速度加快,脉动指数（PI）值均减低,其中颈内动脉虹吸段加快者伴频谱紊乱。（2）10例患侧大脑中动脉（MCA）、16例患侧大脑前动脉（ACA）血流速度减慢伴PI值下降。（3）11例患侧大脑后动脉（PCA）、14例健侧ACA流速加快,频谱形态正常。（4）16例患侧、2例双侧眼上静脉（SOV）呈现反向的静脉动脉化频谱。术后1周及6个月后复查TCD显示,15例球囊栓塞患者术前异常的颈内动脉及SOV等血管的血液动力学参数均恢复或接近正常,2例行ICA闭塞术患者TCD显示患侧ICA完全闭塞（患侧大脑后动脉及健侧大脑前动脉流速加快）。结论 TCD可以实时、动态的观察CCF患者颅内、外血管的血流及频谱改变,为临床提供可靠的血液动力学信息。     

脑性瘫痪患儿颅内血流动力学的改变

目的 探讨彩色经颅多普勒(TCD)在小儿脑性瘫痪诊断中的作用及与临床的关系.方法 对2005-2006年采用TCD检查的资料数据完整的40例小儿脑性瘫痪病例,进行统计学处理及分析.结果 TCD正常11例(27.5%),异常29例,阳性率为72.5%.结论 TCD在小儿脑性瘫痪诊断中有一定的价值,脑瘫儿颅内血流动力呈低流速高阻抗,说明脑瘫儿的大脑供血少于正常儿,属于低灌注循环状态,脑灌注量越低,病情越重,可见脑血循环与脑功能是密切相关的.对脑性瘫痪的诊断如采用多种检查,将起到相辅相成的作用,综合分析意义更大.     

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。     

颈动脉支架术后脑血流动力学的超早期改变

目的应用经颅多普勒超声(TCD)评价颈动脉支架成形术后脑血流动力学的超早期改变。方法回顾我院2017年1月～2019年3月收治的85例颈动脉支架成形术患者,其中12例因颞窗透声不佳排除,剩余73例行TCD监测,采用TCD检测术前、术后1 h、术后6 h患侧大脑中动脉(MCA)收缩期流速峰值(PSV)、搏动指数(PI)的变化情况。结果术前平均收缩压为(152. 47±12. 85) mm Hg,术后1 h平均收缩压(127. 86±16. 48) mm Hg(P <0. 01),术后6 h平均收缩压(126. 75±14. 31) mm Hg(P <0. 01)。术前患侧MCA-PSV为(70. 25±19. 87) cm/s,术后1 h MCA-PSV为(84. 81±17. 88) cm/s(P <0. 001),增幅为24. 95%;术后6 h MCA-PVS为(83. 58±17. 26) cm/s(P <0. 01),增幅为23. 17%。术前患侧MCA-PI为(0. 836±0. 158),术后1 h MCA-PI为(0. 933±0. 178)(P <0. 01),平均增幅为12. 14%;术后6 h MCA-PI为(0. 921±0. 164)(P <0. 01),平均增幅为10. 88%。结论在颈动脉支架植入术后1 h、术后6 h术侧MCA-PSV、MCA-PI就明显增高,而术后1 h与术后6 h对比无明显差异。狭窄程度> 90%者术后1 h MCA-PSV增幅明显升高,可能会增加脑高灌注综合征的发生风险。     

脑动静脉畸形血管内治疗前后血液动力学研究进展

脑动静脉畸形具有高血流、低阻力特征.畸形的部位,大小、血流速度、搏出指数及局部血流量是决定治疗和预后估计的最重要因素.供血动脉压力差的大小与其长度和流速成正比,与血管半径成反比.单光子计算机扫描、经颅多普勒及微导管造影、测压能准确提供血液动力学参数,指导临床治疗,提高治愈率,减少死亡率.     

The Genetic Landscape of Cerebral Steno-Occlusive Arteriopathy and Stroke in Sickle Cell Anemia

Sickle cell disease (SCD) is one of the most common autosomal recessive diseases in humans, occurring at a frequency of 1 in 365 African-American and 1 in 50 sub-Saharan African births. Despite progress in managing complications of SCD, these remain a major health burden worldwide. Stroke is a common and serious complication of SCD, most often associated with steno-occlusive cerebral arteriopathy, but little is known about its pathogenesis. Transcranial Doppler ultrasonography is currently the only predictive test for future development of stroke in patients with sickle cell anemia and is used to guide preventative treatment. However, transcranial Doppler ultrasonography does not identify all patients at increased risk for stroke, and progressive arteriopathy may occur despite preventative treatment. While sibling studies have shown a strong genetic contribution to the development of steno-occlusive arteriopathy (SOA) in SCD, the only genome-wide association study compared a relatively small cohort of 177 patients with stroke to 335 patients with no history of stroke. This single study detected variants in only 2 genes, ENPP1 and GOLGB1, and only one of these was confirmed in a subsequent independent study. Thus, the underlying genes and pathogenesis of SOA in SCD remain poorly understood, greatly limiting the ability to develop more effective preventive therapies. Dissecting the molecular causes of stroke in SCD will provide valuable information that can be used to better prevent stroke, stratify risk of SOA, and optimize personalized medicine approaches.     

