高血压病的脑电图、脑电地形图与 TCD、CT 的对比研究

通过对２９６例各期高血压病人进行的脑电图、脑电地形图等多项检查，并与ＴＣＤ和ＣＴ对比中发现：高血压病的早期即可引起脑功能和脑血流动力学的改变，这些改变可在以上功能性检查中发现，而不能被ＣＴ等形态学检查所揭示。不同时期的高血压病在这些检查中各有差异，基本与病情的发展成正相关。其中ＴＣＤ在反映高血压病的变化中最敏感，其次为脑电地形图和脑电图。本研究的目的是为诊治高血压病、预报和防治脑血管病的发生提供依据。

短暂性脑缺血发作的 TCD 分析

我们通过对５０例临床诊断为短暂性脑缺血发作（ＴＩＡ）的患者经颅多普勒超声仪（ＴＣＤ）进行监测，通过对患者颅内主要动脉的血流峰速、均速及形态的动态观察及分析。结果表明：ＴＣＤ在为诊断ＴＩＡ提供了颅内动脉血流动力学客观指标，且ＴＣＤ以其无创性、可重复性弥补了脑血管造影的不足，为临床医师在诊断及治疗方面提供了客观的依据。特别是对病因诊断及治疗药物的选择提供了科学的依据。

基于XC9572和线阵CCD TCD1501D的数据采集系统的设计

利用复杂可编程逻辑器件XC9572,完成了线阵CCD TCD1501D驱动脉冲的设计,并完成了对输出图像信号的二值化处理,对数据的采集、存储,以及通过用Verilog HDL设计的UART向PC机传送数据的设计。该数据采集系统有高集成度、高性能、高精度、低成本等优点,可以广泛地应用于各种线性测量场合。

The application value of TCD combined with CDUS in the large artery atherosclerosis

Objective:To explore the value of TCD and CDUS on diagnosis of large artery atherosclerosis.Methods:In our study,90 patients who had been admitted to our hospital and diagnosed as LAA according to CISS typing were selected as the research object.A retrospective analysis was conducted,using CTA as golden standard for diagnoses of stenoses.Explore the risk factors of LAA,the reliability of TCD and CDUS in diagnosis of the stenosis and distribution of stenosis in each vessel.Results:Hypertension and type 2 diabetes are risk factors of LAA vascular stenosis.Middle cerebral artery stenosis detection by TCD carries the highest reliability(sensitivity 90.91%,specificity 97.89%,positive predictive value 96.15%,the negative predictive value was 94.9%,the positive likelihood ratio was 43.18,negative likelihood ratio 0.09,Kappa=0.9).The consistency of TCD is as good as CTA in head and neck part.The negative coincidence rate was higher in the anterior circulation vessels(97.98%),followed by the coincidence rate of severe stenosis(95.23%).However,the detection rate of posterior circulation vessels positive,moderate and severe stenosis,mild stenosis gradually decreased by TCD.CDUS carries general reliability in detecting intracranial extracranial stenosis,the highest reliability in internal carotid artery(kappa 0.82),and the worst consistency in vertebral artery(kappa 0.38).The negative coincidence rate of CDUS in extracranial cerebrovascular stenosis was highest(97.22),followed by the overall compliance rate(91.55%).242 branches of vascular stenosis were discovered in our study,among which intracranial artery stenosis 61.15%(148/242)is higher than that in extracranial artery 38.85%(90/242),ratio of moderate to severe stenosis is as high as 82.23%(199/242).Intracranial artery stenosis in ICA is extremely common(51.11%,46/90),and MCA is the common area of intracranial artery stenosis(37.16%,55/148).Conclusions:(1)Hypertension,type 2 diabetes are risk factors for LAA stenosis.(2)TCD detection of intracranial vascular stenosis carries the best consistency,and reliability of MCA is the highest.In our search,MCA possesses the highest rate of stenosis,and negative coincidence rate by TCD examination was the highest,which could be used for screening method for stenosis.The reliability of TCD in diagnosis of moderate and severe stenosis was relatively better than mild stenosis.(3)CDUS detection of anterior circulation lesions is better than that of posterior circulation lesions.Evaluate effect on moderate and severe stenosis was better than that of mild one.The ratio of ICA stenosis was the highest,but the effect on VA was poor.(4)The incidence of intracranial vascular stenosis is more common than that of the intracranial vascular stenosis.

