经颅多普勒超声观察脑损伤患者的血流动力学改变

目的探讨经颅多普勒超声(TCD)检查在颅脑损伤早期诊断中的作用。方法应用TCD观察154例急性轻、中型颅脑损伤患者(114例为脑震荡,40例为脑挫伤)脑血流动力学改变,并与40名健康者(对照组)进行比较。结果脑血流异常者101例,占65.6%,其中脑震荡70例,脑挫伤31例。脑血流异常患者中颅内动脉血流速度增高者占76.2%;血流速度减低者占23.8%,受累动脉以椎基底动脉为主。脑挫伤及脑震荡患者的动脉血流速度均高于对照组(P<0.05),脑挫伤患者高于脑震荡患者,但两者差异无显著意义(P>0.05)。脑血流搏动指数脑挫伤患者为1.45±0.16,脑震荡患者为1.19±0.11(P<0.05)。结论TCD可以早期发现颅脑损伤时的脑血流动力学的不同改变,有助于指导临床治疗。     

闭合性颅脑损伤患者的经颅多谱勒分析

目的探讨经颅多谱勒（TCD）对轻、中型闭合性颅脑损伤的临床诊断价值。方法对60例轻型,52例中型患者进行经颅多谱勒检查,观察各动脉平均血流速度及博动指数,并与56例正常对照组比较。结果轻型闭合性颅脑损伤患者TCD异常率为76.9%,主要改变为平均血流速度增高;而中型闭合性颅脑损伤患者TCD异常为94.2%,主要改变为平均血流速度减慢及血管痉挛,两组患者平均血流速度与对照组比较有显著性差异（P〈0.01）,恢复期患者主要表现为平均血流速度增高。结论TCD检查可反映闭合性颅脑损伤脑血流的变化。对临床诊治与判断预后有一定价值。     

老年椎-基底动脉供血不足性眩晕的病因探讨

选择285例椎-基底动脉供血不足（VBI）性眩晕患者（VBI组）和100例健康老年人（对照组）,均行经颅多普勒超声（TCD）和计算机X线检查,比较脑血流动力学和颈椎片的差异,同时分析脑血流动力学的改变与性别、年龄的关系.结果显示,VBI组TCD和X线颈椎片异常率均高于对照组（P均＜0.01）.VBI组TCD异常患者99例（44.8%）血流速度增快,112例（55.2%）血流速度减慢.脑动脉粥样硬化和颈椎病是造成VBI的最主要原因,VBI性眩晕患者的脑血流动力学改变在女性或＜60岁者主要表现为血流速度增快,男性或≥60岁者表现为血流速度减低.     

经颅多普勒检测糖尿病患者脑血流动力学变化

目的探讨2型糖尿病患者脑动脉血流动力学的变化.方法应用经颅多普勒超声（TCD）检测103例2型糖尿病患者脑动脉平均血流速度、血流频谱形态、搏动指数、血流速度异常动脉分布情况,并与103例健康者进行比较.结果两组受检动脉均为1 133支,糖尿病组脑内动脉血流速度异常102支,异常率为9.0%;103例患者中血流频谱形态异常83例,占80.6%;46例搏动指数增高,占44.7%,与对照组的3.1%、44.7%及18.4%比较,差异有显著性（P＜0.05）;血流速度减慢的受累动脉以椎-基底动脉为主,血流速度增快和血管狭窄较少见于大脑后动脉.结论TCD检查可为临床2型糖尿病患者脑血管疾病的防治提供依据.     

颅内动脉射血速度增快的血管性头痛312例分析

1990年4月至1991年12月,我们用美国Medasonics第二代经颅超声多普勒(TCD)检查,发现312例血管性头痛患者(均可排除颅内肿瘤、颅内感染、颅脑损伤、脑血管意外、中毒、高血压等)的颅底部分动脉射血速度异常增快。现报告并分析讨论如下。一、临床资料本组男109例,女203例;12～30岁98例,31～40岁114例,41～50岁58例,51岁     

经颅多普勒超声观察偏头痛病人间歇期脑血流变化

目的运用经颅多普勒超声（TCD）观察偏头痛病人发作间歇期脑血流变化。方法163例偏头痛病人分为有先兆头痛组和无先兆头痛组，在发作间歇期进行TCD检测，记录颅内各动脉血流速度、频谱特征等参数，进行比较，并与64名正常对照组比较。结果先兆头痛组与无先兆头痛组偏头痛病人各动脉血流速度比较差异无统计学意义（P〉0．05），但偏头痛组较正常对照组均明显增快（P〈0．01）。结论有先兆和无先兆偏头痛于发作间歇期脑动脉血流速度变化相似，但较正常对照组均明显增快，TCD通过检测观察脑血流变化，间接反映偏头痛病人在发作间歇期颅内动脉处于紧张收缩状态。     

