脑导纳环的临床应用及血流图的未来发展

脑导纷环是在脑阻抗基础并受心导纷环在临床成功应用的启发,近年研究开展的一项无创检测脑血流变化的新技术l’I。我国创新性研究成功的双侧脑导纳环,采用头部左右两侧同步描记导纳图与导纳微分图所形成的闭合向量环,可以更全面和更准确地分析脑血管性能和血管容积在心动周期内的改变,将传统的脑阻抗图技术大大向前推进一步。经过动物实验,临床验证阶段,该项技术的仪器已逐步进入临床,为更好地了解和开展该项技术,简要介绍如下。1．脑阻抗日的历史回顾脑阻抗图（ImpedanceEncephalogram,IEG）亦称脑电阻图或脑血流图。于1957年…     

冠心病心导纳环检测指标与心电图结果分析

冠心病是中老年人常见病,对人们健康危害及威胁较大,发病率有上升趋势。早期诊断及正确评定冠心病患者的心脏功能,对其治疗及预后有重要意义。作者采用心导纳环（ＡＤＬ）和心电图（ＥＣＧ）两种检测方法,同时对９６例经临床确诊冠心病的患者及７３例正常人进行检测并分析,现报告如下。资料与方法１．１－检测对象　冠心病组９６例,其中男６１例,女３５例;年龄６０～８２岁（平均６６．８岁）。根据ＷＨＯ（１９７９）诊断标准,心绞痛５５例,陈旧性心肌梗塞２３例,心律失常１８例。心绞痛发作、心律失常诱发及心肌梗塞并发心力哀…     

人脑导纳微分环面积比值对血管弹性的评估价值

目的：探讨脑导纳环重搏波相（Ⅲ相）面积对高血压病患者的血管弹性判定的诊断价值。方法：高血压组患者选自2002-12-26／2003-01-20宣武医院的高血压门诊的就诊患者23例。对照组健康者选自2002—10—21／12—26某大学在校学生和教工63例。两组受试者均知情同意。应用深圳市辉大高科技发展有限公司研制和生产的HD-ENG导纳式双侧脑血流图自动检测仪及相应软件对两组受试者进行脑导纳微分环检测。由检测仪采集的脑导纳血流图信号（△Y），经微电脑自动微分后产生一阶导纳微分图（dy／dt）。以△Y为X轴坐标，dy／dt为Y轴坐标，自动拟合成脑导纳微分环。脑导纳环图可分为4个相限，以X轴为基线，从起点始，环绕X轴时相依次定为Ⅰ，Ⅱ，Ⅲ，Ⅳ相。Ⅲ相：为重搏波相，即从Y轴向右侧形成的一个小环所包含的区域，该面积大小反映脑动脉血管弹性。观察两组受试者脑导纳微分环第三象限面积及与导纳微分环总面积之比，为避免数据偏态分布，取自然对数（ln）调整后数据。结果：23例高血压患者和63名健康者均进入结果分析。①ln（脑导纳微分环的Ⅲ相面积）：高血压组左侧和右侧与对照组比较差别显著。（-05796&;#177;1．3730，-0．7027&;#177;1.4840比-1.7499&;#177;1．5325．-1．8828&;#177;1．4562．t=3．194，3．271，P〈0．05）。②ln（脑导纳微分环的Ⅲ相面积／导纳微分环的总面积）：高血压组左侧和右侧与对照组比较有显著差别（-0.3063&;#177;0．9780，-4．2510&;#177;1．0605比-0．9697&;#177;1．2519，-1．1907&;#177;1．3446，t=2．199，2．353，P〈0．05）。结论：脑导纳微分环可以定量检测脑血管弹性能力，对高血压患者的血管弹性能力的判断具有一定价值。     

脑生理功能活动增强时的脑血流速变化分析

为探讨脑生理功能活动对脑血流速度的影响，笔者采用经颅多普勒(transcranial Doppler，TCD)超声技术，对78例年龄为18-58岁健康人群在平静状态和肢体活动状态下进行TCD检测并进行对比分析。现报告如下。     

