Transcranial Doppler ultrasonography: From methodology to major clinical applications

Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler(TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency(≤ 2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays the most widespread indication for TCD in outpatient setting is the research of right to left shunting, responsable of so called "paradoxical embolism", most often due to patency of foramen ovale which is responsable of the majority of cryptogenic strokes occuring in patients younger than 55 years old. TCD also allows to classify the grade of severity of such shunts using the so called "microembolic signal grading score". In addition TCD has found many useful applications in neurocritical care practice. It is useful on both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoidal haemorrhage(caused by aneurysm rupture or traumatic injury), traumatic brain injury, brain stem death. It is used also to evaluate cerebral hemodynamic changes after stroke. It also allows to investigate cerebral pressure autoregulation and for the clinical evaluation of cerebral autoregulatory reserve.

Evaluation of right-to-left shunt on contrast-enhanced transcranial Doppler in patent foramen ovale-related cryptogenic stroke: Research based on imaging

BACKGROUND Cardiogenic embolism caused by patent foramen ovale(PFO)is a common etiology of cryptogenic stroke(CS),particularly in young and middle-aged patients.Studies about right-to-left shunt(RLS)detection using contrast-enhanced transcranial Doppler(c-TCD)are numerous.According to the time phase and number of microbubbles detected on c-TCD,RLS can be classified and graded.We hypothesized that the characteristics of an infarction lesion on diffusion-weighted imaging differs when combining the type and grade of RLS on c-TCD in patients with PFO-related CS.AIM To explore the characteristics of infarction lesions on diffusion-weighted imaging when combining the RLS type and grade determined by c-TCD.METHODS We retrospectively evaluated CS patients from August 2015 to December 2019 at a tertiary hospital.In total,111 PFO-related CS patients were divided according to whether RLS was permanent(microbubbles detected both at resting state and after the Valsalva maneuver)or latent(microbubbles detected only after the Valsalva maneuver)on c-TCD.Each group was subdivided into small,mild and large RLS according to the grade of shunt on c-TCD.A normal control group was composed of 33 patients who suffered from simple dizziness.Intragroup and intergroup differences were analyzed in terms of clinical,laboratory and diffusion-weighted imaging lesion characteristics.The correlation between RLS grade evaluated by c-TCD and size of PFO determined by transesophageal echocardiography were also analyzed.RESULTS In 111 patients with PFO-related CS,68 had permanent RLS and 43 had latent RLS.Clinical characteristics and laboratory tests were not significantly different among the permanent RLS,latent RLS and normal control groups.The proportion of patients with multiple territory lesions in the permanent RLS group(50%)was larger than that in the latent RLS group(27.91%;P=0.021).Posterior circulation was more likely to be affected in the latent RLS group than in the permanent RLS group(30.23%vs 8.82%,P=0.004).Permanent-large and latent-large RLS were both more likely to be related to multiple(P_(trend)=0.017 and 0.009,respectively),small(P_(trend)=0.035 and 0.006,respectively)and cortical(P_(trend)=0.031 and 0.033,respectively)lesions.The grade of RLS evaluated by c-TCD was correlated to the size of PFO determined by transesophageal echocardiography(r=0.758,P<0.001).CONCLUSION Distribution of the infarct suggested the possible type of RLS.Multiple,small and cortical infarcts suggest large RLS induced by a large PFO.

a Transcranial Doppler Study of Locally Using Dexamethasone after Brain Injury in Rabbits