经颅多普勒检测评估无脑血管病的老年患者脑底动脉环的侧支循环能力

目的 探讨经颅脉的交通前多普勒检测(TCD)评估老年患者脑底动脉环的侧支循环能力。方法 对80例老年无脑血管病患者，在颈总动脉压迫试验时TCD检测前交通动脉和后交通动段血流速度变化。结果 31％患者的前交通动脉和两侧后交通动脉均开放，构成一个血流动力学完整的脑底动脉环。93％患者的脑底动脉环前部开放。61％脑底动脉环后部发育异常，阻碍了侧支血流从基底动脉到颈内动脉。结论 TCD检测有助于了解脑底动脉环的侧支循环能力。     

氟桂利嗪治疗椎基底动脉供血不足性眩晕的TCD改变

经颅多普勒（TCD）对46例椎基底动脉供血不足患者服用氟桂利嗪前后脑血流动力学的改变进行检测观察。结果：氟桂利嗪治疗后椎基底动脉系统血流速度较治疗前显著增快（P＜0．05）,但椎动脉血流治疗前后无显著性差异（P＞0．05）。     

TCD对老年椎——基底动脉供血不足血流动力学的研究

本采用经颅多普勒超声（TCD）技术观察90例椎一基底动脉供血不足(VBI)患和50例正常人．90例VBI患TCD异常达54.4％，其中30例基底动脉血流速度异常，19例椎动脉血流速度异常．TCD比传统的脑电阻田有请多优势．并指导临库用药和估计直管异常的预后。因此，TCD对研究VBI有重要作用．     

阿魏酸钠治疗偏头痛的脑血流动力学研究

目的研究阿魏酸钠治疗偏头痛的脑血流动力学改变及临床意义。方法应用经颅多普勒(TCD)技术检测40例偏头痛患者治疗前及用阿魏酸钠治疗后14天时的脑血流改变,并观察治疗效果。结果40例偏头痛患者治疗前头痛侧与非头痛侧大脑中动脉,大脑前动脉的收缩期峰值流速(Vs)比较有显著差异(P<0.01),头痛侧治疗前与治疗后14天比较Vs有显著差异(P<0.01)。结论阿魏酸钠治疗偏头痛的效果确切,且能明显改善偏头痛患者的脑血流异常指标。     

经颅多普勒超声对昏迷病人监测的临床意义

目的观察不同病因、不同程度昏迷病人的经颅多普勒超声（TCD）特点。方法选择62例昏迷病人。记录昏迷原因、生命体征及有关辅助检查资料，同时进行TCD监测，观察频谱形态、颅内血流变化。结果昏迷病人的11CD表现无特征性改变，当出现中度昏迷或深昏迷时，颅内幕上结构损害，颅内幕下结构损害、代谢及弥漫性脑病病人大脑中动脉血流速度改变不明显．但死亡的18例病人中有13例出现了收缩期末血流速低于舒张期末血流速。结论颅内幕下结构损害、代谢及弥漫性脑病病人脑血流变化不明显，中度昏迷及深昏迷病人出现收缩期末血流速低于舒张期末血流速多，提示脑血管自动调节功能丧失、预后不佳。     

Transcranial Doppler ultrasonography in siblings with sickle cell disease

The risk of stroke in sickle cell disease (SCD) may be influenced by either genetic or environmental factors. Elevated blood flow velocity in the large cerebral arteries, detected by transcranial Doppler (TCD) ultrasonography, predicts an increased stroke risk in children with SCD. We undertook this study to investigate the possibility of a familial predisposition to elevated cerebral blood flow velocity, a surrogate marker for stroke risk. We analysed the results of TCD studies performed on 63 children from 29 families that had more than one child with SCD. We assessed the association of elevated cerebral blood flow velocity with sibling TCD results as well as age and haemoglobin level, which are factors known to affect cerebral blood flow velocity. Positive or negative TCD results were highly correlated between family members (r = 0.61). The presence of a sibling with a positive TCD result was significantly associated with an elevated cerebral blood flow velocity in other siblings with SCD (odds ratio = 50.7, 95% confidence interval 10.1-253.7, P < 0.001). Furthermore, children who had a sibling with a positive TCD result had a significantly higher TCD velocity than children with SCD but without a sibling who were matched for age, sex, genotype and haemoglobin level. Our results are consistent with a familial predisposition to cerebral vasculopathy in SCD.     