经颅多普勒检测拳击练习者的脑血流动力学变化

目的:应用能无创检测颅内动脉血液生理情况的经颅多普勒技术观察拳击运动对脑血流动力学的影响. 方法:实验于2006-04/05在北京体育大学实验中心脑功能室完成.①分组:拳击练习组为8名平均参加拳击练习时间4.25年的男性拳击练习者,平均年龄（20.38±1.19）岁,平均身高（172.13±3.04）cm,,平均体质量（66.00±8.93）kg;对照组为7名男性无拳击练习史者,年龄、身高和体质量均与拳击练习组相匹配,从未参加过拳击运动练习.②评估指标:采用EDAN仪器有限公司产CBS--Ⅱ经颅多普勒对两组受试者的脑血流动力学指标进行检测和对比,指标包括大脑中动脉、大脑前动脉和大脑后动脉的收缩期峰血流速度、舒张末期峰血流速度、平均血流速度、搏动指数. 结果:15名受试者均进入结果分析.①拳击练习组和对照组大脑中动脉、大脑前动脉和大脑后动脉的收缩期峰血流速度、平均血流速度、舒张末期血流速度和搏动指数指标都在正常范围以内.②拳击练习组的大脑中动脉、大脑前动脉、和大脑后动脉的收缩期峰血流速度、平均血流速度、和舒张末期血流速度均低于对照组,而搏动指数均高于对照组,但各项指标在两组间比较差异均无显著性意义（P > 0.05）. 结论:拳击运动对练习者脑血流动力学的影响不大,也不会显著地降低其大脑灌注压.     

阻塞性睡眠呼吸暂停综合征患者脑血流变化

目的 采用经颅多普勒超声(TCD)实时同步检测阻塞性睡眠呼吸暂停综合征(OSAS)患者睡眠呼吸暂停期间脑血流的变化.方法 对12例OSAS患者在SM-SW2000 多导睡眠仪监测睡眠的同时, 采用TCD仪2MHz脉冲波探头监测其大脑中动脉平均血流速度(MFV).结果 OSAS患者呼吸暂停持续时间平均为40.3(15～156)s.动脉血氧饱和度(SaO 2)起始值为97.1(91～99)%,呼吸暂停终止时为84.7(54～95) %, 平均下降12.6(1～40)%.MFV起始值为45.2(20～83)cm/s,呼吸暂停终止时为95.7(53～155)cm/s,平均升高117.3(38～307.2)%.结论 OSAS患者呼吸暂停时,SaO2进行性下降,MCA-MFV 进行性升高;呼吸暂停终止时,MCA-MFV快速下降至起始值以下并逐渐恢复到起始值水平.     

Neonatal bilateral cerebral high flow fistulae leading to detection of a HHT-family carrier

Cerebral and spinal cord high-flow arteriovenous fistulae (HFAVF) are part of the spectrum of lesions found in Hereditary Hemorrhagic Telangiectasia (HHT). HFAVF consist of communications between large arteries and veins without interposed nidi or capillary transitions. The association between HHT and cerebral or spinal HFAVF in children has been reported and suggested as a potential marker for HHT. We present a newborn with bilateral intracranial HFAVF tested positive for HHT1 and belonging to a family non known for carrying a HHT mutation. We also review reported cases of neonates and infants with cerebral and spinal HFAVF emphasizing their associations with genetic syndromes. Our aim is to add a new case to the pertinent literature and emphasize the need for molecular testing in children with spinal or brain HFAVF.     

Effects of blood donation on cerebral blood flow velocity

Eighteen healthy male blood donors, nine with hematocrit (Hct) of 0.40 to 0.45 (normal Hct) and nine with Hct of 0.49 to 0.52 (upper-limit Hct), were monitored by continuous-wave internal carotid Doppler sonography and hematologic tests for 28 days after blood donation, to ascertain whether and to what extent a single standard donation may modify the velocity of cerebral blood flow. The two groups had similar mean predonation values of internal carotid flow velocity (ICFV): blood donation was followed in both groups by a slight, transient decrease of ICFV at the end of phlebotomy, due to donation-induced hypovolemia, and then by an increase of ICFV lasting 7 to 10 days. Analysis of individual profiles revealed that only four of nine upper-limit and six of nine normal Hct donors displayed a positive trend (increase) in the ICFV within the first week after donation, and that it was due mainly to a rise in systolic flow velocity. Mean Hct and arterial oxygen content showed a negative trend (decrease) within the first week that was opposite to the ICFV trend. Other laboratory variables, including serum proteins and plasma fibrinogen concentration, and the iron status indicators did not change, except for serum ferritin, which also decreased within the first week after phlebotomy. It can be concluded that blood donation may result in a short-term increase of blood flow velocity that is independent of Hct predonation levels in approximately one-half of the donors.     

