Objective To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neu...Objective To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neuromonitoring to objectively quantify the physiologic responses Methods In twenty two patients (all less than age 60) scheduled for repair of an aortic arch aneurysm, preoperative verification of effective collateral perfusion through both the carotid and vertebrobasilar arterial systems was documented with transcranial Doppler ultrasonography (TCD) During cardiopulmonary bypass, the sole arterial inflow from the pump was via the right subclavian artery The magnitude of ASCP was quantified by TCD using peak middle cerebral artery velocity, while flow adequacy was measured by continuous regional cerebrovenous oxygen saturation (rSO 2) using dual wavelength spatially resolved near infrared spectroscopy Results All patients experienced an uneventful recovery Flow in the middle cerebral artery became undetectable at ASCP < 5?ml·kg 1 ·min 1 , so adjustments from a 15-20?ml·kg 1 ·min 1 baseline were used to maintain rSO 2 above 50% Furthermore, ASCP flow was highly correlated ( P <0 01) with both peak middle cerebral artery velocity and rSO 2 ( r =0 86 and 0 96, respectively) Conclusion Neuromonitoring guided ASCP may be expected to extend the safe period and is at least partly responsible for the absence of neurologic complications in this patient cohort展开更多
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) tr...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.展开更多
Objective: To investigate the effects of different needle-retaining duration on cerebral hemodynamics in cerebral paralysis (CP) children. Methods: A total of 20 cases of CP children were subjected into this study. Ch...Objective: To investigate the effects of different needle-retaining duration on cerebral hemodynamics in cerebral paralysis (CP) children. Methods: A total of 20 cases of CP children were subjected into this study. Changes of systolic peak value (Vs), blood flow velocity at the end-diastolic phase (Ved), mean velocity (Vm), pulsation index (PI) and resistance index (RI) of the cerebral hemodynamics before and after performing JIN’s Three-Needling Therapy with the needles retained for 30 min (group A) and 5 min (group B) were observed by using transcranial Doppler ultrasonography (TCD). Results: After acupuncture, the blood flow in the middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA) was accelerated, and the resistance of blood vessels decreased. The effect of needle-retaining-30 min was better than that of needle-retaining-5 min. Conclusion: In treating cerebral paralysis by using JIN’s Three-Needling Therapy, sufficient stimulation provided by needle remaining is an important factor for achieving satisfactory therapeutic effects.展开更多
[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,neur...[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.展开更多
文摘Objective To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neuromonitoring to objectively quantify the physiologic responses Methods In twenty two patients (all less than age 60) scheduled for repair of an aortic arch aneurysm, preoperative verification of effective collateral perfusion through both the carotid and vertebrobasilar arterial systems was documented with transcranial Doppler ultrasonography (TCD) During cardiopulmonary bypass, the sole arterial inflow from the pump was via the right subclavian artery The magnitude of ASCP was quantified by TCD using peak middle cerebral artery velocity, while flow adequacy was measured by continuous regional cerebrovenous oxygen saturation (rSO 2) using dual wavelength spatially resolved near infrared spectroscopy Results All patients experienced an uneventful recovery Flow in the middle cerebral artery became undetectable at ASCP < 5?ml·kg 1 ·min 1 , so adjustments from a 15-20?ml·kg 1 ·min 1 baseline were used to maintain rSO 2 above 50% Furthermore, ASCP flow was highly correlated ( P <0 01) with both peak middle cerebral artery velocity and rSO 2 ( r =0 86 and 0 96, respectively) Conclusion Neuromonitoring guided ASCP may be expected to extend the safe period and is at least partly responsible for the absence of neurologic complications in this patient cohort
文摘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.
文摘Objective: To investigate the effects of different needle-retaining duration on cerebral hemodynamics in cerebral paralysis (CP) children. Methods: A total of 20 cases of CP children were subjected into this study. Changes of systolic peak value (Vs), blood flow velocity at the end-diastolic phase (Ved), mean velocity (Vm), pulsation index (PI) and resistance index (RI) of the cerebral hemodynamics before and after performing JIN’s Three-Needling Therapy with the needles retained for 30 min (group A) and 5 min (group B) were observed by using transcranial Doppler ultrasonography (TCD). Results: After acupuncture, the blood flow in the middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA) was accelerated, and the resistance of blood vessels decreased. The effect of needle-retaining-30 min was better than that of needle-retaining-5 min. Conclusion: In treating cerebral paralysis by using JIN’s Three-Needling Therapy, sufficient stimulation provided by needle remaining is an important factor for achieving satisfactory therapeutic effects.
文摘[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.
