双功能、经颅多普勒超声对颈动脉内膜剥脱术的监测

颈动脉粥样硬化性斑块造成的血管狭窄及闭塞是引起缺血性脑血管病(ＣＶＤ)的重要原因之一。采用手术切除颈总动脉(ＣＣＡ)或颈内动脉(ＩＣＡ)硬化斑块,即颈动脉内膜剥离术(ＣＥＡ),自50年代始至今已有40年的历史。在美国每年约有10万人因颈动脉狭窄接受ＣＥＡ治疗。通过ＣＥＡ对ＣＣＡ及ＩＣＡ的狭窄疗治,不但减少了ＣＶＤ的发病率,也降低了因反复发作ＣＶＤ而增加的医疗费用。虽然ＣＥＡ可以预防治疗ＣＶＤ,但在某些情况也可导致缺血ＣＶＤ,因而国外采用一些相应的监测技术,其结果可以评估ＣＥＡ病人的预后。例如术中试验性ＣＣＡ部分阻断,…     

经颅多普勒超声下行颈动脉内膜剥脱术的护理配合

目的总结187例经颅多普勒超声（TCD）监测下行颈动脉内膜剥脱术的护理配合,为临床工作提供保障。方法术中根据TCD监测的结果决定是否实施转流,其中160例没有实施术中转流,27例实施术中转流。结果72例手术均进行顺利。结论术前充分的准备,术中娴熟的配合是确保手术成功的关键。     

经颅多普勒超声监测颈动脉内膜切除术中脑血流的分析

目的：了解CEA术中阻断颈动脉血流后同侧大脑中动脉血流流速的变化。方法：选取2018年7月—2020年2月期间在东阿县人民医院神经外科行颈动脉内膜切除术（carotid endarterectomy,CEA）患者82例。术中应用经颅多普勒超声监测脑血流,同时辅助应用手术中神经电生理监测技术。人群自然分组：有交通动脉开放（n=59）、无交通动脉开放（n=23）。统计阻断前后患者大脑中动脉血流流速的变化。结果：前后交通动脉均开放的平均流速下降百分比、前交通动脉开放的平均流速、后交通动脉开放平均流速、前后交通动脉均不开放平均流速下降百分比以及平均流速下降基础值的百分比比较,差异有统计学意义（P <0.05）。结论：CEA术中阻断血流有交通动脉开放患者的平均流速下降范围小,无交通动脉开放平均流速下降范围大,前交通动脉开放患者平均流速下降范围最小,前交通动脉开放对维持手术中大脑中动脉流速意义重大。     

分析经颅多普勒在颈动脉内膜剥脱术中的应用价值

目的:在颈动脉内膜剥脱术中应用经颅多普勒的临床价值。方法:将2016年3月-2019年3月在我院进行颈动脉内膜剥脱术治疗32例患者作为研究对象,分成A组:单侧狭窄、B组:双侧狭窄,在术中给予经颅多普勒监测大脑中动脉平均血流速(MCA Vm)。观察两组术中MCA Vm、有创血压及术后情况。结果:两组MCA Vm的麻醉前、临阻前、解除临阻后比较无显著差异(P>0.05),但B组临阻后MCA Vm明显低于A组(P<0.05)。两组有创血压在临阻前比较上无显著差异(P>0.05),但B组临阻后、解除临阻后的有创血压明显高于A组(P<0.05)。术后31(96.88%)例无新增脑梗死病灶,1(3.13%)例术后2d出现剧烈头痛,经内科治疗后好转。结论:根据经颅多普勒在颈动脉内膜剥脱术中监测的脑血流变化来调节血压,可有效预防术中脑缺血、过度灌注,临床应用价值显著。     

