经颅三维多普勒监测脑震荡患者疗效与预后

目的：探讨经颅三维多普勒（３Ｄ－ＴＣＤ）监测脑震荡患者脑血流演变规律、特点、与判断治疗疗效预后的价值。方法：将１９９８年２月至１９９９年１０月治疗的１２３例脑震范患者分成胞二磷胆碱组（５９例）,尼莫地平组（６４组）,于住院２４小时,３、８、９天采用３Ｄ－ＴＣＤ监测大脑中动脉（ＭＣＡ）,基底动脉（ＢＡ）脑血流平均峰流速度,并与对照组进行比较,结合后症状消失率、治愈率进行综合分析。结果：脑震荡血流分为     

经颅三维多普勒检测脑震荡患者脑血流演变的特点规律研究

目的：探讨脑震荡所致的脑血管痉挛发生机制和尼莫地平治疗脑震荡作用。方法：224例脑震荡患随机分成尼莫地平组（113例）和对照组（111例）应用经颅三维多谱勒（3D－TCD）检测大脑中动脉（MCA），基底动脉（BA）脑血流平均峰流速度，分析脑血流变化规律，特点，结果：脑震荡脑血流分为脑血流低灌扩张期，脑血管痉挛期，脑血流恢复期，尼莫地平组在脑血管痉挛期和恢复期临床主要症状消失率明显优于对照组，有非常显差异（P＜0．01），结论：脑血管痉挛和脑缺氧，缺血损害是脑震荡主要病理改变之一，脑神经功能障碍是否可逆，主要取决于脑血管痉挛持续时间长短。     

养血清脑颗粒联合尼莫地平治疗脑外伤后脑震荡样症状

目的观察养血清脑颗粒联合尼莫地平治疗脑震荡样症状的治疗效果,探讨其可能的作用机制。方法 80例脑外伤后脑震荡样症状患者,按简单随机方法分为观察组(40例)和对照组(40例)。观察组采用养血清脑颗粒联合尼莫地平治疗,对照组采用尼莫地平治疗,用经颅多普勒对脑震荡样症状患者脑血流变化进行检测并比较其临床疗效。结果与对照组比较,观察组入院第1天脑血流平均峰流速度差异无统计学意义(P>0.05),入院后第7、14、20天脑血流平均峰流速度均明显增加(均P<0.05);治疗组治疗总有效率明显高于对照组,临床症状缓解率明显高于对照组(均P<0.05)。结论养血清脑颗粒联合尼莫地平治疗脑外伤后脑震荡样症状疗效显著,其作用机制可能为活血行气,祛风镇痛,解除脑血管痉挛,减轻脑血流速度。更多还原     

脑震荡后脑功能障碍与相关因素回顾性研究

目的探讨脑震荡后脑功能障碍形成原因、类型和相关因素。方法对1995年3月～1999年10月治疗的86例脑震荡后脑功能障碍临床资料运行回顾性分析.结果86例脑震荡后脑功能障碍占同期脑震荡的21.6％,通过经颅三维多普勒(3D-TCD)检测显示,尼莫地平组在解除脑震荡引起脑血管痉挛和改善脑血流平均峰速度明显优干治疗组。结论伤后是否残留脑功能障碍取决于颅脑损伤程度和由此广生的意识障碍时间与脑血液循环障碍,治疗时间与采取主要治疗方法等。     

经颅三维多普勒检测脑震荡患者脑血流演变的特点规律研究

目的探讨脑震荡所致的脑血管痉挛发生机制和尼莫地平治疗脑震荡作用。方法224例脑震荡患者随机分成尼莫地平组(113例)和对照组(111例)应用经颅三维多谱勒(3D-TCD)检测大脑中动脉(MCA),基底动脉(BA)脑血流平均峰流速度,分析脑血流变化规律、特点。结果脑震荡脑血流分为脑血流低灌扩张期、脑血管痉挛期、脑血流恢复期。尼莫地平组在脑血管痉挛期和恢复期临床主要症状消失率明显优于对照组,有非常显著差异(P<0.01)。结论脑血管痉挛和脑缺氧、缺血损害是脑震荡主要病理改变之一,脑神经功能障碍是否可逆,主要取决于脑血管痉挛持续时间长短。     