Continuous assessment of cerebral autoregulation by TCD during tilt table testing

[SUMMARY] TTTT is a non-invasive and new investigative examination,and a most important method of clinical diagnosis for many diseases,specially for orthostatic syncope,autonomic failure,intracranial hypertension,neurodegenerative diseases,CVAs and so on.At the same time,TCD technique for non-invasive monitoring of CBFV has also provided a new tool for investigating CA.In clinical circumstance,we may carry on assessment of dynamic CA by TTTT,and this kind of method has been proved to be appropriate to examine patients and monitor.we can choose different tilt positions by tilt-table according to the different demands for clinical diagnosis or researches,and record the different appearances of various index signs,we can take advantage of the technique of transfer function analysis of power spectrum between spontaneous changes in CBF and other factors(such as arterial pressure) to do research on the specific mechanism of impaired CA.

Value of TCD foaming Test in Screening Patent Foramen Ovale in Migraine Patients and Efficacy of PFO Occlusion

Objective:To explore the effect of TCD foaming test in screening patent foramen ovale in migraine patients,as well as in the treatment effect.Methods:From September 2019 to August 2020,236 patients with migraine and 362 patients with normal physical examination were treated in our hospital.According to the random number table method,60 patients with migraine were selected as the observation group,and 60 patients with normal physical examination were selected as the control group.48 cases of PFO were confirmed by TCD foaming test Among the patients with migraine,36 patients received interventional occlusion therapy.The therapeutic effect and VAS score of the two groups were analyzed.Results:Through TCD foaming test,the proportion of PFO in the observation group was 80%,and that in the control group was 13.33%.The proportion of PFO in the observation group was significantly higher than that in the control group,and the difference was statistically significant(χ^(2)=53.5714,P<0.01);The symptoms disappeared in 30 patients and improved in 4 patients;Among the 36 patients who received interventional occlusion therapy,the VAS score of patients before and after the operation was significantly changed,and the proportion of patients whose pain disappeared after the operation was 83.33%,which was significantly lower than that before the operation,and the difference was comparable(χ^(2)=51.4286,P<0.01).Conclusion:TCD foaming test for PFO screening has strong applicability,not only safe and convenient,will not cause trauma to patients,and through interventional occlusion treatment,can significantly improve the clinical symptoms of migraine patients and cure patients.

Therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and TCD evaluation

Objective:To explore the therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and the value of dynamic TCD monitoring in predicting the neurological function recovery.Methods: A total of 70 patients with hypertensive cerebral hemorrhage who were admitted in our hospital were included in the study and divided into the minimally invasive group and conservative group with 35 cases in each group according to different treatment protocols. The patients in the two groups were given drug conservative treatments. On this basis, the patients in the minimally invasive group were given urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle. TCD was performed before treatment, 1 d, 5 d, 10 d, and 21 d after treatment. The hematoma and edema volume was calculated. NIHSS was used to evaluate the neurological function recovery.Results: Vs, Vd, and Vm after treatment in the minimally invasive group were significantly elevated, while PI was significantly reduced. Vs, Vd, and Vm after treatment in the conservative group were reduced first and elevated later, while PI was elevated first and reduced later, and reached the lowest/peak 10d after treatment. Vs, Vd, and Vm 5 d, 10 d, and 21 d after treatment in the minimally invasive group were significantly higher than those in the conservative group, while PI was significantly lower than that in the conservative group. The hematoma and edema volume after treatment in the two groups was significantly reduced. The hematoma and edema volume at each timing point was significantly lower than that in the conservative group. NIHSS score after treatment in the minimally invasive group was significantly reduced. NIHSS score in the conservative group was elevated first and reduced later, reached the peak 10d after treatment, and at each timing point was higher than that in the minimally invasive group.Conclusions:The early minimally invasive operation can significantly improve the hematoma adjacent blood flow volume in patients with hypertensive cerebral hemorrhage, and contribute to the neurological function recovery. TCD not only can be applied in the dynamic monitoring of cerebral blood flow volume in patients with hypertensive cerebral hemorrhage, but also has a certain value in evaluating the prognosis of neurological function.