血管超声对颈动脉内膜剥脱术中血管结构变化及血流动力学的评估

目的 分析彩色多普勒血流成像(CDFI)与经颅多普勒(TCD)超声联合应用,在颈动脉内膜剥脱术(carotid endarterectomy,CEA)中对局部动脉形态结构和颅内大脑中动脉(MCA)、颅外颈动脉血流动力学变化的监测,综合评估该检查技术对提高CEA成功率的实用价值.方法 选择行CEA的患者136例,术中通过对颈动脉管径、收缩期峰值及舒张末期血流流速(PSV和EDV)的测量,记录残余狭窄的发生率和检测术中二次手术剥脱前后局部PSV,EDV及颅内MCA血流动力学参数的变化.结果 对136例患者实施了CEA术.根据Panneton术中超声分类标准,将本组CEA术中CDFI结果分类为正常组86例,轻度异常组(25例),显著异常组(25例).显著异常组中16例(64%)进行术中二次剥脱.所有患者围手术期脑卒中发生率为5.9%.术中CDFI发现残余血管狭窄大于50%者为17.6%(24例),狭窄处管径(2.1±1.5)mm,较无残余狭窄者(3.9±1.1)mm明显减小(P=0.000).狭窄段PSV及EDV均明显升高(P=0.000,P=0.000).16例患者经二次手术剥脱后管径明显增宽(P=0.000),狭窄段PSV明显改善(P=0.000).术中二次剥脱患者的残余管径均≤2 mm,PSV>245 cm/s,患侧MCA的PSV及EDV由(47.1±16.7)cm/s和(24.2±9.0)cm/s提高(75.4±34.2)cm/s和(37.0±20.1)cm/s(P=0.000、P=0.001).结论 CDFI与TCD技术联合,可以客观评估CEA术中颈动脉及患侧MCA血管结构及血流动力学变化,即时指导术者实施二次剥脱,减少术中残余狭窄的发生率,提高CEA的成功率.     

多普勒超声检测颈动脉内膜剥脱术后脑血流动力学的改变

目的　探讨多普勒超声在颈动脉内膜剥脱术对改善脑血液供应效果评估中的应用价值。方法　应用彩色多普勒血流显像和经颅多普勒超声分别测定 11例症状性颈内动脉狭窄患者手术前后术侧颈内动脉血流速度、血流量和双侧大脑中动脉血流速度 ,并观察Willis环和眼动脉的血流方向。结果　术后同侧颈内动脉血流速度显著减慢 [术前 (2 91.70± 65 .2 5 )cm /s ,术后 (10 0 .85± 3 5 .68)cm /s ,P <0 .0 0 1] ,血流量显著增加 [术前(2 0 8.19± 49.94)ml/min ,术后 (3 83 .68± 3 7.2 6)ml/min ,P <0 .0 0 1] ;大脑中动脉血流速度较术前略有增高 ,但差异无显著性意义 ;术后侧支循环的反向血流转化为正向血流。结论　彩色多普勒血流显像和经颅多普勒通过对颈内动脉、大脑中动脉血流参数的测定及颅内侧支循环的观察 ,可有效评价手术对改善同侧脑血液供应的治疗效果     

1例进行肺动脉内膜剥脱联合颈动脉内膜切除术患者的护理

总结了1例慢性血栓栓塞性肺动脉高压合并颈动脉狭窄进行肺动脉内膜剥脱联合颈动脉内膜切除术患者术后的护理。从血流动力学的监测与护理、抗凝治疗与护理、呼吸支持与护理、感染的预防与控制、肺康复及早期功能锻炼、再灌注肺水肿及脑高灌注综合征的预防等方面实施护理措施。经过个体化及全面的护理,患者术后恢复良好,术后7 d转回普通病房,术后21 d顺利出院。     

经颅多普勒超声监测羊脑血流方法学的建立

目的建立经颅多普勒超声(Transcranial Doppler Ultrasound, TCD)对羊脑血流速度检测及连续监测的方法.方法通过TCD超声探头在羊头不同部位寻找血流信号,并将其与羊头解剖对比研究,以及超声影像学检查协助定位等方法,确定TCD监测羊脑血流的声窗、探测深度和方向,并进行稳定性和重复性检验.结果1)颞骨颧突上、下方及眼部均可探测到血流信号,但只有颞骨颧突上方(即羊颞窗)颅骨薄而平,适于放置和固定探头;2)垂直方向探测,探测深度25～38mm时,可探测到背向探头方向的血流信号,信号较强且稳定;颅脑超声成像技术测量证实为同侧血管;3)14只羊右侧颞窗连续监测结果显示羊轻微活动后探头固定良好,监测的血流信号稳定,变异系数为2.9～4.6%;4)经立体连线定位解剖发现所测血管为Willis环后交通支发出的第一分支-大脑后动脉,超声束与血流方向的夹角在20～30°.结论所建TCD对羊脑血流速度监测方法具有良好的稳定性和重复性,且可反映右脑血供.     

