Evaluation of changes of intracranial blood flow after carotid artery stenting using digital subtraction angiography flow assessment

AIM: To evaluate the changes of intracranial blood flow after carotid artery stenting(CAS), using the flow assessment application "Flow-Insight", which was developed in our department.METHODS: Twenty patients treated by CAS participated in this study. We analyzed the change in concentration of the contrast media at the anterior-posterior and profile view image with the flow assessment application "Flow-Insight". And we compared the results with N-isopropyl-p-[123I] iodoamphetamine-single-photon emission computed tomography(IMP SPECT) performed before and after the treatment. RESULTS: From this study, 200% of the parameter "blood flow" change in the post/pre-treatment is suggested as the critical line of the hyperperfusion syndrome arise. Although the observed blood flow increase in the digital subtraction angiography system did not strongly correlate with the rate of increase of SPECT, the "Flow-Insight" reflected the rate of change of the vessels well. However, for patients with reduced reserve blood flow before CAS, a highly elevated site was in agreement with the site analysis results. CONCLUSION: We concluded that the cerebral angiography flow assessment application was able to more finely reveal hyperperfusion regions in the brain after CAS compared to SPECT.

Cerebral blood flow volume measurements of the carotid artery and ipsilateral branches using two-dimensional phase-contrast magnetic resonance angiography

The optimal velocity encoding of phase-contrast magnetic resonance angiography （PC MRA） in measuring cerebral blood flow volume （BFV） ranges from 60 to 80 cm/s. To verify the accuracy of two-dimensional （2D） PC MRA, the present study localized the region of interest at blood vessels of the neck using PC MRA based on three-dimensional time-of-flight sequences, and the velocity encoding was set to 80 cm/s. Results of the measurements showed that the error rate was 7.0±6.0% in the estimation of BFV in the internal carotid artery, the external carotid artery and the ipsilateral common carotid artery. There was no significant difference, and a significant correlation in BFV between internal carotid artery ＋ external carotid artery and ipsilateral common carotid artery. In addition, the BFV of the common carotid artery was correlated with that of the ipsilateral internal carotid artery. The main error was attributed to the external carotid artery and its branches. Therefore, after selecting the appropriate scanning parameters and protocols, 2D PC MRA is more accurate in the determination of BFV in the carotid arteries.

Cerebral perfusion in patients with unilateral internal carotid artery occlusion by dual post-labeling delays arterial spin labeling imaging

BACKGROUND Global and regional cerebral blood flow(CBF)changes in patients with unilateral internal carotid artery occlusion(ICAO)are unclear when the dual post-labeling delays(PLD)arterial spin labeling(ASL)magnetic resonance imaging(MRI)technique is used.Manual delineation of regions of interest for CBF measurement is time-consuming and laborious.AIM To assess global and regional CBF changes in patients with unilateral ICAO with the ASL-MRI perfusion technique.METHODS Twenty hospitalized patients with ICAO and sex-and age-matched controls were included in the study.Regional CBF was measured by Dr.Brain's ASL software.The present study evaluated differences in global,middle cerebral artery(MCA)territory,anterior cerebral artery territory,and Alberta Stroke Program Early Computed Tomography Score(ASPECTS)regions(including the caudate nucleus,lentiform nucleus,insula ribbon,internal capsule,and M1-M6)and brain lobes(including frontal,parietal,temporal,and insular lobes)between ICAO patients and controls at PLD 1.5 s and PLD 2.5 s.RESULTS When comparing CBF between ICAO patients and controls,the global CBF in ICAO patients was lower at both PLD 1.5 s and PLD 2.5 s;the CBF on the occluded side was lower in 15 brain regions at PLD 1.5 s,and it was lower in 9 brain regions at PLD 2.5 s;the CBF in the contralateral hemisphere was lower in the caudate nucleus and internal capsule at PLD 1.5 s and in M6 at PLD 2.5 s.The global CBF in ICAO patients was lower at PLD 1.5 s than at PLD 2.5 s.The ipsilateral CBF at PLD 1.5 s was lower than that at PLD 2.5 s in 15 regions,whereas the contralateral CBF was lower at PLD 1.5 s than at PLD 2.5 s in 12 regions.The ipsilateral CBF was lower than the contralateral CBF in 15 regions at PLD 1.5 s,and in M6 at PLD 2.5 s.CONCLUSION Unilateral ICAO results in hypoperfusion in the global and MCA territories,especially in the ASPECTS area.Dual PLD settings prove more suitable for accurate CBF quantification in ICAO.

