经颅脑多普勒在阻塞性睡眠呼吸暂停低通气综合征患者脑血管病变中的临床意义表达

目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者应用经颅脑多普勒(TCD)检查脑血管病变的临床意义。方法选2016年2月至2018年3月本院收治的59例OSAHS患者作为观察组,选同期59名健康体检者作为对照组,均行TCD检查,对比两组基底动脉(BA)、大脑中动脉(MCA)、椎动脉(VA)、大脑后动脉(PCA)、大脑前动脉(ACA)及脑血管狭窄、脑血管痉挛、脑动脉硬化、脑供血不足检出情况、屏气与换气过程MCA血流速度变化情况。结果观察组BA、MCA、VA、PCA、ACA的动脉脉动指数(PI)值高于对照组(P<0.05);脑血管狭窄、脑血管痉挛、脑动脉硬化、脑供血不足检出率高于对照组(P<0.05);屏气前后MCA血流速度增加率、换气前后MCA血流速度下降率低于对照组(P<0.05)。结论 TCD可通过颅内动脉血流速度与脉动指数检测OSAHS患者脑部血流灌注情况,通过屏气试验或低碳酸血症试验测定脑血管反应能力与储备能力,预测脑血管病变发生风险,能为临床针对性干预方案制定提供有价值参考。

缺血性脑卒中早期影像学研究进展

缺血性脑卒中早期诊断与治疗一直是临床关注的热点问题,随着神经影像学的发展,更多技术用于缺血性脑卒中的早期诊断与治疗。本文就缺血性脑卒中早期的影像学做一综述,为缺血性脑卒中早期诊断与治疗提供依据。

脑血流速度对外伤性脑梗塞的预测作用

目的观察重型颅脑外伤术后脑血流动力学指标的时程变化规律,揭示脑血流动力学指标对外伤性脑梗塞的预测价值。方法选取重型颅脑外伤术后患者104例,正常对照组40例,TCD检测大脑前、中、后动脉平均血流速度,对数据进行相关统计分析。结果重型颅脑外伤术后第1天大脑中、前、后动脉平均血流速度明显升高,第3天到达高峰,后逐渐下降,经Mann-WhitneyU检验,5个时间点的平均血流速度均显著高于对照组(P<0.001)。重型颅脑外伤术后第1天、第3天、第5天、第7天和第14天,脑梗塞组大脑前、中、后动脉平均血流速度均明显高于非脑梗塞组(P<0.05)。ROC曲线辨别了大脑中、前、后动脉平均血流速度的判定界值,对预测重型颅脑外伤术后外伤性脑梗塞有较高的灵敏度和特异度。大脑中动脉平均血流速度的曲线下面积显著大于大脑前、后动脉平均血流速度的曲线下面积(P<0.05)。结论脑血管痉挛是颅脑外伤继发性脑损伤的重要危险因素,参与外伤性脑梗塞的病理生理机制,大脑动脉平均血流速度,特别是大脑中动脉平均血流速度可早期预测外伤性脑梗塞的发生,可指导临床,降低颅脑外伤的死亡率和致残率。

脑血流速度联合血液流变学检测对外伤性脑梗死的预测作用

目的通过观察重型颅脑外伤术后大脑中动脉平均血流速度（MCA Vm）和血液流变学诸指标的变化规律，探讨两者联合检测对外伤性脑梗死的预测价值。方法选取重型颅脑外伤术后患者104例和健康体检者40例，用脑血管多普勒（TCD）检测MCA Vm，同时测定全血低切黏度（LWBV）、全血高切黏度（HWBV）、血浆黏度（PV）和纤维蛋白原（Fi）含量，对数据进行相关统计分析。结果重型颅脑外伤组术后第1天，MCAVm、LWBV、HWBV、PV和Fi含量明显升高，第3天达到高峰，以后逐渐下降，术后第1、3、5、7、14天的MCA Vm均显著高于对照组（P〈0.01）。脑梗死者术后5个时间点MCA Vm和血液流变学指标均明显高于非脑梗死者（P〈0．05）。ROC曲线对预测重型颅脑外伤术后外伤性脑梗死有较高的灵敏度和特异度，血浆Fi含量尤为灵敏，TCD检测大脑MCA Vm联合血浆Fi含量测定预测外伤性脑梗死的灵敏度为97.8％，特异度为53.1％。结论脑血管痉挛和血液流变学异常是颅脑外伤继发性脑损伤的重要危险因素，参与外伤性脑梗死的病理生理过程，TCD检测MCA Vm联合血浆Fi含量测定可明显提高外伤性脑梗死预测的灵敏度。