颅内压增高时经颅多普勒超声监测的新进展

颅内压(intracranialpressure,ICP)增高是神经科临床工作中经常遇到的一个重要问题。颅内压持续超过200mmH2O(15mmHg或200kPa)即为颅内压增高或颅内高压(intracranialhypertension,ICH)。许多重症神经系统疾病都伴有不同程度的颅内压增高,其可降低脑灌注,引起不良后果,因而加强对颅内压增高的监测具有重要的临床意义。经颅多普勒超声(transcranialDopplerultrasonography,TCD)是一无创性监测工具,具有简便易行、安全无创和床旁检测等诸多优点。根据其血流速度及其频谱的变化,可对颅内压增高患者脑血流动力学进行动态监测与评估。脑血…     

糖尿病患者颈动脉内膜中膜厚度与血管内皮功能相关性彩色多普勒超声研究

目的应用彩色多普勒超声观察糖尿病患者颈动脉内膜中膜厚度(IMT)并探讨其血管内皮功能及两者的相关性.方法对40例糖尿病患者,测定其颈动脉内膜中膜厚度及反应性充血时和舌下含服硝酸甘油后肱动脉内径的变化,并对它们进行相关性分析.结果糖尿病患者IMT(1.03±0.04mm)较正常对照组(0.77±0.03mm)明显增厚(P＜0.001).反应性充血时肱动脉内径的扩张程度为(2.92±2.65%),与正常对照组相比在统计学上有显著性差异(P＜0.001).舌下含服硝酸甘油后肱动脉内径的变化在两组间有显著性差异(P＜0.001).颈动脉内膜中膜厚度与反应性充血时和舌下含服硝酸甘油后肱动脉内径的变化呈显著负相关(r＝-0.525,P＜0.001,r＝-0.41,P＜0.01).结论糖尿病患者存在明显的血管内皮依赖性及非依赖性舒张功能的损伤.内皮功能的紊乱引起血管壁重构、肥厚、斑块形成.因此糖尿病患者的内皮功能损伤促进了功能粥样硬化的产生并加速了动脉粥样硬化的进程.     

颈部血管彩超、经颅多普勒超声与脑血管造影的一致性分析

目的探讨颈部血管彩超、经颅多普勒超声(TCD)对颈动脉狭窄、椎-基底动脉狭窄和动脉粥样硬化斑块的诊断价值,分析其与脑血管造影的一致性。方法选取2019年1月~2020年6月106例动脉粥样硬化性脑梗死患者为观察组,53例无脑梗死的动脉粥样硬化高血压病和(或)高脂血症患者为对照组。比较两组颈部血管彩超和TCD对颈动脉与椎-基底动脉中重度以上狭窄、不稳定型斑块的检出率。以脑血管造影为金标准,分析颈部血管彩超和TCD的诊断一致性。结果观察组颈动脉与椎-基底动脉中度狭窄、重度狭窄、完全闭塞的检出率均高于对照组(P < 0.05)。观察组颈动脉粥样硬化不稳定型斑块的检出率高于对照组(P < 0.05)。颈部血管彩超联合TCD对中重度以上狭窄检出的敏感度为93.75%,特异性为88.46%,准确率为92.45%,一致性较高(Kappa=0.801);对不稳定型斑块检出的敏感度为87.67%,特异性为87.88%,准确率为87.74%,一致性较高(Kappa= 0.725)。结论颈部血管彩超和TCD诊断颈动脉狭窄、椎-基底动脉狭窄和动脉粥样硬化斑块准确、无创、便捷,对脑梗死的预防、诊断、病因分析具有重要的参考意义。     

