脑梗死后癫痫患者的脑电图与经颅多谱勒检查分析

脑血管病是老年人神经系统常见疾病，也是老年人癫痫发生的主要原因之一，而且脑卒中患者致残率高，影响日常生活。有关脑梗死后癫痫发作患者的脑电图(EEG)和经颅多谱勒(TCD)甚少报道。本文对我院1996～2000年的患者进行回顾分析，现报告如下。     

脑梗死后癫癎患者的脑电图与经颅多谱勒检查分析

脑血管病是老年人神经系统常见疾病,也是老年人癫癎发生的主要原因之一,而且脑卒中患者致残率高,影响日常生活.有关脑梗死后癫癎发作患者的脑电图(EEG)和经颅多谱勒(TCD)甚少报道.本文对我院1996～2000年的患者进行回顾分析,现报告如下.     

脑血管病的脑电图、脑电地形图与TCD、CT的对比研究

对１７４例脑血管病患者脑电图、脑电地形图、ＴＣＤ和ＣＴ的资料进行对比研究。全部病人分为４组，即ＴＩＡ组、腔隙梗塞组、脑梗塞组及脑出血组。结果表明，ＣＴ检查ＴＩＡ组阳性率最低，仅３．３％。对ＥＥＧ，ＢＥＡＭ及ＴＣＤ三者检查结果进行比较，异常率依次为ＢＥＡＭ（８３％）＞ＴＣＤ（８０％）＞ＥＥＧ（５４％），ＢＥＡＭ对检测ＴＩＡ的意义最大。这些观察提示ＥＥＧ／ＢＥＡＭ对各类脑血管病的检测有着相对的特异性、敏感性及重要性，是实现脑血管病早期诊断的重要手段之一。     

TCD观察深刺风池穴对肌紧张性头痛患者脑血液动力学的影响

目的:比较分析肌紧张性头痛采用深刺风池穴治疗前后脑血液动力学变化与临床关系;方法:利用彩色经颅多普勒超声(TCD)技术对400例肌紧张性头痛患者进行双侧椎动脉重要参数检测,并观察用深刺风池穴持续治疗3个疗程前后收缩期血流峰值的差异,并对结果作对照分析;结果:双侧椎动脉的流速变化有显著性差异(P<0.01);结论:深刺风池穴对治疗肌紧张性头痛有一定的效果。     

经阴道彩色多谱勒对不孕症患者卵巢基础状态的评价

目的 探讨卵巢基础状态与卵巢储备之间的关系，评价彩色多谱勒对卵巢储备功能预测的价值。方法 32例不孕症妇女于自然月经周期第三天测定血促卵泡素、促黄体生成素、雌二醇浓度，同时经阴道彩色多谱勒测定双侧卵巢体积、最大平面的平均直径、窦卵泡数、间质血流收缩期最大峰值(PSV)、搏动指数(PI)、阻力指数（RI)，并且行克罗米芬(CC)激动实验。B超监测卵泡发育，应用hCG诱导成熟卵泡排卵。结果 依据CC激动实验结果将患者分为卵巢储备正常组和低下组。卵巢储备下降者窦卵泡总数少(P＜0．05)；PSV降低(P＜0．01)；注射hCG日所获优势卵泡数少；PSV与注射hCG日优势卵泡数正相关(P＜0．05)。结论 应用经阴道彩色多谱勒能简便、有效、无创、快速的预测卵巢储备功能。     

短暂性脑缺血发作病人经颅多普勒分析

目的：评价经颅多普勒超声（TCD）对短暂性脑缺血发作（TIA）的诊断价值。方法：应用经颅多谱勒超声对38例短暂性脑缺血发作病人进行检查。结果：38例TIA患者进行常规TCD检查,其中脑动脉硬化26例,占68％,其中血管狭窄14例,占37％,血流速度减慢12例,占32％,血管痉挛8例,占21％,正常4例,占11％,总异常率89％。结论：TCD检测对于诊断TIA有重要的临床意义。     