头部低频电刺激对脑性瘫痪儿童运动功能及脑血流的影响

目的 探讨双乳突法头部低频电刺激对脑性瘫痪（脑瘫）儿童运动功能及脑血流的影响。方法 将90例脑瘫患儿随机分为电刺激治疗组与康复对照组，另选取30例健康儿童作为正常对照组。康复对照组患儿给予常规康复治疗，电刺激治疗组患儿在上述治疗基础上给予双乳突法头部低频电刺激，2组患儿总疗程均为3个月。应用粗大运动功能测试量表（GMFM）评估2组患儿治疗前、后的运动功能改善情况及临床疗效；采用彩色经颅多普勒超声技术检测治疗前、后2组患儿大脑前、中、后动脉（ACA，MCA，PCA）的平均血流速度。结果 2组患儿经治疗后，发现电刺激治疗组共显效19例（42．2％），好转24例（55．4％），有效率为95．6％；康复对照组共显效10例（22．2％），好转27例（60．0％），有效率为82．2％；2组患儿显效率和有效率比较，差异均有统计学意义（均P〈0．05）。治疗后电刺激治疗组患儿GMFM评分明显高于康复对照组（P〈0．01）。2组患儿治疗前，其ACA、MCA及PCA平均血流速度均明显低于正常对照组（P〈0．001），治疗后电刺激治疗组患儿ACA、MCA及PCA的平均血流速度均较治疗前明显增加（P〈0．001或P〈0．05），而康复对照组与治疗前比较，差异无统计学意义（P〉0．05）。结论 双乳突法头部低频电刺激可明显改善脑瘫患儿的运动功能，增强疗效，并提高脑瘫患儿颅内血流速度，改善脑循环状况，是针对脑瘫患儿安全、有效的临床治疗手段之一，值得进一步推广、应用。     

白藜芦醇甙保护脑海马区缺血神经元的机制探讨——本研究结果为白藜芦醇甙治疗脑卒中及智能障碍提供了一定的理论依据

目的本文采用钙离子特异性荧光指示剂Fura－2/AM,使用光电联合检测系统检测白藜芦醇甙(polydafin,POL)对由谷氨酸引起的海马神经元内游离钙离子浓度[(Ca2＋)i]变化的影响和特征。方法实验设计分3组(n=30),①组加1×10－5mol/L谷氨酸,②组同时加1×10－5mol/L谷氨酸,50μg/mlPOL,③组即在②组回到基线后再给予1×10－5mol/L谷氨酸。结果①组(Ca2＋)i明显升高,②组(Ca2＋)i的变化明显变小,其峰值降低,且第1时相上升速度减慢,第2时相下降的时间也有所缩短,③组出现与①组相似的钙震荡现象,但第1时相与第2时相均缩短,△(Ca2＋)i的变化稍低。结论POL通过影响N－甲基－D天冬氨酸(NMDA)受体的活动,快速抑制谷氨酸诱导大鼠海马神经元内(Ca2＋)i升高,对海马区具有保护作用,从而具有提高认知功能的作用。     

Effect of flordipine on cerebral blood flow

The goal of this study was to determine effects of flordipine (REV 2609), a calcium channel blocker, on blood flow to brain and other organs. Blood flow was measured with microspheres during i.v. infusion of 0.5 to 2.0 mg/kg of flordipine in anesthetized and awake rabbits. In anesthetized rabbits, flordipine (0.5 mg/kg) increased cerebral blood flow by 50%, despite a small decrease in arterial pressure, with no increase in blood flow to skeletal muscle, bowel or kidney. Higher doses of flordipine produced 2- to 3-fold increases in cerebral and myocardial blood flow, marked increases in flow to skeletal muscle, but no increase in blood flow to bowel or kidney. Blood flow remained elevated 1 hr after stopping infusion of flordipine. The increase in cerebral blood flow was not associated with an increase in cerebral oxygen consumption. In awake rabbits, flordipine also produced a dose-related increase in cerebral, myocardial and skeletal muscle flood flow, with no increase in flow to bowel or kidney. Thus, flordipine produces a relatively selective increase in cerebral and myocardial blood flow. The increase in cerebral blood flow is the result of a direct vasodilator effect of flordipine and is not secondary to an increase in cerebral metabolism.     

Effects of pitavastatin on cerebral blood flow

Background: Hypercholesterolemia has been identified as an important risk factor for stroke. It has been reported that statins might reduce the risk for new or recurrent cardiovascular events and strokes.Objective: This paper reports on the effects of pitavastatin on cerebral blood flow in 2 elderly patients.Case summary: Two patients, a 72-year-old right-handed Japanese man and a 77-year-old right-handed Japanese woman, both with a history of cerebral infarction, received 6-month treatment with pitavastatin 2 mg/d for complicated hypercholesterolemia. To assess regional cerebral blood flow (rCBF), single-photon emission computed tomography (SPECT) studies with technetium-99m-ethyl cysteinate dimer were carried out before and after pitavastatin administration. Tomography was evaluated using the Easy z Score Imaging System. None of the patients' other treatments, with the exception of pitavastatin initiation, were modified during the treatment period. In both patients, serum total cholesterol concentrations were improved within 3 months of initiation of pitavastatin treatment, with no marked changes in clinical symptoms. In both patients, improvement was found in rCBF on SPECT. The z score of the left parietal lobe in 1 patient was improved, from 2.20 to 1.69. That of the other patient was also improved, from 2.42 to 1.94.Conclusion: In both patients, clinically significant improvement in rCBF was found after 6-month treatment with pitavastatin 2 mg/d.