The Analysis of Wall Shear Stress Modulated by Acute Exercise in the Human Common Carotid Artery with an Elastic Tube Model

Assessment of the magnitude and pattern of wall shear stress(WSS)in vivo is the prerequisite for studying the quantitative relationship between exercise-induced WSS and arterial endothelial function.In the previous studies,the calculation of the WSS modulated by exercise training was primarily based upon the rigid tube model,which did not take non-linear effects of vessel elastic deformation into consideration.In this study,with an elastic tube model,we estimated the effect of a bout of 30-minute acute cycling exercise on the WSS and the flow rate in the common carotid artery according to the measured inner diameter,center-line blood flow velocity,heart rates and the brachial blood pressures before and after exercise training.Furthermore,the roles of exerciseinduced arterial diameter and blood flow rate in the change of WSS were also determined.The numerical results demonstrate that acute exercise significantly increases the magnitudes of blood flow rate and WSS.Moreover,the vessel elastic deformation is a non-negligible factor in the calculation of the WSS induced by exercise,which generates greater effects on the minimum WSS than the maximum WSS.Additionally,the contributions of exercise-induced variations in blood flow rate and diameter are almost identical in the change of the mean WSS.

CAS and CEA in the Treatment of Severe Internal Carotid Artery Stenosis

Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe carotid artery stenosis who underwent CAS and CEA in the First People's Hospital of Changde City(hereafter referred as "our hospital")from January 2018 to December 2020 were selected as the research objects and divided into CAS group(n=43)and CEA group(n=45).To understand the clinical application value and feasibility of the two surgical schemes by comparing the general situation,cerebral blood flow,MMSE scale,MOCA scale score and serum miR-145,IGF1R levels of the two surgical schemes.Conclusions:CAS and CEA in the treatment of patients with severe internal carotid artery stenosis,have good curative effect,can effectively improve the patient's cerebral blood flow,regulate serum miR-145,IGF 1R levels,promote the recovery of cognitive function,but relatively speaking,the incidence of stroke and hypotension after CAS is higher,and the incidence of hypertension after CEA is higher.

体检人群中超重和肥胖对基底动脉、颈内动脉和椎动脉功能的影响

目的探讨健康体检人群中,体质量指数(BMI)与颅内动脉(基底动脉、颈内动脉和椎动脉)功能的相关性。方法回顾性选取2023年6至8月健康体检者共1169例。收集一般资料、实验室指标以及经颅多普勒数据。依据BMI分为3组:正常组(<24 kg/m^(2))546例、超重组(24~<28 kg/m^(2))484例和肥胖组(≥28 kg/m^(2))139例。比较3组临床特征、实验室指标、颅内动脉血流速度情况。分析BMI与颅内动脉血流速度的相关性,利用多元线性回归及限制性立方条分析BMI与颅内动脉血流速度的关系,并确定颅内动脉血流速度减慢风险增加的临界值。结果与正常组相比,肥胖组和超重组颅内动脉收缩期血流速度、舒张期血流速度和平均血流速度均较低(P<0.05)。多元线性回归分析显示,BMI与颅内动脉收缩期血流速度、舒张期血流速度及平均血流速度呈负相关(P<0.01),与血管搏动指数、阻力指数无相关性(P>0.05)。限制性立方条结果显示,基底动脉和双侧椎动脉血流速度与BMI之间呈线性相关(P>0.05),双侧颈内动脉血流速度与BMI之间呈非线性相关(P<0.05)。结论健康体检人群中BMI与颅内动脉血流速度呈负相关,当BMI超过特定值(24.18~24.26 kg/m^(2))时,颅内动脉血流速度减慢的风险增加。