神经症患者的性别差异分析

目的　探讨神经症患者的临床变量、个性特征与性别的关系。方法　用龚氏修订的艾森克个性问卷调查并对 72例男性和 89例女性神经症患者的临床变量进行回顾性调查及对照比较。结果　不同性别的神经症患者在病程、个性特征及生活事件的内容方面存在较明显差异。结论　应给予中年女性神经症患者更多的心理支持 ,提高广大医务人员尤其内科医师识别、诊断神经症的能力 ,开展联络精神病学工作 ,将对节约医疗资源 ,减少患者的身心痛苦 ,降低神经症的发病率有着重要的现实意义     

头痛与头晕患者脑血管弹性指标变化

头痛、头晕是某些老年性退行性病变中的一种常见头部症状,应用TCD(经颅多普勒超声)和REG(脑阻抗血流图)观察了67例头痛、头晕患者的脑血管弹性指标的变化。结果显示:TCD有41例患者有弹性指标的异常改变,较大的脑血管搏动指数较对照组显著增高;REG有32例患者有弹性指标的异常变化,小的脑血管弹性指标的上升时间和转折高比值,均较对照组显著延长和降低。表明头痛、头晕的发生与脑血管弹性降低有关。     

76例经颅多普勒(TCD)异常患者的临床脑电图(EEG)分析

目的：研究经颅多谱勒(TCD)异常患的脑电图(EEG)异常率。方法：对76例TCD异常患：EEG按病史归类进行分析。结果：既往病史正常EEG示轻度异常5例(5／32)，颈椎病EEG示轻度异常3例(3／17)，本组轻度异常率与正常人(15％轻度异常)相比无差异性，而高血压与糖尿病组EEG示轻度异常6例(6／27)，中度异常4例，与正常人群有显差异。结论：TCD异常患的脑电图异常率与其原有疾病有关。     

儿童心脏神经症48例临床分析

目的 探讨儿童心脏神经症发病因素,表现特点,治疗方法及疗效,以提高儿科医生对该病的认识及诊治水平.方法 取2002年6月～2007年6月儿科门诊及住院病人符合心脏神经症者48例,分析发病情况、临床表现、实验室检查结果及临床诊治情况.结果 药物调节治疗和心理干预可起到很好的治疗效果.结论 应用现代医学模式综合治疗是诊治小儿心脏神经症的关键.     

经颅多普勒超声在椎动脉型颈椎病诊断中的应用

为分析经颅多普勒 (TCD)检测椎动脉型颈椎病 (CSA)的诊断价值 ,采用配对研究方法 ,用 2MHz脉冲多普勒探头经枕骨大孔窗口 ,检测左、右椎动脉及基底动脉的血流速度、流向、音频、血管博动指数等血流动力学指标 ,结果显示 10 8例患者有 80例异常 ,异常率 74 7%,并发现CSA组低流速者占 45 4 %,高流速者占 2 8 7%,正常流速者占 2 5 9%,与正常对照组间有显著差异 (P <0 0 1) ,总体而言 ,低流速型是CSA的主要特征之一。     

经颅彩色多普勒微栓子监测与缺血性脑血管病进展相关性分析

目的:探讨微栓子监测与进展性缺血性脑血管病的临床相关性.方法:将151例急性脑梗死患者分进展性脑梗死(观察组)和非进展性脑梗死(对照组)两组,进行经颅彩色多普勒检查微栓子监测.结果:观察组微栓子信号检测阳性率为8.7%(6/69),对照组微栓子信号检测阳性率1.2%(1/82),两组比较差异有统计学意义(P＜0.05).结论:进展性脑梗死的微栓子信号检出阳性率高,急性期脑梗死患者微栓子信号检测,有助于脑梗死病程预测和预防性治疗.     