高血压经颅多普勒脑血流动力学变化及与病程,年龄的关系

高血压经颅多普勒脑血流动力学变化及与病程、年龄的关系蒋崇福１吴妙英２（１．广州军区空军司令部门诊部，广州５１００７１２．衡阳医学院附属第一医院，衡阳４２１００１）ＡｇｅａｎｄＳｔａｇｅＲｅｌａｔｅｄＣｈａｎｇｅｓｉｎＴｒａｓｃｒａｎｉａｌＤｏｐｐｌｅ...     

Transcranial Doppler ultrasonography in siblings with sickle cell disease

Summary. The risk of stroke in sickle cell disease (SCD) may be influenced by either genetic or environmental factors. Elevated blood flow velocity in the large cerebral arteries, detected by transcranial Doppler (TCD) ultrasonography, predicts an increased stroke risk in children with SCD. We undertook this study to investigate the possibility of a familial predisposition to elevated cerebral blood flow velocity, a surrogate marker for stroke risk. We analysed the results of TCD studies performed on 63 children from 29 families that had more than one child with SCD. We assessed the association of elevated cerebral blood flow velocity with sibling TCD results as well as age and haemoglobin level, which are factors known to affect cerebral blood flow velocity. Positive or negative TCD results were highly correlated between family members ( r =  0·61). The presence of a sibling with a positive TCD result was significantly associated with an elevated cerebral blood flow velocity in other siblings with SCD (odds ratio = 41·9, 95% confidence interval 8·2–214·7, P  < 0·001). Furthermore, children who had a sibling with a positive TCD result had a significantly higher TCD velocity than children with SCD but without a sibling who were matched for age, sex, genotype and haemoglobin level. Our results are consistent with a familial predisposition to cerebral vasculopathy in SCD.     

Transcranial Doppler monitoring during head upright tilt table testing in patients with suspected neurocardiogenic syncope.

The aim of the present study was to evaluate the mechanism of cerebrovascular autoregulation in patients with neurocardiogenic syncope using bilateral transcranial Doppler (TCD) monitoring during head upright tilt table testing (HUT). Two hundred and six patients were prospectively studied. One hundred and fifty-nine subjects (77%) had a prior history of syncope and 47 (23%) had presyncope. Ninety-nine patients (48%) had syncope or presyncope during HUT with a 76% fall in diastolic middle cerebral artery blood flow velocity (D-MCA-BFV). Systolic MCA-BFV (S-MCA-BFV) fell by 33%. Deepening of the dicrotic notch in the Doppler waveform always preceded the fall in D-MCA-BFV. Patients without syncope or presyncope (n=96) had smaller changes in cerebral blood flow velocities during HUT and only twenty-two subjects had transient deepening of the dicrotic notch. Eleven subjects had presyncope during HUT due to an exaggerated response to nitrates with progressive arterial hypotension without bradycardia and changes during TCD monitoring that were intermediate between positive and negative HUT. In conclusion, patients with neurocardiogenic syncope have changes in cerebral blood flow during the event. TCD monitoring during HUT helps to assess these alterations.     

吸烟对短暂性脑缺血发作患者血清可溶性细胞间粘附分子1水平和脑血流动力学的影响

目的　为观察吸烟对短暂性脑缺血发作患者血清可溶性细胞间粘附分子 1水平和脑血流动力学的影响。方法　采用双抗体夹心酶联免疫吸附法测定 31例短暂性脑缺血发作吸烟者、2 5例短暂性脑缺血发作不吸烟者、2 6例健康吸烟者、2 8例健康不吸烟者血清可溶性细胞间粘附分子 1水平 ,应用经颅超声多普勒仪观察脑血流动力学的变化。结果　短暂性脑缺血发作吸烟者血清可溶性细胞间粘附分子 1水平明显高于短暂性脑缺血发作不吸烟者 (P <0 .0 5 )和健康不吸烟者 (P <0 .0 1) ,健康吸烟组明显高于健康不吸烟组 (P <0 .0 5 ) ,重度吸烟组血清可溶性细胞间粘附分子 1水平明显高于轻度吸烟组和健康不吸烟组 (P <0 .0 1) ,中度吸烟组高于轻度吸烟组和健康不吸烟组 (P <0 .0 5 ) ,吸烟指数与血清可溶性细胞间粘附分子 1水平呈正相关 (r =0 .4 2 8,P <0 .0 1) ,吸烟后双侧大脑中动脉血流速度加快 (P <0 .0 5 )。结论　吸烟使短暂性脑缺血发作患者、健康者血清可溶性细胞间粘附分子 1水平升高和大脑中动脉血流速度加快     