颈总动脉流速对创伤合并休克患者容量反应性的评价

目的探讨颈总动脉呼气末及吸气末流速对评估创伤合并休克患者容量反应性的意义。方法前瞻性研究2017年7月—2019年1月上海市浦东新区人民医院重症监护室收治需要机械通气控制呼吸的创伤合并休克患者60例,根据液体复苏后是否具有容量反应性(VR)且扩容前后心输出量(CO)变化是否≥15%将患者分为有反应(VR+组)及无反应(VR-组),各30例。VR+组男性23例,女性7例;年龄18~86岁,平均46.9岁。VR-组男性21例,女性9例;年龄18~90岁,平均46.1岁;采用迈瑞M9便携式多普勒超声取右颈总动脉长轴方向上测量两组患者呼气末最大血流速度(ex-Vmax)、吸气末最大血流速度(in-Vmax)与呼气末平均血流流速(ex-TAmax)、吸气末平均血流流速(in-TAmax),并计算出各自的变异度值:颈总动脉吸呼气末最大血流速度变异度(△Vmax)、吸呼气末平均血流速度变异度(△TAmax),分析不同组别上述数值的变化;绘制受试者工作特征(ROC)曲线,分析以上各项指标在容量反应性评估方面的价值。结果VR+组与VR-组in-Vmax[(71.72±18.67)cm/s vs.(79.47±24.04)cm/s]、in-TAmax[(40.67±11.44)cm/svs.(46.44±15.84)cm/s]比较无明显差异,但ex-Vmax[(61.00±17.84)cm/s vs.(76.86±25.28)cm/s]、ex-TAmax[(34.83±11.01)cm/s vs.(44.66±15.43)cm/s]比较差异有统计学意义(P<0.05)。VR+组与VR-组△Vmax(19.42%±14.18%vs.5.09%±13.59%)、△TAmax(18.19%±11.63%vs.4.29%±7.57%)比较差异有统计学意义(P<0.001)。ex-Vmax与ex-TAmax对创伤合并休克患者容量评估的ROC曲线下面积分别为0.695和0.678,而△Vmax与△TAmax的ROC曲线下面积均>0.800,分别是0.803和0.863,提示△Vmax、△TAmax对于创伤合并休克患者容量的评估更敏感。结论呼气末颈总动脉最大血流流速及平均血流流速、吸呼气末最大血流流速差异度及平均血流流速变异度均可用来评估机械通气创伤合并休克患者的容量反应性,且吸呼气末最大血流流速变异度及平均血流流速变异度对容量反应性的评估效果更佳。

颈内动脉狭窄血流动力学数值模拟

目的:基于血流动力学数值模拟条件,探究对颈内动脉进行不同程度人工干预狭窄的颈动脉模型的血流动力学特性,并从血流动力学角度分析颈内动脉位置处产生狭窄及由于其狭窄导致脑部供血疾病的原因。方法:采集内蒙古民族大学附属医院提供的健康个体二维CT数据,应用医学建模软件MIMICS20.0将二维的颈动脉CT数据进行三维模型重建,然后借助3-Matic Medical软件,对颈动脉模型中的颈内动脉同一位置进行不同程度的人为干预狭窄,得到颈内动脉25%、50%、75%狭窄程度的颈动脉模型。经格式转化、边界条件设置、网格划分等操作后,导入计算流体力学软件FLUENT14.5进行颈动脉血管及血液两相流血流动力学数值模拟与分析。结果:比较颈内动脉同一位置3种不同狭窄程度下的血液流线及速度矢量图可知,随着狭窄程度的增大,颈动脉窦处血液的涡旋流动现象迅速减弱,而颈内动脉狭窄处上方和下方血液出现明显的涡旋流动,并且血液流动出现选择性偏流。颈内动脉狭窄程度从25%到50%再到75%的过程中,狭窄处的血管壁面压力始终较低,狭窄下方的血管壁面压力逐渐增大,为高压力区域。狭窄处为高切应力区域,并且狭窄位置上方和下方的低切应力范围明显变大。结论:利用计算机软件进行人为干预狭窄获取模型的技术进行实验研究具有方便、快捷的特点。颈内动脉狭窄从25%到50%再到75%时,颈动脉的血液流场发生明显改变,颈内动脉出现明显的涡旋流动现象,血管壁面的力学性质也发生一定变化。