Stroke Prevention in Sickle Cell Disease (STOP) Study Guidelines for Transcranial Doppler Testing

The Stroke Prevention in Sickle Cell Disease (STOP) trial used transcranial Doppler (TCD) to screen children with sickle cell disease with no history of stroke. Children (who consented) who had time-averaged mean of the maximum (TAMM) velocities in the middle cerebral artery and/or distal internal carotid artery were randomized to transfusion or standard. Over a slightly more than 20-month average follow-up, there were 11 strokes in the standard care arm and 1 stroke in the transfusion arm. This study has caused a great deal of interest in using TCD to screen children with sickle cell disease. For the STOP TCD data to be applied appropriately, it is necessary for users of TCD to understand how the STOP TCD examinations were performed, how the TCD velocities were measured, and which velocities were used. This article will review the STOP TCD scanning protocol and the reading protocol and review the TAMM velocity and how it differs from other velocity measurements.     

血管神经因素在偏头痛发病中的协同作用

目的 探讨血管神经因素在偏头痛发病中的协同作用。方法 131例符合偏头痛诊断的患者,同时进行经颅多普勒（transcranial Doppler,TCD）和皮肤交感反应（sympathetic skin response,SSR）检测,根据TCD收缩期血流速度（peak velocity,Vp）作为分组指标,分析不同脑血流速度下交感活性改变对血液动力学的影响。结果 脑血流速度增高者（高流速组,Vp≥120 cm/s）87例,正常者（正常流速组,80cm/s相似文献   

Psychosocial and Neurocognitive Aspects of Sickle Cell Disease

Sickle cell disease (SCD) comprises a group of recessively inherited blood disorders and is the most common genetic disorder in the world ( Embury et al., 1994 ). It is a chronic condition of variable severity that mainly affects people of African and African-Caribbean heritage. Over the last 20 years life expectancy has increased significantly, particularly for patients receiving western healthcare so that increasing attention has been directed to the psychosocial adaptation and neurocognitive profile of children and adolescents with SCD. Previously, research suggested that, like children with other chronic health conditions, children and adolescents with SCD were at increased risk for emotional and behavioural disorders. More recent research has not demonstrated increased rates of such difficulties. Increasing evidence suggests that children with severe disease are, however, at significantly increased risk for cerebro-vascular events and neurocognitive difficulties. This paper reviews the literature regarding the psychological and neurocognitive functioning of children with SCD and outlines a number of ways that psychological input may significantly contribute to more effective health care for these children and their families.     

Cerebral Vasoreactivity in Children with Sickle Cell Disease: A Transcranial Doppler Study

Background

Impairment of vasodilatory capacity reflecting reduced cerebrovascular reserve was previously shown in adults with sickle cell disease (SCD) and might play a role in the pathophysiology of stroke in such patients. We examined the hypothesis that children with SCD would also have a higher frequency of impaired cerebral vasoreactivity when compared with healthy age- and gender-matched controls.

Dynamic Vascular Analysis Shows a Hyperemic Flow Pattern in Sickle Cell Disease

BACKGROUND: By the age of 20 years, 10% of sickle cell disease (SCD) patients have experienced a stroke. It is unclear if SCD stroke is due primarily to hemodynamic effects of intracranial stenosis, or metabolic failure from anemia. Transcranial Doppler ultrasound (TCD) identifies a SCD subgroup with high stroke risk, but high mean flow velocity (MFV) can be due to stenosis or high flow rate, as with metabolic hyperemia of severe anemia. Dynamic Vascular Analysis (DVA; New Health Sciences, Inc., Bethesda, MD) is a new way to analyze TCD data, with potential to separate structural from metabolic causes of high MFV. METHODS: Eighty SCD patients, regardless of hemoglobin genotypes, aged 2 to 22 years, without clinical stroke or transient ischemic attack (TIA), who had TCD (1/1/02 to 1/1/04) as part of routine outpatient clinical follow-up, with both the TCD report and study videotape available, were included. Waveforms were reviewed and marked by protocol, and DVA indices calculated including MFV, pulsatility index (PI), systolic acceleration (SA), dynamic flow index (DFI), dynamic pressure index (DPI), and dynamic compliance index (DCI). Mean and standard deviation were defined for the whole group, and for four subgroups, by age. RESULTS: MFV, DFI, and DPI were highest at 6- to 9-year-olds, declining thereafter. The 14- to 22-year-old group was also compared to a group of healthy young athletes (15- to 22 years old). SCD patients had higher MFV, lnSA, DFI, DPI, and lower PI and DCI in most segments, suggesting global hyperemia. CONCLUSION: This is the first report of cross-sectional results of DVA in a cohort of SCD outpatients without prior clinical stroke (TIA). These results suggest hyperemia without significant focal intracranial stenosis. There were also differences between asymptomatic SCD and young athletes, and the MFV, DFI, and DPI were highest at the age of 6 to 9 years, decreasing as age increased.     

Sickle cell disease and posterior reversible leukoencephalopathy

Sickle cell disease can present with neurological manifestations. One such presentation is with posterior reversible leukoencephalopathy also known as reversible posterior leukoencephalopathy. The condition is classically described as reversible over time; it commonly presents with oedematous changes involving the white matter of the occipital and parietal regions. Only a few patients with the association between sickle cell disease and posterior reversible leukoencephalopathy have been described in the adult literature. We present two patients from our institutions to emphasise the association between the two conditions and summarise the published cases in the literature.