Objective To explore the effect of locally using dexamethasone on the blood flow velocity in the middle cerebral artery(FVmca) and cerebral edema after brain injury. Methods 20 rabbits were classified to 2 groups, group A( the control group) and B (the treated group). An experimental rabbit model was conducted to contusion by bone window plasty with extradural hitting. Group B was treated by locally infiltrating of dexamethasone at equidistance to lesions. Group A was given normal saline the same way as Group B. The changes of FVmca using trans－cranial Doppler and moisture in brain tissues were observed. Results The normal value of FVmca was (31.8± 4.5)cm/s, while the value of FVmca in group A and B were (15.4± 3.9)cm/s and (22.1± 3.5)cm/s separately.Water content in damaged hemisphere in Group A and B were (81.54± 0.55)％ and (79.35± 0.50)％ respectively. There was a significant difference between the 2 groups (P<0.05). The levels of FVmca in group A and B were lower than that of control and there was also a significant difference between group A and B (P<0.05).Conclusions FVmca decreased and the brain moisture increased after brain injury while FVmca increased and the brain moisture reduced after treatment with dexamethasone. It demonstreated that local treatment of dexamethasone had an obvious therapeutical effect on brain injury.

Nitrogen monoxide vector of ultrasonic atomizing inhalation improves vertebro-basilar artery insufficiency Hemodynamic changes are detected by transcranial Doppler test

BACKGROUND： Latest researches at home and abroad indicate that glycerol trinitrate plays its function because it can metabolize into nitrogen monoxide （NO） in vivo. OBJECTIVE： To study the therapeutic effects of NO vector of ultrasonic atomizing inhalation on vertebro-basilar artery insufficiency （VBI） through transcranial Doppler （TCD） detection and serum NO content and indirect effect of TCD on cerebral blood flow changes. DESIGN： Randomized grouping and controlled clinical study. SETTING： Department of Neurology, the Fourth People＇s Hospital of Jinan. PARTICIPANTS： A total of 130 patients who were diagnosed as VBI were selected from Department of Neurology, the Fourth People＇s Hospital of Jinan from December 2001 to December 2005. The involved inpatients were checked by CT and MRI, and met the VBI diagnostic standard enacted by the Fourth National Academic Meeting of Cerebrovascular Disease in 1995. All patients and their relatives provided the confumed consent. They were randomly divided into low-dose treatment group （n =60）, high-lose treatment group （n =30） and control group （n =40）. METHODS： Patients in the low-dose and high-dose treatment groups were given ultrasonic atomizing inhalation of 3 mg and 5 mg glycerol trinitrate, respectively, for 20 minutes, once a day. In addition, ligustrazine and energy mixture were used once a day for three days in a course. Cases in the control group were only given ligustrazine and energy mixture. All selected cases accepted TCD, blood NO content was checked at the time of beginning, after the first time and after a period of treatment. According to the TCD test, VBI patients were divided into two groups （high-low flow velocity）. The vertebral artery （VA） and basal artery （BA） of left or right sides were detected by 2 Hz detector via occipital window. MAIN OUTCOME MEASURES： ①Blood flow velocity of systolic phase, blood flow velocity of diastole phase and vascular resistance in left and right VA and BA detected by using TCD before treatment, after treatment for one course; ②content of serum NO indirectly measured by using nitric acid disoxidation technique. RESULTS： All 130 VBI patients were involved in the final analysis. ①Changes of hemodynamic indexes： Systolic phase of VA and diastole phase of BA were higher in low-dose treatment group than that in the control group after first treatment, and there was significant difference （P 〈 0.05）; meanwhile, systolic phase and diastole phase of VA and systolic phase of BA were also higher in treatment group than that in the control group after one course （P 〈 0.05）. However, both systolic phase and diastole phase of VA and BA were lower in high-dose treatment group than that in the control group after first treatment and one course, and there was significant difference （P 〈 0.05）. ②Content of serum NO： After first treatment, there was no significant difference between low-dose treatment group and high-dose treatment group （P 〉 0.05）; but both groups were higher than control group, and there was significant difference （P 〈 0.05, 0.01）. CONCLUSION： NO vector of ultrasonic atomizing inhalation can improve VBI so as to improve cerebral blood-supply state.