基于双向流固耦合分析载瘤对颈动脉血管发展及影响

目的研究带有囊形瘤体的颈动脉血管在血液周期性流动过程中的力学特性和瘤体变化,探究囊形瘤体发展的具体机制以及瘤体对血液流动的影响。方法采用双向流固耦合方法对颈动脉血管内囊形瘤体和血液之间的相互作用进行有限元数值仿真研究。分析血管的形变、关键区域的血液速度和力学特性以及瘤体对血管的影响过程。结果在瘤体与血管的交界线上,瘤体呈现较大的形变,瘤体壁面压力低。瘤体对侧血管壁和血管分叉周围的三角区域壁面压力高,易于发生拉伸或破裂。瘤体内部血液速度明显低于正常血管,形成的漩涡使瘤体内部空间未能被充分利用。瘤体在脉动周期内所受的壁面剪切力一直较小,容易导致杂质沉积形成粥样硬化斑块。结论囊形瘤体会干扰血管内血液正常流动;囊形瘤体会促进镜像瘤体产生。研究结果为囊形瘤体的治疗和预防提供理论参考。通过了解囊形瘤体的力学特性和对血管的影响,医生可以更好地制定个性化的治疗方案,提高治疗效果。

颈动脉斑块负荷联合超声定量参数在评估急性脑梗死患者神经功能缺损程度中的应用价值

目的探讨颈动脉斑块负荷联合超声定量参数在评估急性脑梗死(ACI)患者神经功能缺损程度中的应用价值。方法选取2020年1月至2023年1月河南中医药大学第一附属医院收治的106例ACI患者作为研究对象,所有患者均接受彩色多普勒超声检查。采用国立卫生研究院卒中量表(NIHSS)评估ACI患者神经功能缺损程度,并以此分为轻度缺损组、中度缺损组及重度缺损组。比较不同组别ACI患者颈动脉斑块负荷指标与超声定量参数,使用Pearson相关性检验颈动脉斑块负荷指标、超声定量参数与患者NIHSS评分的相关性;绘制受试者工作特征(ROC)曲线分析颈动脉斑块负荷指标联合超声定量参数对ACI患者神经功能缺损程度的评估价值。结果106例ACI患者中,轻度、中度缺损组各35例,重度缺损组36例。重度缺损组斑块厚度、管壁面积、血管总面积及标准化管壁指数(NWI)高于中度、轻度缺损组,且中度缺损组高于轻度缺损组,差异均有统计学意义(P<0.05);重度缺损组管腔面积低于中度、轻度缺损组,中度缺损组低于轻度缺损组,差异均有统计学意义(P<0.05)。重度缺损组颈总动脉内膜中层厚度(IMT)、舒张末期血流速度(EDV)高于中度、轻度缺损组,中度缺损组高于轻度缺损组,差异均有统计学意义(P<0.05);重度缺损组颈总动脉收缩期峰值血流速度(PSV)低于中度、轻度缺损组,中度缺损组低于轻度缺损组,差异均有统计学意义(P<0.05)。Pearson相关性检验显示,斑块厚度、管壁面积、血管总面积、NWI、IMT、EDV与NIHSS评分呈正相关(r>0,P<0.05),PSV、管腔面积与NIHSS评分呈负相关(r<0,P<0.05)。绘制ROC曲线,结果显示,颈动脉斑块负荷指标联合超声定量参数对中度、重度神经功能缺损均有较高的评估价值,曲线下面积(AUC)分别为0.936、0.987。结论颈动脉斑块负荷联合超声定量参数可有效评估ACI患者的神经功能缺损程度。