重型颅脑伤后胃血流改变的彩超多普勒实验研究

本文对猫颅脑伤模型进行了伤后早期不同时间胃网膜动脉多普勒测定，并对比研究了伤后早期胃血流及其声像图特征。结果显示，实验动物颅脑撞击伤后，收缩期血流峰值速度（ＰＦＶ），舒张末期血流速度（ＥＤＶ）和平均血流速度（ＭＦＶ）３小时测值最大，到６小时又回落接近伤前水平。此外，动脉搏动指数（ＰＩ）和阻力指数（ＲＩ）则随着伤后时间的延长逐渐增大，将上述参数行组间和组内对照，差异显著（ｐ＜０．０５，ｐ＜０．０１）     

严重烧伤休克期切痂对肠粘膜损伤的影响

目的：探讨严重烧伤休克期切痂对肠粘膜损伤的影响。方法：采用４０％总体表面积（ＴＢＳＡ）Ⅲ度烫伤犬模型,随机分为切痂组（Ｅ组）和非切痂组（Ｃ组）,伤后１小时按Ｐａｒｋｌａｎｄ公式补给平衡盐溶液,Ｅ组动物伤后３小时切痂。分别于伤前、伤后３０分钟及３、６、１２、２４和４８小时测定血浆二胺氧化酶（ＤＡＯ）、乳酸、内毒素（ＬＰＳ）含量,伤后４８小时检测肠组织丙二醛（ＭＤＡ）、超氧化物歧化酶（ＳＯＤ）含量。结果：２组动物伤后血浆ＤＡＯ、乳酸、ＬＰＳ含量明显增加。切痂后能明显降低血浆中ＤＡＯ、ＬＰＳ和乳酸含量,肠组织中ＭＤＡ含量也明显减少。结论：严重烧伤休克期切痂有利于保护肠粘膜屏障功能。     

彩色多普勒超声对窒息新生儿脑血流动力学的观察

目的：为探讨窒息新生儿脑血流动力学的变化,应用彩色多普勒超声对４９例患儿进行脑血流动力学的观察。方法：对４９例窒息新生儿的大脑前动脉血流参数进行检测,并与２０例健康新生儿进行对照。结果：出生后４８小时内,窒息儿大脑前动脉收缩期、舒张末期,平均血流速度均下降,其中以舒张末期血流速度下降为明显,与对照组有显著差异,（Ｐ〈０．０１）。结论：对窒息儿脑血流动力学的观察,有助于对脑损伤的诊断和治疗。     

脑震荡早期血清中NO浓度与脑血流变化关系

近年临床实验研究表面,脑震荡伤后脑血流可产生异常变化,且有脑血管痉挛改变[1-3]。一氧化氮（NO）是血管内皮细胞衍化的具有调节血管张力,维持血流稳定的因子。本文为探讨脑震荡伤不同时期NO浓度变化规律、为临床诊治和预后判定提供客观依据,从2010年2月至10月对62例脑震荡伤患者血浆浓度进行测定,同时,     

急性脑出血的经颅多普勒超声研究

目的：评价急性脑出血的脑血流动力学。方法：应用经颅多普勒超声（ＴＣＤ）对４０例急性脑出血病人测量了发病后４８小时内的大脑中动脉平均血流速（Ｖｍ）及脉动指数（ＰＩ）。根据ＣＴ测定脑出血量并与Ｖｍ及ＰＩ进行比较。结果：ＴＣＤ异常率７５％，异常表现为ＰＩ增高（６７．５％），Ｖｍ减慢（３２．５％）和Ｖｍ增快（５％）。出血量＞２５ｍｌ时出血侧ＰＩ增高，Ｖｍ减低。与小量出血比较，大量出血组（＞２５ｍｌ，１４例）的ＰＩ增高显著（Ｐ＜０．００５）。结论：研究发现大量脑出血可发生非对称的脑血流动力学改变，反映这种非对称性ＰＩ较Ｖｍ更可靠。     

