颈中、下交感神经节阻滞对基底动脉血流动力学的影响

目的观察颈中、颈下交感神经节阻滞对基底动脉血流动力学的影响. 方法采用经颅多普勒超声(TCD)脑血流分析技术,测定颈中、颈下交感神经节阻滞前后基底动脉平均血流速度(Vm).结果发现两组行一侧(左侧)交感神经阻滞后基底动脉Vm均显著增高(P＜0.01).结论颈中、颈下交感神经阻滞同样可改善脑血流,但颈中交感神经节阻滞(MCGB)操作简便、安全,故建议临床上用该方法代替传统的颈下交感神经节(又称星状神经节)阻滞(SGB),治疗缺血性颅-面部的血管性疾病.     

针刺结合颈交感神经阻滞治疗椎动脉型颈椎病及其对血流动力学的影响

目的观察针刺结合颈交感神经阻滞治疗方法对椎动脉型颈椎病患者的疗效及对血流动力学的影响。方法选择诊断明确的椎动脉型颈椎病患者60例,随机分为对照组和治疗组各30例。对照组仅行针刺治疗,治疗组患者在针刺治疗后行颈交感神经阻滞治疗。1个疗程结束后评估治疗效果,运用TCD观察两种疗法治疗前后椎动脉、基底动脉Vs、Vd及Vm的变化并进行组间比较。结果两组总有效率及治愈率比较,差异均有统计学意义(P<0.05)。治疗组双侧椎动脉、基底动脉的Vs、Vd、Vm值经治疗后明显加快,接近或已经恢复到正常值范围,与对照组比较差异有统计学意义(P<0.05)。结论针刺结合颈交感神经阻滞治疗椎动脉型颈椎病疗效优于单纯针刺疗法,能显著改善椎-基底动脉血流。     

经颅多普勒对高血压患者颅内动脉血流动力学影响的研究

目的 探讨高血压患者颅内动脉血流动力学变化,为临床治疗提供客观依据。方法收集我院确诊为高血压患者120例为研究组,另收集100例体检无高血压、高血糖、高血脂等,无心脑血管疾病史者为对照组。采用经颅多普勒检测2组患者颅内动脉血流动力学情况,检测指标包括双侧大脑中动脉（MCA）、大脑前动脉（AC）、大脑后动脉（PCA）、双侧椎动脉（VA）及基底动脉（BA）等各条血管的收缩峰值血流速度（Vp）、血管搏动指数（PI）、血管阻力指数等指标（RI）。结果研究2组血流异常109例,占90．8％,明显高于对照组（P〈0．05）。研究组各条颅内血管流速均较对照组高,左侧大脑中动脉（MCAL）、右侧大脑中动脉（MCAR）、左侧大脑后动脉（PCAL）差异有统计学意义（P〈0．05）。研究组各RI均较对照组高,其中MCAL、MCAR、左侧大脑前动脉（ACAL）、右侧大脑前动脉（ACAR）、BA差异有统计学意义（P〈0．05）。研究组PI血管搏动指数均较对照组高（P〈0．05）。结论TCD检查能有效反应高血压患者血流动力学异常改变。是一种客观、有效的检查手段,能为临床治疗提供客观、科学的依据,大大降低了高血压患者并发脑血管意外的可能。     

椎-基底动脉血流异常的TCD表现

椎-基底动脉血流异常所致的眩晕、头昏、头痛、颈部酸麻是临床缺血性脑血管病的一种常见症状,其临床发作时间短,症状消失快,且无特异性,常以中老年人多发,长期以来由于缺乏对椎-基底动脉血流情况的检测手段和方法,对其定性与定位诊断有一定的困难.近年来经颅多普勒（TCD）的应用为椎-基底动脉血流异常提供了无创伤性、安全、方便的方法,并且能动态或适时了解椎-基底动脉的血流动力学情况,为椎-基底动脉血流异常的诊断与鉴别诊断提供了重要依据[1].     