冠状动脉旁路移植术中应用瞬时血流测定评估桥血管血流量的研究进展

冠状动脉旁路移植术是外科手术治疗终末期多支冠状动脉狭窄病变的重要方法。术中桥血管是否通畅直接影响患者的手术效果、术后安全及远期生活质量。瞬时血流测定(TTFM)具有易于操作、损伤小等优点常被用来评估术中桥血管的血运成效,判断异常的桥血管血流量,从而进一步反映桥血管通畅性,在一定程度上可提高手术质量,减少远期桥血管闭塞及改善患者预后。现通过对TTFM的临床应用进行详细描述,就冠状动脉旁路移植术中应用TTFM对评估桥血管血流量,进而反映桥血管通畅性的临床研究做一综述。

颈动脉校正血流时间对急诊创伤患者气管插管后低血压预测价值

目的探究颈动脉校正血流时间(FTc)对急诊创伤患者气管插管后低血压预测价值。方法选取2021年1月至2022年12月于本院收治的110例急诊创伤患者,其中,有5例患者因转院、死亡等退出本次研究,最终有105例患者纳入,并将其按插管后是否出现低血压分为35例低血压组、70例非低血压组,均在麻醉前超声检测,观察颈动脉FTc,统计分析临床基本资料。对比两组血流动力学指标变化,分析急诊创伤患者气管插管后发生低血压的风险因素及颈动脉FTc急诊创伤患者气管插管后低血压的预测价值。结果经单因素分析显示,急诊创伤患者气管插管后低血压发生情况主要与年龄、插管前平均动脉压(MAP)、动脉血氧饱和度、急性生理与慢性健康评分(APACHEⅡ)评分、休克指数(SI)有关(P<0.05)。与非低血压组对比,低血压组的心率(HR)、舒张压(DBP)、收缩压(SBP)、FTc水平表达有所升高(P<0.05)。以急诊创伤患者气管插管后发生低血压情况为因变量,选单因素分析中P<0.05的变量为自变量行多因素Logistic回归分析,结果发现,年龄、动脉血氧饱和度、插管前MAP、APACHEⅡ评分为急诊创伤患者气管插管后低血压发生的主要危险因素(P<0.05)。颈动脉FTc对急诊创伤患者气管插管后低血压预测有较高的的临床价值(P=0.001)。结论观察急诊创伤患者气管插管后血流动力学相关指标的水平变化,通过颈动脉FTc可有效提高对急诊创伤患者气管插管后低血压的预测价值。

经皮穴位电刺激内关穴对全麻诱导后低血压的预防作用

目的探究经皮穴位电刺激内关穴对全麻诱导后低血压的预防作用。方法前瞻性选择2022年4~10月在广州中医药大学深圳医院择期行全身麻醉气管插管下手术的80例患者进行研究,按照随机数表法分为观察组和对照组,每组40例。观察组患者于术前10 min开始接受经皮内关穴电刺激,持续30 min,对照组患者仅在同样部位连接电极但不予电刺激。分别于患者麻醉前10 min(T1)、麻醉后气管插管后3 min(T2)、30 min(T3)后记录两组患者血流动力学指标[心率(HR)、舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)],并比较两组患者治疗期间的羟胺用药情况、输液量和尿量情况;同时采用超声监测两组患者颈动脉情况,记录并比较颈动脉校正血流时间(FTc)及颈动脉峰流速呼吸变异度(ΔVpeak);术后随访24 h,比较两组患者的术后恢复情况。结果组间比较:T1时,两组患者的HR、DBP、SBP、MAP比较差异均无统计学意义(P>0.05),T2、T3时,观察组患者的HR、DBP、SBP、MAP明显高于对照组,差异均有统计学意义(P<0.05);组内比较:两组患者T3的HR、DBP、SBP、MAP明显高于T2,T2的HR、DBP、SBP、MAP明显高于T1,差异均有统计学意义(P<0.05)。组间比较:T1时,两组患者的FTc、ΔVpeak比较差异均无统计学意义(P>0.05),T2、T3时,观察组患者的FTc、ΔVpeak水平明显低于对照组,差异均有统计学意义(P<0.05);组内比较:两组患者T3的FTc、ΔVpeak明显高于T1,T2的FTc、ΔVpeak明显高于T2,差异均有统计学意义(P<0.05)。观察组患者的去间羟胺用药率为7.5%,明显低于对照组的47.50%,差异有统计学意义(P<0.05),但两组患者的输液量、尿量比较差异均无统计学意义(P>0.05);术后24 h,观察组患者的恶心呕吐、头晕的发生率分别为10.00%、2.50%,明显低于对照组的62.50%、15.00%,差异均有统计学意义(P<0.05),但两组患者的胸闷、呼吸困难发生率比较差异均无统计学意义(P>0.05)。结论经皮穴位电刺激内关穴能够有助于稳定患者麻醉期间的血流动力学,有效预防全身麻醉诱导后低血压,同时超声检测颈动脉血流指标有助于评估患者血容量情况,及时纠正容量不足,从而减少低血压发生率。