Transcranial Doppler Ultrasonography to Prevent Cerebrovascular Accident in Children with Sickle-Cell Disease

Sickle-cell disease (SCD) is the most common cause of ischemic stroke in children and it happens in about 11% of patients between the age of 2 and 20 years old. About 7% of the world population is affected by hemoglobin disorders, mostly sickle cell anemia. SCD has a high prevalence in the population of African offspring and it is a public health problem in Brazil that affects more than 30,000 million people. Prevention of primary stroke might be feasible with a way to identify children at greatest risk. Transcranial Doppler Ultrasonography (TCD) to SCD patients can be a valuable service that results in a significant decrease of first stroke rates. In this work, we present a review about TCD as an effective strategy to detect children with SCD who are at risk for stroke.

TRANSCRANIAL DOPPLER CHARACTERISTICS IN PERSISTENT VEGETATIVE STATUS,LOCKED-IN SYNDROME AND BRAIN DEATH

Aim. Comparison of the trascranial Doppler (TCD) characteristics of cerebral circulation in persistent vegetative status (PVS), locked in syndrome and brain death patients. Methods. Using TCD ultrasound to detect the flow velocity and waveform patterns of middle cerebral artery (MCA) and basilar artery (BA) in patients with PVS, locked in syndrome and brain death. Results. The mean velocities of middle cerebral artery (Vmca) and basilar artery (Vba) were 30.0cm/s and 24.3cm/s in PVS patients respectively, which decreased 45.0% and 14.4% in comparing with normal value. For patients with locked in syndrome, Vmca and Vba were 49.7cm/s and 9.8cm/s, which decreased 5.0% and 61.7% than the normal value respectively. These results showed that the decrease of anterior circulation was predominant in PVS, and the decrease of posterior circulation was predominant in locked in syndrome. A unique diastolic reverse flow, short peak systolic wave or undetectable flow signal in middle cerebral artery were predominant in brain death patients, which was completely different from that of either PVS or locked in syndrome. Conclusion. TCD was a valuable tool in distinguishing PVS, locked in syndrome and brain death patients according to the differences in velocities and patterns of anterior and posterior cerebral arteries.

Microembolic signal detection by transcranial Doppler: Old method with a new indication

Transcranial Doppler(TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke(or stroke with undetermined etiology), and patent foramen ovale(PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.

Carotid Doppler and transcranial Doppler in diagnosing transient ischemic attack: A healthy control

BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler （TCD） can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA？ OB3ECTIVE： To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN： Contrast observational study SETTING： Department of Neuroelectrophysiology, Central People＇s Hospital of Huizhou PARTICIPANTS： A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People＇s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People＇s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS： HD15000 color Doppler ultrasound （Philips Company, USA） and Muliti-DopX2 TCD （DWL Company, Germany） were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker： Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque （mild： stenosis 〈 50%; moderate and severe： stenosis t〉 50%）. With TCD, the following results were regarded as stenosis： blood velocity of average envelope 〉 120 cm/s （diagnostic criteria of vascular stenosis of basilar artery： blood velocity of average envelope 〉 80 cm/s）, increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES： Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS： All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler： Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% （46/54） and incidence of stenosis of carotid artery was 41% （22/54）, which were higher than those in control group [52% （26/54）, 41% （22/54）, x^2 = 13.42, 10.90, P 〈 0.01]. ② Results of TCD： In experimental group, positive rate of atherosclerosis at base of skull was 89% （48/54） and incidence of stenosis of internal cranial artery was 48% （26/54）, which were higher than those in control group [62% （31/50）, 0, x^2 = 10.28, 32.00, P 〈 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION： The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.

Comparison of detection results of hypoxic-ischemic encephalopathy at different degrees in infant patients between brain electrical activity mapping, transcranial Doppler sonography and computer tomography examinations