Interest of Transcranial Doppler (TCD) in Emergency in Traumatic Brain Injury Patients at Gabriel Touré University Hospital, Bamako, Mali

Introduction: Transcranial Doppler is a simple, non-invasive and inexpensive examination which allows the assessment of cerebral perfusion. In countries with limited resources, which do not have a means of monitoring intracranial pressure, this examination offers hope of survival for patients with traumatic brain injury. This study was designed to investigate the incidence of early cerebral circulation abnormalities after traumatic brain injury using transcranial Doppler (TCD). Methodology: A descriptive and analytical study was conducted over one year, including patients with traumatic brain injury and an initial Glasgow Coma Scale (GCS) score of less than 15. Non-inclusion criteria: Stroke, brain tumor, cerebral abscess. Exclusion criteria: Inadequate insonation window. Results: Out of 854 traumatic brain injury patients admitted to the emergency department, 112 were included in the study. The average age was 30.14 years, with a sex ratio of 4.1. Initially, 83.5% had moderate traumatic brain injury, and 12.1% had severe traumatic brain injury. Brain CT scans were performed in 95.7% of the patients. Edematous-hemorrhagic contusion was observed in 95% of the patients. On initial TCD, the pulsatility index in the middle cerebral artery was greater than 1.3 in 49.4% of the patients. Diastolic velocity was less than 20 cm/s in 46.4% of cases, and mean velocity was greater than 150 cm/s in 8.7% of cases. In this group, low diastolic velocity indicated cerebral hypoperfusion suggestive of intracranial hypertension. When the pulsatility index was greater than 1.9, no patient had a normal diastolic velocity. Among patients with severe traumatic brain injury, 61.5% had an abnormal pulsatility index compared to 42.3% of patients with moderate traumatic brain injury. Conclusion: TCD is a simple tool for analyzing intracerebral hemodynamics.

超声联合TCD技术诊断颈部动脉粥样硬化性脑梗死的临床价值

目的:探讨超声联合TCD技术诊断颈部动脉粥样硬化性脑梗死(CAEI)的临床价值。方法:以62例CAEI患者为对象,以同期62例健康人为对照组。均接受血管超声及TCD检查,分析二者诊断CAEI的价值。结果:观察组颈总动脉收缩期内径(Ds)、内中膜厚度(IMT)值高于对照组(P<0.05)。观察组Vd、Vs低于对照组,RI、PI高于对照组(P<0.05)。观察组斑块检出率为85.48%,高于对照组(19.35%,P<0.05)。模型1(Ds+IMT)诊断CAEI的AUC、灵敏度、特异度分别为0.754(95%CI:0.669-0.827)、79.03%、74.19%;模型2(Vs+Vd+RI+PI)诊断CAEI的AUC、灵敏度、特异度分别为0.814(95%CI:0.735-0.878)、82.26%、70.97%;模型3(Ds+IMT+Vs+Vd+RI+PI)诊断CAEI的AUC、灵敏度、特异度分别为0.871(95%CI:0.799-0.924)、90.32%、74.19%。模型3诊断CAEI的AUC高于模型1、模型2(P<0.05)。结论:超声联合TCD检测可了解CAEI患者的颈动脉斑块及血流信息,有助于提高诊断的准确度。

TCD联合MRI对中枢性眩晕患者的诊断研究

本研究旨在探讨经颅多普勒(TCD)与磁共振成像(MRI)联合应用在中枢性眩晕患者诊断中的价值。方法 选取某医院于2022年5月至2023年6月间收治的60例中枢性眩晕患者作为研究对象,对所有患者进行TCD与MRI检查,并分析诊断结果。结果 TCD诊断出中枢性眩晕患者50例,MRI诊断出51例,而联合诊断则检出59例。TCD检查揭示50例患者存在动脉血流状态异常,其中椎-基底动脉异常占47例,包括单纯硬化、单纯狭窄、狭窄合并硬化血流速度减慢或加快等多种情况。MRI检查发现脑梗死48例,涉及脑干、小脑、丘脑及枕叶等不同部位,另有3例脑出血,均位于小脑。联合诊断的敏感度和准确度均达到98.33%,显著高于单一TCD或MRI诊断。结论 TCD与MRI联合诊断在中枢性眩晕患者的诊断中具有显著优势,值得临床推广。