单侧颈内动脉闭塞患者脑灌注与症状、闭塞时期及闭塞位置的关系

目的 评估单侧颈内动脉闭塞(ICAO)患者症状与脑灌注关系、闭塞时期及位置对脑灌注的影响。方法 纳入2021年9月~2023年3月在西安交通大学第二附属医院神经内科就诊的符合纳入排除标准的16例ICAO患者,通过Dr Brain's软件动脉自旋标记模块计算区域脑血流量(CBF)。比较症状性及无症状ICAO、急性及慢性ICAO、起始部及颅内段闭塞患者全脑、双侧大脑中动脉供血区、大脑前动脉供血区、ASPECTS区域(尾状核、豆状核、岛带、内囊、M1、M2、M3、M4、M5、M6)、脑叶(额叶、顶叶、颞叶、岛叶)的区域脑血流量在标记后延迟时间(PLD)为1.5 s和2.5 s的差异。结果 症状性及无症状、急性及慢性、起始部及颅内段ICAO患者全脑CBF、非闭塞侧半球各区域CBF在PLD 1.5 s及PLD 2.5 s的差异均无统计学意义(P>0.05)。起始部和颅内段ICAO患者闭塞侧半球区域CBF在PLD 1.5 s及PLD 2.5 s的差异均无统计学意义(P>0.05)。在PLD 1.5 s时,症状性ICAO患者闭塞侧M5区域CBF较无症状者明显降低,闭塞侧内囊CBF较无症状者升高(P<0.05);在PLD 2.5 s时,症状性及无症状ICAO患者各区域CBF的差异均无统计学意义(P>0.05)。在PLD 1.5 s时,急性ICAO患者闭塞侧大脑中动脉、M1、M5及额叶区域CBF较慢性ICAO者降低(P<0.05);在PLD 2.5 s时,急性ICAO患者在闭塞侧大脑中动脉、M1、M5、M6及额叶的区域CBF较慢性ICAO者降低(P<0.05)。结论 急性ICAO较慢性ICAO患者闭塞侧大脑中动脉供血区和部分ASPECTS皮质区域脑灌注受损更加严重,症状性ICAO与闭塞侧ASPECT部分区域灌注进一步受损有关,颈内动脉不同闭塞位置的脑灌注无差异。