TCD、MRA对儿童脑血管烟雾病诊断的对比研究

目的 探讨经颅多普勒超声（TCD）在儿童烟雾病的特征表现并与核磁共振（MRA）对照比较其诊断价值。方法 对6例由MRA确诊为烟雾病患儿的TCD检查资料比较分析。结果 6例患者TCD获得的检测结果具有一定的特征性，TCD所测出的病变血管与MRA证实的病变部位基本符合，TCD与MRA对照分析结果：①MRA显示血管狭窄，TCD均见相应动脉血流速度增快；②MRA显示血管严重狭窄，TCD显示该血管血流速度减慢、血流频谱降低或无血流信号；③椎动脉系统因其与颈内动脉系统由后交通动脉相连，当颈内动脉系统出现狭窄闭塞，椎动脉系统血流代偿性增快，也为TCD所证实。结论 TCD作为一种无创的检查手段，可以对烟雾病患者的脑血流进行追踪观察，对于烟雾病的早期诊断，具有重要的临床意义，并且具有明显优势。     

Development of methods to analyse transcranial Doppler ultrasound signals recorded in microgravity

During space flights, several clinical syndromes may be the result of changes in cerebral circulation. The purpose of the paper is to describe the development and initial evaluation of a system for recording, processing and displaying transcranial Doppler ultrasound (TCD) waveforms from the middle cerebral artery (MCA) in microgravity. Volunteers were repeatedly subjected to 15–20 s intervals of microgravity (‘near zero gravity’) during flights on the KC-135 military aircraft. Continuous TCD recordings from the MCA were stored on magnetic tape. The paper describes the system that was developed to digitise the Doppler ultrasound data and markers that corresponded to the various levels of microgravity, obtain the maximum and mean Doppler waveforms, identify the waveforms and quantify them. The results demonstrate the feasibility of making TCD recordings in a microgravity environment and illustrate excellent performance of the system and its ease of operation. Quantitative waveform analysis of the recordings from the first subject studied in the supine position showed statistically significant changes in MCA velocity waveforms during microgravity.     

经颅三维多普勒技术评估脑震荡诊断与治愈标准

目的 探讨脑震荡经颅三维多普勒（3D－TCD）不同时期特点、参数，为诊断和判定治愈标准的评估提供一种无创的检查方法；方法 135例脑震荡患分别于24小时内、3－7天、治疗终结采用3D－TCD检测大脑中动脉（MCA）、基底动脉（BA）、脑血流平均峰流速度（vm)参数、频谱形态、特点，并与临床诊断和治愈标准进行比较分析；结果 符合诊断101例，基本符合（临界值）12例，不符合22例（占16．2％）；临床判定治愈96例（71．1％），好转39例（28．9％），而3D－TCD判定符合治愈118例（87．4％）；结论 3D－TCD技术作为脑震荡诊断依据和治愈标准之一是可行的，也是评估判定预后客观的检测新技术。     

Reliability of Hand-Held Transcranial Doppler with M-mode Ultrasound in Middle Cerebral Artery Measurement

Purpose

To determine the intra- and interrater agreement of mean flow velocity (MFV) and pulsatility index (PI) measurement in middle cerebral arteries, assessed by transcranial Doppler (TCD) with M-mode.

Introduction of an embolus detection system based on analysis of the transcranial Doppler audio-signal

A new embolus detection system (EDS) is presented, built with the intention of detecting ongoing cerebral embolization in patients at risk of transient ischaemic attacks or stroke. It is based on the analysis of the audio-Doppler signal of a transcranial Doppler machine. The algorithm of the EDS estimates the intensity, duration and zero-crossing dynamics of the audio signal. The EDS has a multi-layer neural network which classifies events into micro-emboli signals (MES) or artefacts. The decision-making component of the software has been validated against human experts. Data from patients in the post-operative phase of carotid surgery were used for the validation process. The results showed agreement in MES and artefact classification of > 93%. Apart from a monitoring display, the monitoring system includes a verification unit that allows the user to listen and to look at all data of individual MES and artefacts. Moreover, the system allows the user to record, store and re-calculate all data files. Data are stored using European Data Format, which allows data transportation over the Internet. The EDS may have a potential in stroke risk stratification, evaluating the effect of novel anti-thrombotic therapies, and in peri-operative and remote monitoring of carotid endarterectomy.     