BACKGROUND： It has been proved that brain electrical activity mapping （BEAM） and transcranial Doppler （TCD） detection can reflect the function of brain cell and its diseased degree of infant patients with moderate to severe hypoxic-ischemic encephalopathy （HIE）. OBJECTIVE： To observe the abnormal results of HIE at different degrees detected with BEAM and TCD in infant patients, and compare the detection results at the same time point between BEAM, TCD and computer tomography （CT） examinations. DESIGN ： Contrast observation SETTING： Departments of Neuro-electrophysiology and Pediatrics, Second Affiliated Hospital of Qiqihar Medical College. PARTICIPANTS： Totally 416 infant patients with HIE who received treatment in the Department of Newborn Infants, Second Affiliated Hospital of Qiqihar Medical College during January 2001 and December 2005. The infant patients, 278 male and 138 female, were at embryonic 37 to 42 weeks and weighing 2.0 to 4.1 kg, and they were diagnosed with CT and met the diagnostic criteria of HIE of newborn infants compiled by Department of Neonatology, Pediatric Academy, Chinese Medical Association. According to diagnostic criteria, 130 patients were mild abnormal, 196 moderate abnormal and 90 severe abnormal. The relatives of all the infant patients were informed of the experiment. METHOOS： BEAM and TCD examinations were performed in the involved 416 infant patients with HIE at different degrees with DYD2000 16-channel BEAM instrument and EME-2000 ultrasonograph before preliminary diagnosis treatment （within 1 month after birth） and 1,3,6,12 and 24 months after birth, and detected results were compared between BEAM, TCD and CT examinations. MAIN OUTCOME MEASURES： Comparison of detection results of HIE at different time points in infant patients between BEAM. TCD and CT examinations. RESULTS： All the 416 infant patients with HIE participated in the result analysis. （1） Comparison of the detected results in infant patients with mild HIE at different time points after birth between BEAM, TCD and CT examinations： BEAM examination showed that the recovery was delayed, and the abnormal rate of BEAM examination was significantly higher than that of CT examination 1 and 3 months after birth [55.4%（72/130）vs. 17.0% （22/130 ）,x^2=41.66 ;29.2% （ 38/130 ） vs. 6.2% （ 8/130 ）, x^2=23.77, P 〈 0.01 ], exceptional patients had mild abnormality and reached the normal level in about 6 months. TCD examination showed that the disease condition significantly improved and infant patients with HIE basically recovered 1 or 2 months after birth, while CT examination showed that infant patients recovered 3 or 4 months after birth. （2） Comparison of detection results of infant patients with moderate HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination 1,3,6 and 12 months after birth [90.8% （178/196）,78.6% （154/196）,x^2=4.32,P 〈 0.05;64.3% （126/196）,43.9% （86/196） ,x^2=16.44 ;44.9% （88/196） ,22.4% （44/196）,x^2=22.11 ;21.4% （42/196）, 10.2% （20/196）,x^2=9.27, P 〈 0.01]. BEAM examination showed that there was still one patient who did not completely recovered in the 24^th month due to the relatives of infant patients did not combine the treatment,. TCD examination showed that the abnormal rate was 23.1%（30/196）in the 1^st month after birth, and all the patients recovered to the normal in the 3^rd month after birth, while CT examination showed that mild abnormality still existed in the 24^th month after birth （1.0% ,2/196）. （3） Comparison of detection results of infant patients with severe HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination in the 1^st, 3^rd, 6^th and 12^th months after birth[86.7% （78/90）,44.4% （40/90）,x^2=35.53;62.2% （56/90）,31.1% （28/90）,x^2=17.51 ;37.8% （34/90）,6.7% （6/90）, x^2=27.14, P 〈 0.01]. BEAM examination showed that mild abnormality still existed in 4 infant patients in the 24^th month after birth. TCD examination showed that the abnormal rate was 11.1% （10/90） in the 3^rd month after birth, and all the infant patients recovered in the 6^th month after birth. CT examination showed that the abnormal rate was 6.7%（6/90） in the 12^th month after birth, and all of infant patients recovered to the normal in the 24^th month after birth.CONCLUSION ： BEAM is the direct index to detect brain function of infant patients with HIE, and positive reaction is still very sensitive in the tracking detection of convalescent period. The positive rate of morphological reaction in CT examination is superior to that in TCD examination, and the positive rate is very high in the acute period of HIE in examination.