IVC/Ao及颈动脉校正血流时间与脓毒症休克患者容量反应的关系及预测价值

目的评估呼气末下腔静脉最大直径与心脏收缩期腹主动脉最大内径的比值(IVC/Ao)和颈动脉校正血流时间(FTc)对脓毒症休克患者容量反应的预测价值。方法纳入2020年6月至2023年6月西安市中心医院共86例脓毒症休克患者,采用经胸心脏超声监测容量负荷试验前后每搏输出量(SV),计算SV增加值(ΔSV)。容量反应阳性组(ΔSV≥15%)45例,男28例,女17例,年龄(63.21±6.95)岁;阴性组(ΔSV<15%)41例,男24例,女17例,年龄(64.17±7.24)岁。记录下腔静脉塌陷指数(IVCCI)、IVC/Ao、试验前后平均动脉压(MAP)、中心静脉压(CVP)、心率、FTc及颈动脉峰流速变异度(ΔVpeak-CA)。分析容量负荷试验前IVC/Ao、FTc、ΔVpeak-CA与ΔSV的相关性,采用受试者操作特征曲线(ROC)分析这几项指标对脓毒症休克患者容量反应阳性的预测价值。统计学方法采用χ^(2)检验、t检验。结果阳性组患者试验后FTc较试验前升高(t=4.63,P<0.001)。试验前阳性组患者IVCCI、IVC/Ao和ΔVpeak-CA均高于阴性组[(28.77±3.36)比(14.20±3.87)、(1.55±0.16)比(1.19±0.12)、(12.81±4.59)%比(8.04±4.29)%],差异均有统计学意义(t=18.68、11.71、4.97,均P<0.05)。ΔSV与FTc呈负相关,与IVC/Ao、ΔVpeak-CA和IVCCI均呈正相关(均P<0.001)。列线图模型结果显示,FTc水平较高及IVC/Ao、ΔVpeak-CA和IVCCI水平较低患者容量反应阴性的风险更高。ROC分析显示,几项指标联合预测容量反应的曲线下面积(AUC)为0.946。结论IVC/Ao和颈动脉FTc是预测脓毒症休克患者容量反应阳性的有效指标,可以作为临床上判断脓毒症休克患者是否需要液体复苏的有用工具。

彩超对颈动脉狭窄患者诊断效能及血流参数的评估

目的 探究颈动脉狭窄患者应用彩色多普勒超声的诊断效果及应用血流参数的评估价值。方法 回顾性分析78例2021年7月至2023年6月安阳市第六人民医院(安阳市口腔医院)收治的颈动脉狭窄患者的临床资料为B组,同期65例健康者为A组,A、B组研究对象均接受彩色多普勒超声、数字减影血管造影检查,“金标准”为数字减影血管造影检查结果,对彩色多普勒超声、数字减影血管造影检查出的颈动脉狭窄程度,彩色多普勒超声检查诊断效能,彩色多普勒超声检查A、B组平均流速(MFV)、收缩期峰值流速(PSV)、阻力指数(RI)、舒张末期流速(EDV)数据。结果 彩色多普勒超声检查颈动脉正常符合率93.48%(43/46)、轻度狭窄符合率94.55%(52/55)、中度狭窄符合率100%(34/34)、重度狭窄符合率92.48%(19/21)。彩色多普勒超声应用于颈动脉狭窄的诊断中其准确度为96.15%、灵敏度为97.27%、特异度为93.48%、阳性预测值为97.27%、阴性预测值为93.48%。经彩色多普勒超声检查B组阳性侧相较于A组双侧MFV、PSV、RI、EDV数据升高(P<0.05),B组阴性侧相较于A组双侧MFV、PSV、RI、EDV数据升高(P>0.05),B组阳性侧相较于B组阴性侧MFV、PSV、RI、EDV数据升高(P<0.05)。结论 彩色多普勒超声检查颈动脉狭窄患者与数字减影血管造影检查符合率一致性较高,具有较高的诊断准确率与灵敏度,可对血流动力学的改变予以监测,诊断颈动脉狭窄临床价值较高。

Transcranial Doppler for detection of changes in ophthalmic artery blood flow

The ophthalmic artery （OA） is a main branch of the internal carotid artery （ICA）. Severe internal carotidartery stenosis or occlusion may not only affect the blood supply to the brain, but may also cause OA insufficiency, leading to ocular ischemia. Therefore, research on the hemodynamic changes in the OA in patients with ICA stenosis or occlusion has increasingly attracted more ophthalmologists＇ attention.1 Transcranial Doppler （TCD） is simple and noninvasive, has been widely used in the inspection of cerebrovascular disease,