应用经颅多普勒超声经眼窗对大脑前动脉和大脑中动脉血流的探测

目的探讨TCD经眼窗探测ACA和MCA血流的可行性。方法对50名双侧颞窗、眼窗均透声良好的健康体检者，采用TCD经眼窗探测双侧大脑半球血流改变，并与经颞窗（对照组）探测的大脑半球血流改变进行比较，同时对612例共67个透声不良颞窗，经眼窗探测的双侧ACA和MCA血流速度结果进行分析。结果经眼窗探测50名健康者ACA血流速度，与对照组比较差异无统计学意义（P〉0．05）；经眼窗探测的MCA血流速度显著低于对照组（P〈0．01），但仍有48支（48％）MCA与经颞窗探测的血流速度差值〈10％。67个透声不良颞窗中，女性发生率（8％）显著高于男性（3％），P〈0．01。经眼窗检出ACA48支（72％），MCA38支（57％），男、女性别差异无统计学意义（P〉0．05），ACA的检出率高于MCA。结论经眼窗探测ACA结果可靠，探测MCA具有参考价值。当颞窗透声不良时，经眼窗检测可提高TCD的检出率。     

经颅多普勒超声诊断大脑中动脉狭窄的价值

目的 探讨经颅多普勒超声(transcranial Doppler ultrasound,TCD)诊断大脑中动脉(middle cerebral artery,MCA)狭窄的价值.方法 对行数字减影血管造影(digital subtract angiography,DSA)和TCD检查的缺血性脑血管病患者的临床资料进行回顾性分析,以DSA为金标准,分析TCD诊断MCA狭窄的敏感性和特异性.对正常以及不同狭窄程度MCA的TCD血流速度进行比较,计算MCA不同狭窄程度时TCD血流速度的最佳截断值.结果 103例患者DSA证实存在MCA狭窄或闭塞,其中轻度狭窄12例,中度狭窄22例,重度狭窄40例,闭塞39例.与DSA相比,TCD检测中度以上MCA狭窄或闭塞的敏感性为78.8%,特异性为96%,准确度为93%,漏诊率为21.2%,误诊率为4%.轻度狭窄组与正常组之间血流速度无显著差异,中度狭窄组与正常组之间血流速度存在显著差异(P＜0.001),中度狭窄组与重度狭窄组之间血流速度无显著差异.判定中度狭窄的最佳收缩期峰值血流速度截断值为163.5 cm/s,平均血流速度的最佳截断值为108.5 cm/s.结论 TCD在诊断MCA狭窄或闭塞方面具有一定的优势,可作为DSA检查之前的一种安全而廉价的筛选手段.

Abstract：

Objective To explore the value of the diagnosis of middle cerebral artery (MCA) stenosis with transcranial Doppler ultrasound (TCD). Methods The clinical data in patients with ischemic cerebrovascular disease examined with digital subtract angiography (DSA)and TCD were analyzed retrospectively. DSA was used as a gold standard to analyze the sensitivity and specificity of the diagnosis of MCA stenosis with TCD. The normal and TCD blood flow velocity with different degrees of stenosis were compared. The best cut-off point of the TCD blood flow velocity of MCA at different degree of stenosis was calculated. Results DSA confirmed that 103 patients had MCA stenosis or occlusion, in which 12 were mild stenosis, 22 were moderate stenosis, 40 were severe stenosis, and 39 were occlusion. Compared to DSA, the sensitivity of TCD in detection of moderate and severe MCA stenosis or occlusion was 78. 8%, the specificity was 96. 0%, and the accuracy was 93. 0%, the missed diagnosis rate was 21. 2%, and the misdiagnosis rate was 4. 0%. As to the blood flow velocity, there was no significant difference between the mild stenosis and normal groups; while there was significant difference between the moderate stenosis and normal groups (P ＜0. 001). In addition, there was no significant difference in blood flow velocity between the moderate stenosis and severe stenosis groups. Determining the cut-off value of the best peak systolic velocity of the moderate stenosis was 163. 5 cm/s, while the best cut-off value of the mean velocity was 108. 5 cm/s. Conclusions TCD has certain advantages in the diagnosis of the MCA stenosis or occlusion, and it can be used as a safe and inexpensive screening means before DSA examination.