TCD辅助尿激酶静脉溶栓及局部亚低温治疗急性脑梗死的疗效观察

目的 探讨TCD辅助尿激酶静脉溶栓及局部亚低温治疗急性脑梗死的疗效。方法 对尿激酶组（24例）给予尿激酶静脉溶栓;亚低温联合组（24例）患者给予尿激酶联合局部亚低温治疗;TCD联合组（25例）患者给予TCD辅助尿激酶静脉溶栓;尿激酶＋TCD＋亚低温组（联合治疗组）（26例）患者给予TCD辅助尿激酶静脉溶栓后再予局部亚低温治疗。于溶栓前、溶栓后2 h、24 h、7 d、14 d采用NIHSS评分评价患者神经功能缺损程度。于3个月后采用mRS评分评价患者的神经功能。结果 TCD联合组及联合治疗组血管再通率显著高于尿激酶组（均P〈0.05）。与溶栓前比较,各组溶栓后各时间点NIHSS评分均显著下降（均P〈0.05）。与尿激酶组比较,TCD联合组及联合治疗组溶栓后各时间点NIHSS评分均显著下降;亚低温联合组溶栓后7 d、14 d时NIHSS评分均显著下降（P〈0.05~0.01）。与亚低温联合组比较,TCD联合组及联合治疗组溶栓后24 h、7 d、14 d时NIHSS评分均显著下降（均P〈0.05）。尿激酶组mRS评分显著高于亚低温联合组、TCD联合组及联合治疗组（均P〈0.05）。联合治疗组mRS评分显著低于亚低温联合组及TCD联合组（均P〈0.05）。各组间并发症发生率差异无统计学意义（均P〉0.05）。结论 TCD辅助溶栓及局部亚低温联合溶栓治疗在改善患者远期功能障碍方面显著优于单用尿激酶溶栓治疗或仅联合TCD及亚低温治疗,且并发症发生率无显著升高,是一种安全、有效的方法。

MRA和TCD对椎基底动脉短暂缺血性发作的研究

探讨椎基底动脉短暂缺血性发作（ＶＢＴＩＡ）的发病机理。方法患者组６５例，对照组２６例，作磁共振血管成像（ＭＲＡ）和经颅多普勒（ＴＣＤ）检查。测量ＶＢＴＩＡ的脑血流量（ＣＢＦ）。结果对照组双侧椎动脉（ＶＡ）ＣＢＦ为１１２．３～２７８．９ｍｌ／ｍｉｎ（均值１９５．６），较患者组４８．０～２６２．０ｍｌ／ｍｉｎ（均值１４．９０）高（Ｐ＜０．０１）。１５例患者ＣＢＦ降低，双侧ＶＡ广泛迂曲者下降明显，均值为１０７．５ｍｌ／ｍｉｎ，ＶＡ重、中、轻度狭窄或发育不良者均值分别为１２０．０、１４１．３、１５４．２（ｍｌ／ｍｉｎ）。三者健侧ＣＢＦ占双侧ＣＢＦ的百分比分别为９１．５％、８２．０％、６５．８％。结论通过ＭＲＡ和ＴＣＤ可以测量ＣＢＦ，它是诊断ＶＢＴＩＡ的量化指标，对诊断ＶＢＴＩＡ和认识其发病机理具有重要意义。

SPECT、TCD及BAEP对椎基底动脉缺血性眩晕的诊断价值

目的 探讨SPECT、TCD及BAEP对椎基底动脉缺血性眩晕 (VBAIV)的诊断价值。方法 对 10 0例临床诊断为VBAIV患者进行SPECT、BAEP、TCD检查 ,并对其检查的结果进行分析、对比。结果 10 0例中SPECT的阳性率为 87 0 % ,BAEP为 5 8 3% ,TCD为 78 0 %。结论 SPECT的阳性率最高 ,能较灵敏地直接反映脑缺血的部位 ;BAEP阳性率最低 ,但能较正确的反映出脑干缺血的依据 ;TCD检查简单、方便 ,对脑血管和脑血流状态反映较灵敏 ,但定位准确性较差。三者在该病的诊断中均可提供有价值的客观依据 ,且有互相补充的作用。

FID/TCD并联气相色谱法测定天然气水合物的气体组成

建立了一种氢火焰离子化检测器(FID)与热导检测器(TCD)并联检测的气相色谱分析技术。该方法一次进样,即可实现天然气水合物中C1～C6、CO2、H2S、O2+N2 16种气体成分的同时测定。实验优化了色谱柱、升温程序、柱流速、进样口温度、检测器温度、TCD参考气和尾吹气流速等仪器分析参数。在优化条件下,16种气体分子在实验浓度范围内线性关系良好,r2为0.999 03～0.999 98,方法检出限为0.000 3～0.046 mol/mol,相对标准偏差(n=6)为1.6%～5.0%。对祁连山冻土区、南海神狐海域、人工合成水合物样品的分析表明,该方法简便实用、灵敏可靠,可满足天然气水合物气体组成的分析要求。