Intraoperative pulsed Doppler assessment of carotid endarterectomy

A 20 MHz pulsed Doppler velocimeter and fast Fourier transform spectrum analyzer were used at operation to assess the velocity patterns just prior to and immediately following carotid endarterectomy (TEA). In all 45 sides studied, the status of the endarterectomized segment was verified by operative arteriography. Corresponding Pre-TEA and Post-TEA internal carotid artery spectra were compared to each other and classified according to criteria developed using the ultrasonic Duplex scanner. Of 39 arteries with significant Pre-TEA flow disturbances, improvement in Post-TEA spectral characteristics was observed in 35, and 4 were not changed. Six arteries had only minimal flow disturbances both before and after endarterectomy. In one case the initial Post-TEA spectrum showed a worsening of the flow disturbance which was found on operative arteriography to be due to a stenosis secondary to a technical error. After vein patch angioplasty, the spectrum and repeat arteriogram were both improved. No other significant technical problems were encountered. Although the velocity patterns were improved by endarterectomy in most cases, some residual flow disturbance often remained. Technical factors were not a major cause of the Post-TEA flow disturbances. Lack of improvement or deterioration in the spectra after closure of the arteriotomy may be useful in selecting patients for operative arteriography. Intraoperative spectra also provide important baseline data for long term followup studies.     

经颅多普勒超声监测OSAS患者睡眠呼吸暂停期间的脑血流变化

目的采用经颅多普勒超声(TCD)对阻塞性睡眠呼吸暂停综合征(OSAS)患者的睡眠呼吸暂停期间脑血流变化进行监测。方法选取符合OSAS诊断标准的50例患者,并选取同时期就诊的正常人50例作为对照组,对上述研究者采用TCD仪2 MHz脉冲波探头监测大脑中动脉平均血流速度(MFV),观察有无出现狭窄、闭塞、血流频谱的改变。结果 50例患者中,TCD检查共发现39例异常,发生率为78.0%(39/50),其中有29例为血流速度减慢,发生率为58.0%(29/50),9例为血管狭窄,发生率为18.0%(9/50);12例正常,概率为24.0%(12/50)。50例对照组中,共有10例患者出现TCD检查异常,发生率为20.0%(10/50),OSAS患者TCD异常检出率相比于正常对照组显著升高(P0.01)。中重度OSAS患者的脑血流异常情况发生率显著高于轻度患者。随访1年,OSAS组共出现8例脑血管事件,发生率为16.0%(8/50),对照组仅有1例,发生率为2.0%(1/50),组间比较差异有统计学意义(P0.05)。OSAS患者屏气前后大脑中动脉血流速度均相对于正常者升高(P0.01),屏气后的增加率明显低于正常人群(P0.01),随着OSAS疾病的严重程度上升,其屏气前后大脑中动脉血流速度明显上升(P0.05)。结论 OSAS患者由于长期的缺氧而使其容易出现动脉硬化改变,引起脑血流下降或是出现脑动脉狭窄。OSAS越严重,则出现脑血流动力学的异常发生率也就越高,越容易发生脑血管事件。     

The perioperative diagnosis of cerebral ischemia during reconstructive operations on the carotid arteries (initial experience in using transcranial oximetry)

Intraoperative monitoring of cerebral ischemia during surgery on the brachiocephalic arteries is carried out by several methods: transcranial dopplerography, electroencephalography, recording of the somatosensory evoked potentials, puncture measurement of intravascular pressure, etc. However, not all these methods are sufficiently informative, reliable, and safe. One of the methods meeting these requirements is noninvasive cerebral oximetry. The study was carried out by the Invos-3100 device (Somanetics, USA). The method of cerebral oximetry is based on optic spectroscopy using infrared light in the 650-1100 nm waveband. Monitoring was carried out in 34 patients with involvement of the brachiocephalic arteries. The results persuasively prove high informative value and safety of the method.     

Characteristics of Doppler embolic signals observed following carotid endarterectomy

Postoperative Doppler embolic signals following carotid endarterectomy (CEA) are associated with an increased risk of stroke, but the characteristics of these signals are rarely reported. In this study, we survey signals from 1485 emboli, assumed to consist predominantly of thrombus. Data were obtained by monitoring the middle cerebral arteries of 100 consecutive CEA patients during postoperative recovery. The distribution of embolic signal frequencies, intensities and durations revealed that embolic signals do not occur randomly in the sonogram. In particular, we find that the signals possess a characteristic distribution of velocities reflecting the preferred path of the embolus through the artery (at approximately 75% of the distance between the centre of the artery and the artery wall). Embolic signals were more likely to be observed at cardiac cycle positions between 35% and 80% from the start of systole than elsewhere. After eliminating other considerations, we hypothesized that this peak in the distribution of signals in the sonogram arose due to the localization of emboli trajectories and a strong tendency for emboli to detach from the carotid bifurcation during systole.