两种剂量利多卡因行颈中交感神经节阻滞治疗偏头痛的临床研究

目的观察50mg、100mg两种剂量利多卡因行颈中交感神经节阻滞治疗偏头痛后，霍纳综合征出现的阳性率、霍纳综合征开始出现时间和持续时间以及阻滞后出现的并发症和临床效果。方法偏头痛患者按照给药剂量不同完全随机分为50mg组和100mg组：50mg组36例，给予1％利多卡因5ml；100mg组34例，给予1％利多卡因10ml。颈中交感神经节阻滞采用气管旁颈6横突法，1次／d，两侧交替阻滞，共7次。治疗1个月后评价其疗效。结果2组在出现霍纳综合征阳性率、霍纳综合征开始出现时间和持续时间上差异无统计学意义（P〉0．05）。但100mg组并发症明显多于50mg组（P〈0．01）。50mg利多卡因与100H氓利多卡因行颈6横突交感神经节阻滞治疗偏头痛的临床效果相同（P〉0．05）。结论临床上行颈6横突交感神经节阻滞治疗偏头痛，50mg利多卡因可减少并发症的发生。     

椎-基底动脉供血不足病人TCD检查分析

本文应用经颅多普勒对 85例临床诊断为椎 基底动脉供血不足 (ＶＢＩ)的病人与 4 5例无ＶＢＩ者的椎 基底动脉血流动力学改变进行分析。现报告如下。1　资料与方法85例ＶＢＩ病人均为 1999～ 2 0 0 1年间我院门诊及住院病人 ,经ＴＣＤ检查资料完整者。其中男 4 5例 ,女 4 0例 ;年龄 30～ 78岁 ,平均 5 9岁。临床表现 :头痛、头昏、眩晕 ,少数人伴有恶心、呕吐、耳鸣 ,后仰或转颈时症状加重 ,另有高血压、动脉粥样硬化或颈椎病史。无ＶＢＩ组 4 5例 ,男 2 5例 ,女2 0例 ;年龄 4 0～ 6 8岁 ,平均 5 4岁。采用美国巴瑞公司生产的ＦＤ Ｔ98型Ｔ…     

高频超声对腹壁下动脉血流动力学研究

目的研究正常人腹壁下动脉（inferior epigastric artery,IEA）血流动力学。方法应用高频分辨彩色多普勒血流显像技术（CDFI）检测180正常人360条IEA各项血流参数,包括收缩期最大血流速度（Vmax）、平均血流速度（Vmean）、舒张期最小血流速度（Vmin）、搏动指数（PI）和阻力指数（RI）,并作统计学分析。结果360条正常人IEA显示率100％,IEA血流参数左右差异无统计学意义（P〉0．05）;男性血流速度高于女性（P〈0．05）;RI表现为老年组〉中年组（P〈0．05）,老年组〉青年组（P〈0．05）,而中年组与青年组差异无统计学意义（P〉0．05）。结论提出了正常IEA的基本参数,为腹壁下动脉穿支皮瓣（deep inferior epigastric perforator,DIEP皮瓣）的临床应用提供了科学的依据。高频超声可作为一种可靠、直观、无创的了解DIEP皮瓣血运的检测方法。     

椎基动脉供血不足的基底动脉血流动力学变化的研究（附49例报告）

本文应用ＴＣＤ对４９例５０岁以上ＶＢＩ患者与同年龄段３０例正常人ＢＡ血流动力学的变化进行回顾性分析，发现ＶＢＩ组ＢＡ的Ｖｍ减低者占５７％（２９／４９），Ｖｍ增高者占３７％（１８／４９），Ｖｍ正常者４％（２／４９），敏感性９６％，且异常组ＰＩ值普遍升高（Ｐ＜０．０５），提示血流阻力升高、血管顺应性明显减低是ＶＢＩ患者病理性特征之一。故本文认为ＴＣＤ在诊断ＶＢＩ方面是一种无创性、敏感性高、而独具价值的辅助检查手段。     