Evaluation of Early Acute Cerebral Infarction with Transcranial Doppler

Objective:For patients with early acute cerebral infarction(ACI),transcranial Doppler ultrasound was used in the clinical examination,and its application effect was observed and analyzed.Methods:This study was carried out between October 2018 and October 2019.50 patients with ACI included as the research object was evaluated by transcranial Doppler and CT examination,and the application of the two examination methods was compared.Results:The results of transcranial Doppler examination showed that the abnormal rate of blood flow velocity and the ratio of both sides(VACA)in patients with early ACI was higher than that of CT examination.Conclusion:With the impact on the location and area of vascular occlusion in patients,VACA can effectively reflect the status and effectiveness of the collateral circulation function of the patient’s pia vessels during cerebral infarction.

TCD监测颅内血流动力学变化与脑小血管病患者病情严重程度及神经功能恶化的相关性

目的探讨经颅多普勒超声(TCD)监测颅内血流动力学变化与脑小血管病(CSVD)患者病情严重程度及神经功能恶化的相关性,为早期制定治疗方案、改善CSVD预后提供参考依据。方法回顾性分析2022-01—2023-12在郑州大学第二附属医院住院的98例CSVD患者的临床资料,采用磁共振成像(MRI)评估CSVD患者的MRI总负荷,采用经颅多普勒(TCD)监测大脑中动脉(MCA)和大脑前动脉(ACA)双侧血流动力学参数血流速度(Vm)、搏动指数(PI),比较轻中度负荷组和重度负荷组MCA和ACA的Vm、PI值,分析MCA和ACA的Vm、PI值与CSVD患者MRI负荷严重程度的相关性。根据CSVD患者入院1周内是否发生神经功能恶化分为恶化组和未恶化组,比较2组患者MCA和ACA的Vm、PI值,分析MCA和ACA的Vm、PI值与CSVD患者发生神经功能恶化的相关性。结果重度负荷组患者入院时MCA和ACA的Vm(41.35±5.47、35.44±3.37)均低于轻中度负荷组(48.32±6.43、44.61±4.86),而重度负荷组MCA和ACA的PI(1.17±0.26、0.98±0.23)均高于轻中度负荷组(0.92±0.21、0.78±0.19),组间比较差异均有统计学意义(P<0.05);MCA和ACA的Vm与MRI负荷严重程度呈负相关,而PI与MRI负荷严重程度呈正相关(均P<0.05);恶化组入院时MCA和ACA的Vm(39.38±4.37、34.11±2.34)均低于未恶化组(48.34±6.07、44.11±4.82),而恶化组MCA和ACA的PI(1.25±0.22、1.06±0.16)均高于未恶化组(0.91±0.19、0.76±0.19),组间比较差异有统计学意义(P<0.05);MCA和ACA的Vm与CSVD患者神经功能恶化的发生呈负相关,而PI与CSVD患者神经功能恶化的发生呈正相关(均P<0.05)。结论颅内血流动力学参数异常与CSVD患者病情严重程度和神经功能恶的发生均具有相关性,通过TCD监测CSVD患者的颅内血流动力学参数,可早期评估CSVD患者的严重程度,早期发现神经功能恶化的风险。

c-TCD在肺动静脉畸形相关脑梗死中的诊断意义

右向左分流目前被认为与隐源性卒中密切相关,右向左分流分为心内分流及心外分流,在心内分流中卵圆孔未闭(patent foramen ovale,PFO)已经得到神经内科医生的广泛认识,但在心外分流中,由于肺动静脉畸形(pulmonary arteriovenous malformation,PAVM)发生率低,往往被忽视,但其卒中及复发的概率要远高于PFO。目前发泡试验已经广泛应用到右向左分流的筛查中,对于早期分流及三个心动周期内出现栓子的阳性患者,我们往往将其全部归为PFO,并且认为肺内右向左分流栓子出现的时间要长于在心内分流的时间。但事实上分流的时间并不存在某一绝对界值,单纯根据时间不能区分心内及心外分流,本文主要分析使用对比增强经颅多普勒超声(con‑trasted transranial Doppler sonography,c-TCD)检测PAVM所致右向左分流及其分流特点。