心肺复苏后昏迷患者颅内循环变化的临床分析

目的 分析心肺复苏后昏迷患者颅内血流变化与预后的关系.方法 对68例心肺复苏后4～24小时仍处于昏迷状态的患者进行颅内血流检测.连续动态观察大脑中动脉和基底动脉血流变化.结果 55例患者显示脑血流停止频谱特征:振荡渡、钉子波和血流信号消失,其中12例在早期表现为血流速度增快.13例存活患者早期为血流速度增快,并持续一定时间后流速逐渐降低,血流频谱呈高阻力改变,但舒张期血流一直存在.最终11例进入持续植物状态,2例恢复正常.结论 经颅多普勒超声能够快速准确地检测心肺复苏后昏迷患者颅内血流的变化,对指导脑功能恢复治疗具有重要的临床意义.     

经颅三维多普勒技术对脑震诊断、疗效及愈后的评估

Objective In order to offer a noninvasive and objective examination method for assessing the clinical diagnosis and eurative criterion of concussion patients, the patients color three - dimensional transcranial doppler( 3D - TCD) characteristic at deferent phases, parameter and clincal manifestation were studied Method Parameter of Median Cerebral Artery(MCA), Base Artery(BA), the average peak forwand velocity of cerebral blood flow, train figure were tested by 3D - TCD within 24 hours, 3 - 6 days and at the end of treatment, respectively. The results were compared with clinical diagnoses and curative criterion. Result Among 135 patients who had clinically diagnosed concussion, agreeable diagnoses 101 cases, basically agreeable diagnooses 12 cases, disagreeable diagnosis 22 cases(16. 2%) .At the end of treatment, according to clinical determination 96 cases(71.1%) were cured, 39 cases(28.9%) were improved. Wave train character, figure and diagnoses prameter of cerebral spasm caused by concussion were suggested Conclusion To be one of the diagnostic bases and curative criterion, 3D- TC D technology is performable. Meanwhile, it is a new testing objective technique for assessing curative and determining prognosis.     

经颅多普勒超声评价催眠解压疗法预防性治疗偏头痛的疗效观察

目的探讨经颅多普勒血流变化评价催眠解压疗法预防性治疗无先兆偏头痛患者的近期疗效。方法 47例偏头痛缓解期患者随机分为催眠解压组(治疗组)和对照组。治疗组在偏头痛缓解期内应用催眠和中频电针疗法治疗,每次治疗60 min,隔日一次,共治疗4周。对照组23例不进行任何治疗。于治疗前和治疗后分别记录两组患者偏头痛的症状评分,经颅多普勒(TCCD)血流速度等指标变化,判定近期疗效。结果 1治疗组颅内主要动脉收缩期最大血流速度峰值(Vp)、同名血管不对称差值比较P﹤0.05和P﹤0.01。两组间颅内主要动脉(大脑中动脉、大脑前动脉、大脑后动脉、椎动脉、基底动脉)收缩期最大流速及同名血管不对称差值比较差异均有统计学意义(P﹤0.05,P﹤0.01)。2治疗组头痛发作次数、持续时间、伴随症状、发作程度治疗后明显优于治疗前(P﹤0.05,P﹤0.01),治疗后组间比较显示,除持续时间评分外,治疗组其他各项评分均优于对照组(P﹤0.05,P﹤0.01);结论催眠解压疗法不仅可以改善无先兆偏头痛患者的临床症状,且能调节脑血管舒缩状态,改善脑血流,对于预防偏头痛的发作,改善其发作频率和程度都有较好的效果。     

经颅多普勒超声对降颅压药物的评价

目的考察经颅多普勒超声(TCD)评价降颅压药物疗效的可行性。方法应用TCD监测20例(甘露醇组10例,甘油组10例)高颅压患者的用药前后大脑中动脉(MCA)流速变化。结果甘露醇组在用药后30 min MCA流速增至高峰,与用药前比较有非常高度显著性差异(P<0 .001),持续时间约4~6 h。甘油组在用药后2 h MCA流速增至高峰,与用药前比较有非常高度显著性差异(P<0. 001),6~8 h流速逐渐降低,至10~12 h恢复至用药前水平。结论TCD可用于监测颅内压的变化及评价降颅内压药物的疗效。     