急性脑梗死患者心脏功能和颅内外动脉血流动力学的临床研究

目的　应用超声检测方法研究急性脑梗死患者心脏功能和颅内外动脉血流动力学变化。方法　选择2019年1月至12月连云港市第二人民医院神经内科住院的急性脑梗死（acute cerebral infarction,ACI）患者79例（ACI组）,男50例,女29例,年龄42～87（66.27±9.89）岁;对照组为同期健康体检者33例,男19例,女14例,年龄41～86（64.15±10.11）岁。两组行心脏彩超检查获取心脏结构和功能指标,动脉超声检查获取动脉内径、血流速度、阻力指数和动脉内膜中层厚度;经颅多普勒超声检查获取颅内动脉血流速度。计量资料采用独立样本t检验,率的比较采用χ²检验。结果　（1）ACI组左房内径为（39.40±3.13）mm、左室舒张末期内径为（50.26±3.48）mm、右室内径为（23.93±1.89）mm、肺动脉压为（38.11±3.37）mmHg（1 mmHg=0.133 kPa）,均较对照组增加［分别为（38.00±3.32）mm、（48.82±2.51）mm、（22.89±1.23）mm、（36.08±2.35）mmHg］,差异均有统计学意义（t=2.007、2.276、2.677、2.907,P=0.048、0.026、0.009、0.005）。（2）ACI组左、右颈总动脉舒张末期血流速度（Vd）,左颈内动脉Vd及右颈内动脉收缩期峰值血流速度（Vs）均低于对照组,差异均有统计学意义（均P<0.05）;ACI组左、右颈总动脉阻力指数高于对照组,差异均有统计学意义（均P<0.05）。ACI组两侧椎动脉舒张末期流速差（ΔVd）高于对照组,差异有统计学意义（P<0.05）。（3）ACI组右侧大脑前动脉Vd高于对照组,差异有统计学意义（P<0.05）;ACI组两侧大脑前动脉ΔVd,两侧大脑中动脉ΔVd,两侧椎动脉ΔVd高于对照组,差异均有统计学意义（均P<0.05）。结论　ACI患者通过调节心脏结构与颅内外动脉血流速度以改善脑的供血。     

TCD和CDFI联合检测对椎-基底动脉狭窄的诊断价值

目的 将通过经颅多普勒超声(TCD)和彩色多普勒血流显像(CDFI)联合检测诊断的椎-基底动脉狭窄患者的检测资料进行分析,并与数字减影血管造影(DSA)做对比研究,客观评价二者对椎-基底动脉狭窄的诊断价值.方法 经TCD,CDFI诊断的椎-基底动脉狭窄患者38例,均进一步行磁共振血管造影(MRA)、DSA检测,对比分析其检测结果.结果 与DSA比较,TCD,CDFI对椎动脉的检测敏感性为83%,特异性为91%;TCD对基底动脉狭窄检测的敏感性为75%,特异性为93%.以DSA为标准,TCD对基底动脉近段、中段、远段的检出率分别为100%,50%和33%.以DSA为标准,TCD+CDFI对椎-基底动脉狭窄的检出率为79%,MRA的检出率为96%,TCD,CDFI,MRA三者联合检出率为98%.结论 ①TCD,CDFI对椎-基底动脉狭窄的特异性较高,且无创、经济、方便,故可作为首选筛查手段.但因其敏感性不是很高,故当临床出现后循环神经缺失症状,而检测结果阴性时,可结合MRA检查;②TCD,CDFI,MRA三者联合对VBA狭窄有较好的准确性.     

Differential modulation by basilar and mesenteric endothelium of angiotensin-induced contraction in canine arteries

The contraction of ring segments of canine mesenteric and basilar arteries in response to angiotensins II and III was investigated. Removal of the mesenteric endothelium resulted in markedly intensified contraction in response to angiotensin II but did not affect the contractile response to angiotensin III. This angiotensin II-induced contraction was augmented by indomethacin (10⁻⁵ M) and by methylene blue (5 × 10⁻⁶ M) in the intact rings. These findings suggest that mesenteric endothelium modulates the vasoconstriction induced by angiotensin II but not that induced by angiotensin III. They also indicate that the mesenteric endothelium may contain relaxing factors such as prostacyclin or endothelium-derived relaxing factor as mediators. In contrast with mesenteric endothelium, removal of the basilar endothelium produced a much reduced contraction in response to either angiotensin. Acetylcholine, which caused a dose-dependent contraction in the basilar artery, elicited only a low-grade response if the functional endothelium was absent. These results suggest that basilar endothelium may release a contracting factor. It is possible that the main modulator of the peripheral arteries is a relaxing factor but that of the cerebral arteries is a contracting factor.     