TCD对颈内动脉重度狭窄引起大脑中动脉血流动力学变化及侧支循环的评估价值

目的探讨经颅多普勒超声(TCD)对颈内动脉重度狭窄引起大脑中动脉血流动力学变化及侧支循环的评估价值。方法选取2020年10月至2022年10月在洛阳市中心医院就诊的96例颈内动脉狭窄患者作为研究对象,根据数字减影血管造影(DSA)结果分为轻度狭窄、中度狭窄、重度狭窄,采用TCD测量大脑中动脉血流动力学参数[收缩期峰值血流速度(Vs)、搏动指数(PI)、脑血流储备能力(CVR)],分析大脑中动脉血流动力学参数与颈内动脉狭窄程度相关性及评估价值,并比较有无侧支循环开放患者大脑中动脉血流动力学参数及DSA、TCD对侧支循环开放检出率。结果不同颈内动脉狭窄程度患者Vs、PI、CVR比较:重度狭窄<中度狭窄<轻度狭窄(P<0.05);经相关性分析显示,大脑中动脉血流动力学参数Vs、PI、CVR与颈内动脉狭窄程度均呈负相关(P<0.05);Vs、PI、CVR对轻度与中度颈内动脉狭窄诊断曲线下面积(AUC)分别为0.798、0.763、0.854,联合诊断AUC为0.893,对轻度、中度与重度颈内动脉狭窄诊断AUC分别为0.832、0.795、0.856,联合诊断AUC为0.927;与无侧支循环患者比较,有侧支循环患者Vs、PI、CVR较高(P<0.05);TCD、DSA对于侧支循环开放检出率比较,差异无统计学意义(P>0.05)。结论TCD可评估颈内动脉重度狭窄引起的大脑中动脉血流动力学变化,为临床早期诊断颈内动脉狭窄程度、侧支循环建立提供参考,以针对性制定治疗方案,改善预后。

TCD对急性脑梗死机械取栓术后脑血流监测应用

目的:探讨经颅多普勒超声(TCD)在急性脑梗死(ACI)机械取栓术后脑血流监测中的应用价值。方法:选取2021年6月—2023年8月我院收治的85例ACI患者作为研究对象,均行机械取栓术治疗,治疗7天后采用神经功能缺损评分(NIHSS)评价患者神经功能,依据治疗前后的差值(ΔNIHSS)进行分组,将ΔNIHSS≥4分归为神经功能改善良好组,将ΔNIHSS<4分归为神经功能改善不良组;并随访至治疗后90天,采用改良Rankin评分量表(MRS)评估患者预后,MRS≤2分归为预后良好组,MRS>2分归为预后不良组;并于治疗前及治疗7天后开展TCD检查,明确大脑中动脉舒张末期血流速度(EDV)、收缩期峰值血流速度(PSV)、平均最大血流速度(MV)、搏动指数(PI)变化,并比较治疗前后及不同组别间脑血流参数差异。结果:85例ACI患者治疗后大脑中动脉EDV、PSV、MV高于治疗前,PI低于治疗前,差异有统计学意义(P<0.05);85例ACI患者治疗前NIHSS评分为(12.25±1.52)分,治疗后NIHSS评分为(7.52±1.12)分,ΔNIHSS为(4.73±0.45)分,其中神经功能改善良好组62例,神经功能改善不良组23例;神经功能改善良好组治疗前后大脑中动脉EDV、PSV、MV均高于神经功能改善不良组,PI均低于神经功能改善不良组,差异有统计学意义(P<0.05);85例ACI患者治疗90天MRS评分为(1.89±0.23)分,其中预后良好59例,预后不良26例;预后良好组治疗前后大脑中动脉EDV、PSV、MV均高于预后不良组,PI均低于预后不良组,差异有统计学意义(P<0.05)。结论:TCD在ACI患者机械取栓术后脑血流监测中可评估患者颅脑血流动力学信息,且血流参数与患者神经功能及恢复关系密切,或可作为早期评估患者术后脑血流情况的重要选择之一,为临床治疗提供一定的参考依据。

