烟雾病行STA—MCA分流术前后脑血流的TCD检测

目的应用经颅多普勒超声（TCD）动态观察烟雾病（MMD）行颞浅动脉一大脑中动脉（STA—MCA）分流术前、后脑血流的变化，探讨TCD对MMD治疗效果评估的价值。方法18例MMD患者在实施STA—MCA手术前、后分别行床边TCD检查。对患者手术前后大脑中动脉（MCA）主干峰值流速（Vp）、舒张末期流速（Vd）、平均流速（Vm）以及血管搏动指数（PI）、频谱形态、音频信号进行检测，并对手术前、后的数值进行对比分析。结果术前MCA主干血流速度异常增高者，频谱紊乱，音频信号粗糙或乐性杂音，术后血流速度降至正常范围或接近正常范围，频谱形态规则，音频信号清晰柔和。术前MCA主干血流速度降低者，为低脉动型，波浪型频谱，术后血供增加，血流速度升高至正常范围，频窗清晰。对比手术前、后Vm的数值，差异均具有显著性（P〈0．05）。结论TCD可以实时动态的检测MMD患者行STA—MCA分流术前、后脑血流动力学的变化，为MMD治疗方法的选择和术后疗效评价提供客观依据。

Assessment of Curative Effect of Superfidal Temporal Artery-Middle Cerebral Artery Bypass on Moyamoya Disease by TCD

Objective To explore the application of transcranial Doppler sonngraphy (TCD) to assessment of the curative effect of superficial temporal artery-middle cerebral artery bypass (STA-MCA BP) on Moyamoya disease. Methods The peak flow velocity (Vp), diastolic flow velocity(Vd), mean flow velocity (Vm) and pulsatility index (PI), pattern of the spectrum and audibility signal of the middle cerebral arteries (MCAs) were detected by TCD before and after STA-MCA BP in 18 patients with Moyamoya disease. Vm and pattern of waveform were compared between pre- and post-operation. Results Before the operation, Vm was (117.6±14.0)cm/s, which was higher than that in MCA oftbe healthful adults, the pattern of spectrum was deranged, and audibility signal was rough in 14 MCAs of the patients with Moyamoya disease. After the operation, Vm was decrease to normal range or close to the normal range [(78.5±9.2)cm/s], the pattern of spectrum was regular and the audibility signal was limpid and gentle in these 14 MCAs. Before the operation, Vm was (48.3±7.4)cm/s which was lower than that in MCA of the healthful adults, and the pattern of the spectrum was undulate in 7 MCAs of the patients with Moyamoya disease. After the surgery, Vm increase to the normal range and the spectrum was limpid in these 7 MCAs. The blood supply to the brain was increased in all the patients after the operation. There was significantly difference in V. Between pre- and post-operation (P<0.05), Conclusions The changes in the cerebral hemodynamics may be detected by TCD, which can provide objective information for evaluating the curative effect of STA-MCA BP on Moyamoya disease.