高压氧进出舱前后脑底动脉血流动力学的三维经颅多普勒检测

为探明高压氧对脑底动脉血流动力学的作用机制,本文应用三维经颅多普勒仪(3D-TCD)对患有各种不同类型脑病的43例高压氧治疗(第Ⅰ组)及正常健康对照组(第Ⅱ组)36例分别于入舱前、及出舱后30分钟,1h、2h检测ACA、MCA及PCA血流速度。结果:第Ⅰ组,36/43例(83.7%)于出舱后脑底动脉血流速度明显加快,其中出舱后30分钟血流速度加快者有22例,一小时开始加快者有8例,6例于二小时才开始加快,5例无变化,2例减低。无1例于1小时恢复正常,仅有13例于二小时恢复正常。血流流变学进出舱前后无明显改变,甲皱微循环以流态改变为著,尤以出舱后一小时加快最明显,形态及袢周变化不明显。第Ⅱ组36例中,脑底动脉血流速度均于出舱后30分钟明显加快,持续一小时恢复至入舱前状态。本研究表明正常健康人与脑部疾病患者不仅对高压氧的反应不同,而且在恢复至入舱前状态上也有明显差别,作者认为这可能就是高压氧对脑部疾病的一种治疗效应。本研究还表明高压氧进出舱前后脑血流速度的加快与血流流变学无明显关系,而是由于血管收缩、血管阻力增加所致。     

Sumatriptan and Cerebral Blood Flow Velocity Changes During Migraine Attacks

Transcranial Doppler studies on the effects of sumatriptan on cerebral hemodynamics have shown conflicting results. We evaluated blood flow velocity changes in 21 patients suffering from migraine with (n = 4) or without aura (n = 17) during a spontaneous attack, before and after treatment with sumatriptan. Flow velocity in the internal and external carotid, middle cerebral, and basilar arteries was measured by means of transcranial Doppler. During the attack, measurements were taken before subcutaneous sumatriptan injection, then after 30 minutes, 2 hours, and 24 hours. An additional measurement was taken 1 week later, in a headache-free state. We found a significant reduction of flow velocity during the attack in the middle cerebral artery on both sides (P < 0.05). After sumatriptan administration, flow velocity increased in the internal carotid artery on both sides (P < 0.05) and in the middle cerebral artery on the headache side (P = 0.0001), but not in the external carotid and basilar arteries (P > 0.05). Flow velocity changes may reflect the vasodilation present at the onset of the migraine attack followed by vasoconstriction in the internal carotid and middle cerebral arteries after sumatriptan treatment. Since vasoconstriction occurs in responders and nonresponders to treatment, it is unlikely to be the primary mechanism by which sumatriptan relieves headache.     

Expression of neuron—specific enolase and gial fibrilous acidic protein in cerebral tissue of experimental cerebral concussion

Objective To study the changes and significance of neuron-specific enolase(NSE)and glial fibrilous acidic protein(GFAP)in rat cerbral concussion,Methods 80 Wistwar male rate were used for animal model of cerebral concussion,which were sacrificed on the 1st,3rd,7th,14th and 30th days after injury and the brain tissue were taken off.The expression of NSE and GFAP were studied in the course of cerebral concussion by means of immunohistochemistry,Results Rats in 100 g-group seen the clinical manifestation for typical concussion.The pathologic changes were the cerebral vascular constriction and dilation,congestion and edema of cerebral tissue and neuronal deganeration and necrosis.NSE was increased on the 1st day,and the positive area was seen in the plasma of the neurons in the cerebral cortex and the cerebellum, and also seen in blood vessels,cerebrospinal fluid in aqueduct and interstital matrix.NSE was obtained at peak on the 7th day,decreased on the 14th day and stil l raised on the 30th day.GFAP was increased on the 1st day,which the positive area was seen in the plasma of astocytes,and obtained at peak on the 3rd day,which fiber-like GFAP was in short,thick and astrocytes increased.GFAP decreased on the 7th day and obtained normal level in 30 days.Conclusion the main pathologic changes of cerebral concussion were blood circulatory disorder nd nervous cells degeneration,apoptosis and necrosis,NSE and GFAP participated in the course of cerebral concussion,may play an important role in the damage of blood-brain barrier,nervous cells degeneration and necrosis.