Vasodilation activity of dipfluzine metabolites in isolated rat basilar arteries and their underlying mechanisms

Identifying the metabolites of a drug has become an indispensable task in the development of new drugs. Dipfluzine (Dip) is a promising candidate for the treatment of cerebral vascular diseases and has 5 metabolites (M1∼M5) in rat urine and liver microsomes, but their biological activity is still unknown. Because selective cerebral vasodilation is a main role of Dip, we investigated the vasodilation of Dip and its 5 metabolites in isolated Sprague-Dawley (SD) male rat basilar arteries preconstricted with high-K⁺ or 5-HT. The results showed that only M1 possessed concentration-dependent inhibitory activity on the vasoconstriction of arteries with or without the endothelium, and M1 has a more potent vasodilatory effect than Dip on both contraction models. Like Dip, the vasodilatory mechanisms of M1 may be not only related to receptor-operated and voltage-dependent calcium ion channels of smooth muscle cells but also to the release of NO and EDHF from endothelial cells and the opening of Ca²⁺-activated K⁺ channels and ATP-sensitive potassium ion channels. Unlike Dip, the vasodilation mechanism of M1 is also related to the opening of voltage-sensitive K⁺ channel. Together with more selectivity to non-VDCC than Dip, this may partially explain why M1 has stronger vasodilatory effects than Dip. The mechanisms of vasodilation of Dip and M1 may result from the combined action of these or other factors, especially blocking non-endothelium dependent non-VDCC and endothelium dependent IK_Ca channels. These results point to the possibility that M1 provides synergism for the clinical use of Dip, which may inform the synthesis of new drugs.     

地尔硫卓在颈丛阻滞麻醉中的血流动力学稳定作用

目的研究地尔硫卓对颈丛阻滞麻醉引起的血流动力学变化的影响。方法 60例择期行甲状腺手术的女性患者随机平均分为地尔硫卓组(Dil组)和对照组(C组)。行一针法双侧颈浅丛和单侧颈深丛神经阻滞后10min后对血压升高增加、心率增快显著的患者,Dil组采用静脉注射地尔硫卓0·1mg/kg,继用输注泵以5μg/(kg·min)持续静脉输注;C组采用静脉注射硝酸甘油100μg,继用输注泵以0·5μg/(kg·min)持续静脉输注。记录麻醉前(T0)、颈丛阻滞后10min(T1)、20min(T2)、30min(T3)的SBP、DBP、HR,计算SBP与HR的乘积(RPP)。结果 C组在T1~T3时及Dil组在T1时的SBP、DBP和RPP均明显高于T0时,HR快于T0时,差异有统计学意义(P<0·05),C组在T2~T3时的SBP、DBP、RPP较T1时下降,HR较T1时增快,但差异无统计学意义(P>0·05);Dil组在在T2~T3时的SBP、DBP、RPP和HR与T1时相比较明显降低或减慢,差异有统计学意义(P<0·05),与T0时比较无统计学差异(P>0·05);在T2~T3时Dil组SBP、DBP、RPP和HR均较C组降低或减慢,差异有统计学意义(P<0·05)。结论地尔硫卓在颈丛阻滞麻醉过程中具有血流动力学稳定作用,可以缓解颈丛麻醉带来的血压升高、心率增快等副反应。     

Chronic treatment of haloperidol causes vasoconstriction on basilar arteries of rats, dose dependently

Haloperidol is a widely used antipsychotic drug, which exerts its effects via antagonizing the dopaminergic D2 receptors. Also it affects a number of receptors on vascular bed and other tissues. The impact of haloperidol on vascular bed seems still debatable and not clear. In the present study, haloperidol was given to adult rats in 0.5, 1, 2.5 and 5 mg kg(-1) doses, once a day, intraperitoneally in 1 ml volumes, for 9 weeks. After decapitation under Pentothal anesthesia, brains and basilar arteries were dissected out at midpontine level immediately. Conventional histopathology and morphometric analysis were carried out on the dissected artery branches. Medial and adventitial layers, endothelial cells and internal elastic membranes were observed as normal in the control group. It was determined clearly that the lumen of basilar artery in the control group was larger than in the other groups and also it was observed that is more regular the lumen contours of basilar artery in control group compared with other groups. Finally, wall thickness of basilar artery in all experimental groups decreased significantly due to the vasoconstriction. Regarding the total, lumen and wall volumes, 1 mg kg(-1) haloperidol induces vasoconstriction more than the other groups.     

