经眶窗经颅多普勒检测大脑中动脉血流动力学的临床应用

A evaluation of hemodynamics of middle cerebral artery through orbital window by TCD

目的：评价经颅多普勒（TCD）经眶窗检测大脑中动脉（MCA）在临床应用的可行性及可靠性。方法：对颞、眶窗检测信号良好的60例患者分别在2个部位测定MCA的峰值流速（Vs）、平均流速（Vm）、舒张末期流速（Vd）和脉动指数（PI）,对其中6例行MRI检查者测量了经颞及经眶的检测角度;另对25例颞窗双侧或一侧缺如者行眶窗检测MCA。结果：眶窗检测的MCA血流速度结果明显低于颞窗,Vs、Vm和Vd分别是（69.27±15.57）、（45.56±11.63）、（33.09±8.31）和（88.68±17.07）、（59.55±10.69）（、44.85±7.65）（P〈0.01）,但两窗的PI为（0.853±0.118）和（0.847±0.120）,无明显差异（P〉0.05）。检测角度经眶窗斜角方向（30～50度）、深度（8～9 cm）均大于经颞窗斜角方向（9～35度）、深度（5.5～6 cm）。颞窗缺如者的眶窗MCA检出率达86%。结论：眶窗检测MCA方法可行、检出率高,PI结果与颞窗检测一致,因此,颞窗缺如患者可经眶窗检测大脑中动脉血流速度,但要注意两窗所测血流速度的结果有差别,故临床宜慎用经眶窗测定的MCA血流速度结果。

Objective： To test the blood flow of middle cerebral artery（MCA） insonated by Transcranial Doppler（TCD） through optical and temporal window and to access the feasibility and reliability of this method in clinical application.Methods： 60 patients with good temporal window and 25 patients with poor temporal window（bilateral： 8 cases,unilateral： 17 cases） were examined by TCD.Systolic velocity（Vs）,mean velocity（Vm）,diastolic velocity（Vd）,and pulsatility index（PI） in MCA were evaluated.6 cases out of 60 patients with good temporal window were measured in transoptical and transtemporal detecting angle by MRI.Results： There was no difference in PI between the MCAs insonated through optical and temporal window（P〉0.05）.However,there were significant differences in Vs,Vm and Vd between the MCAs insonated through optical and temporal window（P〈0.01）.The detecting angle was bigger in transoptical than transtemporal from the 25 patients with poor temporal window.MCA could be insonated through optical window in 86% patients.Conclusion： MCA can be insonated through optical window.PI measured by transoptical and transtemporal investigation is consistent.However,flow velocity is slower in transoptical than in transtemporal,so the flow velocity of MCA in transoptical test needs to be cautious in clinic application.