Close Correlations Between Carotid Arterial Mean Blood Flow Velocity,Body Mass Index,and Temperature in Normal Individuals

Objective:Assessing carotid and radial pulses is an essential sphygmology method in traditional Chinese medicine(TCM).It is believed in TCM and by doctors that pulse force is markedly linked with the physiological state of a human,including body mass index(BMI)and temperature.However,comprehensive analysis elucidating these potential correlations remains undetermined.Therefore,this investigation aimed to assess the association of pulse strength with human metabolism.Materials and Methods:The mean blood flow velocity(MBFV)of the carotid artery and pulse force of 122 healthy adults included in this investigation were assessed using ultrasound and manual palpation.Their thermal texture map was also acquired.Results:No substantial variation was observed in the carotid arterial MBFV among normal individuals(P>0.05)regardless of body side and gender.However,young individuals had higher blood velocity than middle-aged individuals(P<0.05).Furthermore,it was identified that MBFV was negatively associated with BMI and torso temperature;however,it was positively linked with hand temperature.Conclusions:This investigation revealed that carotid arterial MBFV could indicate the physical state of humans,including BMI and temperature,and therefore,is valuable for elucidating the effect of TCM on yin–yang.The data validated some TCM beliefs and supported the implementation of sphygmology in TCM.

彩色多普勒超声对脑梗死颈动脉粥样硬化斑块的诊断价值

目的探讨彩色多普勒超声对脑梗死颈动脉粥样硬化斑块的诊断价值。方法选取2021年5月—2023年9月本院收治的脑梗死患者50例设为观察组;选取同期的健康体检者50例设为对照组。两组均予彩色多普勒超声检查,比较两组动脉增厚及斑块形成情况,分析斑块类型及血管狭窄程度,对比两组颈动脉血流指标。结果观察组颈动脉内-中膜增厚率、斑块形成率、多发斑块率均高于对照组(P<0.05)。两组斑块多集中于颈动脉分叉处,观察组此处斑块占比为55.81%,对照组占比为52.38%(P>0.05)。观察组软斑、混合斑的占比高于对照组(P<0.05),扁平斑、硬斑的占比低于对照组(P<0.05)。观察组血管狭窄率高于对照组(P<0.05)。观察组收缩、舒张末期血流速度均小于对照组,且阻力指数大于对照组(P<0.05)。结论彩色多普勒超声检查能有效识别脑梗死患者颈动脉粥样硬化斑块形成情况,可判定斑块类型、血管狭窄程度以及颈动脉血流信息。

支架取栓术联合血栓抽吸术对老年颅内大血管急性闭塞患者的影响

目的:分析支架取栓术与血栓抽吸术联合治疗老年颅内大血管急性闭塞患者的临床效果。方法:选取2021年1月—2023年10月在浙江中医药大学衢州市人民医院接受治疗的老年颅内大血管急性闭塞患者100例,随机分为对照组与治疗组,各50例。对照组接受支架取栓术治疗,治疗组接受支架取栓术联合血栓抽吸术治疗。对比两组治疗效果、并发症、颈动脉血流速度、凝血功能、血清学指标。结果:治疗组治疗总有效率高于对照组(P=0.022)。治疗组皮下积液、脑脊液漏、颅内血肿发生率均低于对照组(P<0.05)。术后3 d,两组收缩期峰值血流速度、平均血流速度均高于手术前,治疗组均高于对照组(P<0.05)。术后3 d,两组凝血酶原时间、活化部分凝血活酶时间高于手术前,纤维蛋白原水平低于手术前,治疗组优于对照组(P<0.05)。术后3 d,两组丙二醛水平低于手术前,治疗组低于对照组;两组超氧化物歧化酶水平高于手术前,治疗组高于对照组(P<0.05)。结论:支架取栓术与血栓抽吸术联合治疗老年颅内大血管急性闭塞的效果较好,可以减少并发症发生率,提高颈动脉血流速度,改善凝血功能,减轻氧化应激反应,保护血管内皮细胞功能。