慢性疼痛患者与神经症患者MMPI模式特征的对照研究

目的：研究慢性疼痛患者的个性特征及其与神经症患者的异同。方法采用ＭＭＰＩ对５９例慢性疼痛患者进行测试，并将结果与社会症患者的ＭＭＰＩ模型式特征相比较。结果：慢性疼痛患者的ＭＭＰＩ表现为Ｈｓ、Ｄ、Ｈｙ、Ｐｔ等临床量表分升高，其模式特点与神经症患者的模式特征相一致，尤其与神经症中的疑病症和癔症有更多的相似之处。结论：慢性疼痛患者具有神经症患者类似的个性特征。     

TCD血流动力学指标评价急性脑梗死患者认知功能损伤程度的价值

目的 探讨经颅多普勒超声（TCD）检查评价急性脑梗死（ACI）后患者认知功能受损的价值。方法 选取2015年5月~2019年4月我院收治的ACI后合并认知功能障碍的患者110例设为认知障碍组,ACI后认知功能正常患者110例设为ACI组,比较两组的大脑中动脉（MCA）平均血流速度（Vm）、阻力指数（RI）、搏动指数（PI）、MCA的屏气指数（BHI）、不同程度认知障碍患者Vm、RI、PI、BHI测定值及认知障碍患者的MCA的Vm、RI、PI、BHI测定值与MoCA评分的关系。结果 认知障碍组的PI测定值高于ACI组,差异具有统计学意义（P＜0.05）;认知障碍组的BHI测定值、MoCA评分低于ACI组,差异具有统计学意义（P＜0.05）;两组Vm、RI测定值比较,差异无统计学意义（P＞0.05）;中度认知障碍患者的PI测定值高于轻度认知障碍患者,差异具有统计学意义（P＜0.05）;中度认知障碍患者BHI测定值、MoCA评分低于轻度认知障碍患者,差异具有统计学意义（P＜0.05）;认知障碍组PI测定值与MoCA评分呈负相关（r=-0.492,P=0.000）;认知障碍组的BHI测定值与MoCA评分呈正相关（r=0.507,P=0.000）;两组Vm、RI与MoCA评分无相关性（r=-0.084、-0.107,P=0.226、0.214）。结论 ACI患者认知功能障碍患者MCA的PI指数升高、BHI降低,TCD血流动力学指标用于评价ACI患者发生认知功能损害具有一定的临床价值。     

Transcranial magnetic stimulation in the rat

Transcranial magnetic stimulation (TMS) allows for quantification of motor system excitability. While routinely used in humans, application in other species is rare and little is known about the characteristics of animal TMS. The unique features of TMS, i.e., predominantly interneuronal stimulation at low intensity and non-invasiveness, are particularly useful in evaluating injury and recovery in animal models. This study was conducted to characterize the rodent motor evoked potential to TMS (MEP_TMS) and to develop a methodology for reproducible assessment of motor excitability in the rat. MEP_TMS were compared with responses evoked by electrical stimulation of cervical spinal cord (MEP_CES) and peripheral nerve. MEP were recorded by subcutaneous electrodes implanted bilaterally over the calf. Animals remained under propofol infusion and restrained in a stereotactic frame while TMS followed by CES measurements were obtained before and after 2 h of idle time. TMS was applied using a 5-cm-diameter figure-of-eight coil. MEP_TMS had onset latencies of 6.7±1.3 ms. Latencies decreased with higher stimulation intensity (r=–0.7, P<0.05). Two morphologies, MEP_{TMS, 1} and MEP_{TMS, 2}, were distinguished by latency of the first negative peak (N1), overall shape, and amplitude. MEP_{TMS, 2} were more frequent at higher stimulation intensity. While recruitment curves for MEP_{TMS, 1} followed a sigmoid course, no supramaximal response was reached for MEP_{TMS, 2}. Mid-cervical spinal transection completely abolished any response to TMS. MEP_CES showed a significantly shorter latency (5.29±0.24, P<0.0001). Two types of MEP_CES resembling MEP_{TMS, 1 and 2} were observed. Neither MEP_TMS nor MEP_CES changed on repeat assessment after 2 h. This study demonstrates the feasibility and reproducibility of TMS in the rat. Sigmoid recruitment curves for MEP_{TMS, 1} suggest input-output properties similar to those of the human corticospinal system. Latency differences between CES and TMS point to a supraspinal origin of the MEP_TMS. The two morphologies likely reflect different cortical or subcortical origins of MEP_TMS. Electronic Publication