Effect of carotid artery stenting surgery combined with nimodipine on cerebral anterior circulation hemodynamics

Objective To evaluate the effect of carotid artery stenting combined with nimodipine on cerebral hemodynamics by comparing and analyzing the change of anterior cerebral blood flow before and after treatment through transcrania Doppler （TCD）. Methods Twenty patients with ischemic cerebrovascnlar disease were detected in blood flow velocity of bilateral middle cerebral arteries （MCA） and anterior cerebral arteries （ACA） and artery pulsatility index with TCD before and two weeks after treatment. Results After treatment, TCD examination showed dynamic changes in blood flow significantly, lpsilateral MCA flow velocity significantly increased; ipsilateral ACA flow velocity did not change significantly; there was no significant increase in the contralateral MCA flow velocity; flow rate decreased significantly in contralateral ACA. Conclusion Carotid artery stenting combined with nimodipine treatment can cause anterior cerebral hemodynamic changes in ipsilateral hemisphere and significantly improve blood flow

Effect of thinking on intracranial blood flow velocities

Objective To determine the effect of thinking on intracranial blood flow velocities.Methods Transcranial Doppler(TCD)was used to measure the blood flow velocities of the cerebral arteries,when 10 normal persons were at rest and during thinking.Results The mean flow velocities(MFVs)of the cerebral arteries during thinking were significantly higher than those at rest,especially in the MCA and ACA.The MFVs were raised from between 10.3% to 14.3%.Conclusions Thinking can increase the blood flow velocities of cerebral arteries significantly.

Clinical, brain electric earth map, endothelin and transcranial ultrasonic Doppler findings after hyperbaric oxygen treatment for severe brain injury

目的 探讨高压氧治疗重型颅脑损伤的疗效及机制。方法 重型颅脑损伤患者 35例为治疗组 ,2 0例为对照组 ,观察高压氧治疗前后临床 (GCS)、脑电地形图 (BEAM)、血内皮素 (ET)、经颅多普勒超声 (TCD)及预后 (GOS)的变化。结果 治疗组患者经高压氧治疗后临床 (GCS)、脑电地形图及预后均明显改善 ,与对照组相比有统计学意义。高压氧治疗 1个疗程后 ,治疗组血内皮素由 91 2 4± 12 18ng/L下降到 6 8 88± 14 37ng/L(P <0 0 1) ;经颅多普勒超声示大脑中动脉Vm也由 6 4 2± 4 8cm/s下降到 51 6± 4 2cm/s(P <0 0 1) ;同时 ,大脑中动脉VsPI也明显下降。统计学有显著性意义 (P <0 0 1)。结论 高压氧治疗能够明显改善重型颅脑损伤患者的临床、脑电地形图及预后 ,并且通过降低急性期血内皮素、改善大脑中动脉血流速度及血管阻力来改善重型颅脑损伤后脑血管痉挛及脑缺血缺氧。同时 ,降低颅内压是高压氧治疗重度颅脑损伤的重要机制之一。

Clinical Observation on Acupuncture for Migraine

Objective： To observe the clinical efficacy of acupuncture treatment for migraine. Methods： Forty cases were randomly allocated to a treatment group and a control group, 20 cases in each group. Cases in the treatment group were treated with acupuncture, while cases in the control group were treated with oral Sibelium. After that, the changes of cerebral blood flow were observed before and after treatment. Results： There was significant difference in clinical efficacies between two groups （P〈0.05）. There were also significant differences in arterial blood flow velocities of before and after treatment. Acupuncture can produce substantial differences （P〈0.05） in blood flow velocities of vertebral artery （VA）, middle cerebral artery （MCA） and anterior cerebral artery （ACA） during an increased flow rate. It can also produce statistical differences in blood flow velocities of VA during a decreased flow rate （P〈0.05）. Conclusion： Acupuncture can effectively alleviate the pain of migraine sufferers and exert a two-way regulation on the cerebral blood flow.