Effects of flunarizine on electrical and mechanical responses of smooth muscle cells in basilar and ear arteries of the rabbit

Summary The effects of flunarizine on electrical and mechanical responses of smooth muscle tissues of the rabbit basilar and ear arteries to transmural stimulation, highpotassium solution (high-K), 5-hydroxytryptamine and noradrenaline were studied. In the basilar artery, 10^–6 M flunarizine (69 min application) blocked spike potentials generated by outward current stimuli or transmural stimulation without change in the resting membrane potential or membrane resistance. The spike potentials generated in the ear artery were attenuated by a long exposure (up to 2 h) to a high concentration of flunarizine (10^–6 M). Membrane depolarizations produced by high-K, noradrenaline or 5-hydroxytryptamine were not blocked by flunarizine. Flunarizine inhibited smooth muscle contractions produced by transmural stimuli, high-K, noradrenaline or 5-hydroxytryptamine in both arteries, however the inhibition developed slowly, and the ear artery required a longer period of incubation with flunarizine than the basilar artery. The inhibitory effects of flunarizine on basilar artery were more marked against transmural stimulation or high-K induced contractions than against agonist-induced contractions.     

两种麻醉方法对急性等容血液稀释血流动力学及氧耗的影响

目的研究全身麻醉和硬膜外阻滞对急性等容性血液稀释时血流动力学和心脏氧耗的影响。方法 44例ASA分级Ⅰ～Ⅱ级的择期手术患者,随机平均分为全身麻醉组(G组)和硬膜外阻滞麻醉组(E组),根据放血量公式V=EBV×(H0-Hf)/Hav,麻醉后两组分别用50 ml注射器从桡动脉放血,放血速度平均40 ml/min,同时等速输入等量血定安;测定并记录稀释前后的血红蛋白(Hb)和血细胞比容(Hct);两组于麻醉前(HD)、麻醉后30 min(HD0)、血液稀释后5 min(HD1)和30 min(HD2)时分别测定并计算HR、SAP、DAP、MAP、CVP、MPAP、PAWP、CI、SI、LVSWI、RVSWI和TI值。结果两组血液稀释后Hb和Hct显著下降(P<0.01);G组HD0时HR、SAP、SDP和MAP值比HD时显著下降(P<0.05),低于E组同时间点各值(P<0.05);两组稀释后CI和SI显著增加(P<0.05),其中HD1和HD2时,G组CI比HD0时分别增加34.97%和31.79%,SI比稀释前分别增加19.89%和26.64%,E组与G组CI和SI的增幅相似;G组麻醉后LVSWI和TI显著下降(P<0.05),其中TI在HD0、HD1和HD2时,分别比麻醉前下降了19.38%、24.80%和31.18%,G组麻醉后和稀释后LVSWI和TI分别显著低于E组各值(P<0.05)。结论全身麻醉患者血流动力学与清醒患者一样具有代偿血液稀释的能力,而且左心室做功和心脏氧耗少,全身麻醉比硬膜外阻滞可能更适用于手术中的急性等容性血液稀释。     

窦神经阻滞对颈动脉狭窄介入治疗中血流动力学紊乱的防治作用研究

目的探讨窦神经阻滞对颈动脉狭窄介入治疗中所致血流动力学紊乱的防治作用。方法首先运用颈动脉化学损伤法建立颈动脉狭窄的动物模型并检验之,然后将实验动物随机分为两组并给予窦神经阻滞及生理盐水窦神经周围注射两种不同处理,观察二者在颈动脉窦受牵拉刺激后的血压变化。结果运用化学损伤法成功地建立了颈动脉狭窄的动物模型。在颈动脉窦受牵拉刺激后,生理盐水窦神经周围注射组血压变化明显,窦神经阻滞组血压无显著变化。结论窦神经阻滞对刺激颈动脉窦压力感受器所致的血流动力学变化有明确有效的防治作用。