TCD脑血流监测在颈动脉内膜剥脱术中指导血压调控的应用

目的探讨经颅彩色超声多普勒系统(TCD)监测脑血流在颈动脉内膜剥脱术(CEA)中指导血压个体化调控的作用。方法选择2018年12月至2020年12月在邢台市第三医院收治的140例拟行CEA治疗的颈动脉狭窄患者,其中男性74例,女性66例;年龄45~65岁,平均年龄57.41岁;糖尿病10例,高血压12例;美国麻醉师协会(ASA)分级:Ⅱ级30例,Ⅲ级110例。采用随机数字表法分为研究组和对照组,每组分为70例。对照组采用传统手段控制血压,研究组根据TCD脑血流参数指导调节血压。术中连续监测两组患者的有创动脉压力并对大脑中动脉平均血流速度进行监测。记录两组各个时刻点大脑中动脉血流速度(Vm)及外周有创动脉收缩压,比较两组患者围术期相关指标,统计术中心动过速/心动过缓发生次数及术后心脑血管事件发生情况。结果研究组术中硝酸甘油、去甲肾上腺素用量低于对照组[(34.87±10.27)μg vs(48.56±6.92)μg、(15.97±4.54)μg vs(24.15±3.99)μg。P<0.05],心动过缓发生率明显少于对照组(2.86%vs 19.40%。P<0.05)。在T00、T0、T3和T4时,两组间Vm值和收缩压比较,差异无统计学意义(P>0.05)。在T1和T2时,研究组Vm值和收缩压明显低于对照组[T1:(38.87±6.19)cm/s vs(44.42±4.16)cm/s,(119.84±8.12)mmHg vs(150.78±6.51)mmHg;T2:(29.46±4.58)cm/s vs(34.94±3.64)cm/s,(142.04±10.91)mmHg vs(152.23±5.84)mmHg。P<0.05]。其中两组患者在T2时Vm值显著下降[(29.46±4.58)cm/s vs(34.94±3.64)cm/s。P<0.05],收缩压值显著上升[(142.04±10.91)mmHg vs(152.23±5.84)mmHg。P<0.05]。研究组术后并发症发生率低于对照组(7.14%vs 20.90%。P<0.05)。研究组CEA后颈动脉超声心动图改变或术后再狭窄<50%、50%~69%和继发血栓形成的患者数明显少于对照组(2.86%vs 11.94%、2.86%vs 13.43%、1.43%vs 8.96%、0.00%vs 5.97%。P<0.05)。结论TCD监测颈动脉狭窄患者脑血管血流动力学对CEA麻醉中血压的调控具有较好的指导意义,有利于实现血压个体化调控,提高血压调控准确率,减少心脑血管事件的出现。

缺血性脑血管病颅内动脉狭窄或闭塞的TCD、MRA对比研究

目的 比较经颅多普勒 (TCD)与磁共振血管成像 (MRA)对缺血性脑血管病颅内动脉狭窄或闭塞诊断的准确性。方法 回顾分析 5 0例缺血性脑血管病患者的TCD与MRA检测结果 ,全部病例均有脑血管造影 (DSA)对比验证。结果 TCD对缺血性脑血管病颅内动脉狭窄或闭塞诊断的特异性为 98.6 % ,敏感性为 83.9% ;MRA分别为 92 .6 %和 79.7%。TCD假阳性率为 10 .3% ,假阴性率为 2 .5 % ;MRA分别为 35 .7%和 3.5 %。结论 在诊断缺血性脑血管病颅内动脉狭窄或闭塞方面 ,TCD与MRA均有很好的可靠性 ,但TCD较MRA有更高的准确性。