脑干腔隙性梗塞的MRI、TCD与临床

本文对８５例脑干腔隙性梗塞（腔梗）患者的头颅ＭＲＩ、部分ＴＣＤ及临床特征作回顾性分析。结果：本组患者发病年龄较大，７５％有长期高血压史，临床表现为复杂性、多样化特点，且多数缺乏典型的交叉或脑干孤立症征。ＭＲＩ扫描显示腔隙灶以桥脑腹侧居多，病灶＜０．５ｃｍ者可无症状或症状轻微。ＴＣＤ可很好反映椎－基底动脉系统的血管弹性及血流速度，对脑干腔梗的诊断有一定的帮助，但定位不甚准确。ＭＲＩ仍是诊断脑干腔梗的最佳手段。

正天丸对血瘀型偏头痛血流动力学及多普勒超声(TCD)的影响

目的 :以血流动力学及颅多普勒超声 (TCD)为指标 ,观察正天丸对血瘀型偏头痛的疗效。方法 :对 30例血瘀型偏头痛患者给予正天丸口服治疗 ,治疗 1个月后复查血液流变学指标、甲皱壁微循环积分值、TCD ,并作前后对比观察。结果 :治疗后血液流变学指标、甲皱壁微循环积分值、TCD与治疗前比较均有显著性差异 (P <0 .0 5 )。结论 :正天丸能显著降低血瘀型偏头痛患者全血粘度、血浆粘度及改善甲皱壁循环异常与TCD的变化。

TCD评估针刺百会穴对颈性眩晕椎-基底动脉供血的影响

[目的]观察经颅多普勒(TCD)评估针刺百会穴对颈性眩晕椎-基底动脉供血的影响。[方法]设针刺百会穴治疗组与空白对照组进行对照观察,在TCD显示下,分别记录观察前后椎-基底动脉的血流速度。[结果]治疗组针刺百会穴后其椎-基底动脉血流速度有较明显的改善,而对照组未见明显改变,经统计学处理两组有显著性差异(P<0.05)。[结论]针刺百会穴对颈性眩晕椎-基底动脉供血的改善有较明显的效果。

柴胡加龙骨牡蛎汤配合颈椎牵引治疗颈性眩晕20例的TCD观察

目的观察柴胡龙骨牡蛎汤配合颈椎牵引治疗颈性眩晕的TCD疗效。方法选择40例颈性眩晕患者,采用区组随机化方法及异体配对设计,分为治疗组和对照组,每组各20例。治疗组予柴胡龙骨牡蛎汤配合颈椎牵引治疗,对照组予盐酸氟桂利嗪胶囊配合颈椎牵引治疗,治疗4周进行疗效评估,两组治疗前后均对患者进行TCD检查。结果治疗组治疗后VA及BA的Vm与治疗前比较均明显提高(P<0.01),PI明显降低((P<0.01),对照组治疗后VA及BA的Vm与治疗前比较也有提高(P<0.05),PI降低(P<0.05);2组治疗后比较,治疗组的VA及BA的Vm均高于对照组(P<0.05),治疗组的VA及BA的PI均低于对照组(P<0.05)。结论柴胡龙骨牡蛎汤配合颈椎牵引对颈性眩晕有较好的治疗效果。

经食管超声心动图右心声学造影与对比增强TCD检查在检测隐源性脑卒中患者右向左分流的效果比较

目的比较经食管超声心动图右心声学造影与对比增强TCD检查在检测隐源性脑卒中患者右向左分流的效果。方法选取2016年9月至2017年9月佛山市第一人民医院收治的隐源性脑卒中患者82例,所有患者均进行经食管超声心动图右心声学造影和对比增强TCD检查。对比两种检查方法对于隐源性脑卒中患者右向左分流的检出率及半定量分流分级程度。结果对比增强TCD对右向左分流的检出率[58. 5%(48/82)]显著高于经食管超声心动图右心声学造影[30. 2%(25/82)](P <0. 05)。对比增强TCD对右向左分流的半定量分级明显高于经食管超声心动图右心声学造影(均P <0. 05)。经食管超声心动图右心声学造影后出现吞咽疼痛3例,食管穿孔2例,声音麻痹3例,血压异常5例,合计并发症发生率为15. 9%(13/82),而对比增强TCD后未见相关并发症。结论相对于经食管超声心动图右心声学造影技术,对比增强TCD检查对隐源性脑卒中右向左分流检出率更高,半定量分流程度更高,具有更广阔的应用空间。