131例头晕患者的TCD及颈椎X线改变

目的 :探讨头晕患者的脑血流动力学改变、与颈椎退行性变等的关系。方法 :131例头晕患者 ,应用TCD2MHz探头探测双侧MCA、ACA、PCA、VA及BA ;应用计算机X线摄影设备拍摄颈椎正侧斜位片 ,比较脑血流动力学改变的性别差异。结果 :71例 (5 4 .2 0 % )血流速度增快 ,35例 (2 6 .72 % )血流速度减低 ,2 5例 (19.0 8% )血流速度正常 ,血流速度异常主要表现在椎基底动脉系统 ,且男女有显著性差异 ;12 0例 (91.6 0 % )伴有颈椎退行性变。结论 :头晕患者的脑血流动力学改变主要为椎基底动脉系统血流速度增快 (女性 )或减低 (男性 ) ;

早期康复训练对急性脑缺血患者的经颅超声Doppler和脑电图的影响

目的:探讨并比较早期康复训练对急性脑缺血周边及损伤侧病灶区的血液动力学和脑电图的影响。方法:脑缺血患者60例,随机分为康复治疗组和对照组,各30例,均予脱水和血液稀释扩容等药物治疗。康复治疗组增加康复治疗,每日2次,每次45min。两组疗程均为1个月。治疗前后检测病灶区血管Vm、PI、脑电图和事件相关诱发电位(P300)。结果:康复治疗组临床疗效总有效率96.7%,对照组76.7%;两组治疗后脑血流量均明显改善,但康复治疗组比对照组改善明显(字2=5.01,P<0.01);康复治疗组脑电地形图改善率95.8%,对照组78.2%(字2=5.35,P<0.05);P300潜伏期康复治疗后缩短明显,经统计学处理差异显著(t=5.46,P<0.01)。结论:早期康复治疗可提高脑缺血患者的脑血流量、改善脑电图和事件相关诱发电位,并有较好的临床治疗效果。

兔急性颅内高压模型的经颅多普勒(TCD)波形改变

目的 :探讨颅内高压状态下经颅多普勒 (transcranialDoppler ,TCD)频谱波形的动态变化规律 ,探索颅内压(intracranialpressure ,ICP)与TCD频谱形态变化的关系。方法 :采用硬膜外球囊注水法制作急性颅内高压动物模型 ,2 0只新西兰白兔随机分为对照组 (8只 ,硬膜球囊不注水 )、实验组 (12只 ,硬膜外球囊分次注水 ) ,持续监测ICP及TCD。结果 :急性局灶性颅内压升高时 ,TCD频谱出现相应变化 ,并存在“S2 峰状波”及“双尖塔状波”两种典型波形 ,两种波形变化对应相对固定的ICP段。结论 :TCD频谱的变化能较早地反映ICP的变化及颅内高压 (intracranialhypretension ,ICH)

TCD监测颅内动脉瘤夹闭术后脑血管痉挛的临床分析

目的探讨应用经颅多普勒(transcranial Doppler,TCD)超声诊断颅内动脉瘤夹闭术后脑血管痉挛(CVS)的灵敏度、特异度及影响CVS的相关因素。方法对32例颅内动脉瘤患者行夹闭手术前后应用TCD监测CVS。术前行颅脑CT检查确定蛛网膜下腔出血(SAH)的Fisher分级。采用临床病例分析统计方法,归纳、分析颅内动脉瘤患者术后TCD检查资料。结果以大脑中动脉平均血流速度(VMCA)高于120 cm/s为诊断CVS的标准,术后有17例发生CVS,发生率为53.1%。TCD检测CVS的灵敏度为75%,特异度为78%。Fisher分级Ⅲ、Ⅳ级患者中CVS的发生率有高于Ⅰ、Ⅱ级的趋势。结论 TCD为监测CVS的有效方法;颅内动脉瘤术后CVS的发生可能与Fisher分级的等级有关。TCD可以早期发现颅内动脉的血流速度增高,预测CVS,指导临床医生及时调整治疗方案,避免造成严重并发症。