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TCD持續(xù)性腦血流監(jiān)測應(yīng)用文獻(xiàn)集錦（一）

經(jīng)顱（TCD）常規(guī)應(yīng)用主要包含：

腦動脈狹窄與閉塞的診斷，側(cè)枝代償?shù)呐袛啵?/span>

腦血流微栓子監(jiān)測；

蛛網(wǎng)膜下腔出血（SAH）腦動脈痙攣的監(jiān)測；

卵圓孔未閉篩查（發(fā)泡試驗）

......

--北京協(xié)和醫(yī)院徐蔚海教授（德力凱臺歷TCD應(yīng)用章節(jié)）

《Plasma Osteoprotegerin Correlates with StrokeSeverity and the Occurrence of Microembolic Signals inPatients with Acute Ischemic Stroke》

《HindawiDisease MarkersVolume 2019, Article ID 3090364, 7 pages》

作者：Yanyan Cao, Congxian Cui, Hongqin Zhao , Xudong Pan , Wenjian Li, Kun Wang , and Aijun Ma

【Abstract】

Background Instability of atherosclerotic plaques is associated with the occurrence of stroke. Microembolic signals (MESs) are anindicator of unstable plaque. A relationship between plasma osteoprotegerin (OPG) and ischemic stroke has already beenidentifified. The aim of this study was to investigate whether plasma OPG levels have a relationship with MESs and to evaluatethe feasibility of OPG as a biomarker of stroke severity and occurrence of MESs.

Methods Our study consisted of 127 patientswith large artery atherosclerosis stroke and 56 controls. Patients were classifified into subgroups based on stroke severity andthe occurrence of MESs. MES-monitoring was performed for 60 min using transcranial Doppler 【Delica EMS-9EB】within 72 h of strokeonset. Stroke severity at admission was assessed by the National Institutes of Health Stroke Scale.

Results Plasma OPGlevels were signifificantly associated with stroke, MESs, and stroke severity at admission (adjusted OR [95% CI]: 1.002[1.001–1.003] p < 0 001; 1.002 [1.001–1.003] p = 0 001; 1.001 [1.000–1.002] p = 0 028). When plasma OPG levels were used todetermine the stroke severity, the area under the receiver-operating characteristic curve (AUC) was 0.734 (95% CI: 0.625-0.843)based on a cutoffff value of 1998.44 pg/ml; the sensitivity and specifificity of this test were 80.6% and 65.6%, respectively.Furthermore, when the levels of OPG were used to distinguish the presence of MESs, the AUC was 0.766 (95% CI: 0.672-0.860);the cutoffff value was 2107.91 pg/ml. The sensitivity of this cutoffff value was 68.8% and the specifificity was 73.7%.

Conclusions Plasma OPG levels correlate with stroke severity and the occurrence of MESs.

《Safety and effectiveness of selective carotid angioplasty prior tocardiac surgery: a single-centre matched case–control study》
（Interactive CardioVascular and Thoracic Surgery 26 (2018) 834–839）
作者：Rudolf W.M. Keunen-Department of Neurology, Haga Teaching Hospitals, Leyweg 275, 2545 CH The Hague, Netherlands

【Abstract】
OBJECTIVES: Reducing the rate of postoperative stroke after cardiac surgery remains challenging, especially in patients with occlusive cerebrovascular disease. Angioplasty in all patients with high-grade carotid artery stenosis has not been shown to be effective in reducing thepost-surgical stroke rate. In this study, we present the initial results of a different approach using selective carotid angioplasty only inpatients with poor intracranial collaterals.
METHODS: We conducted a single-centre study to assess the safety of this procedure. The postangioplasty complication rate of the studygroup was compared to that of patients who were scheduled for symptomatic carotid artery angioplasty. To determine the effectiveness ofthis procedure, the post-cardiac surgery complication rate of the study group was compared with that of the matched case controls.

【2-MHz pulsed bidirectional TCD system (Delica9-series, Delicate Manufacturer, Shenzhen, China)】
RESULTS: Twenty-two patients were treated with selective carotid angioplasty without developing persistent major neurological complications. All patients except 1 patient subsequently underwent surgery without developing persistent major neurological disabilities. Twopatients died of cardiogenic shock within 30 days.
CONCLUSIONS: Selective carotid angioplasty prior to cardiac surgery in patients with a presumed high risk of stroke was relatively safeand effective in this study group. Although this strategy does not prevent stroke in these high-risk patients, data suggest that this approachshifts the postoperative type of stroke from a severe haemodynamic stroke towards a minor embolic stroke with favourable neurologicaloutcomes. Larger studies are needed to determine whether this strategy can effectively eliminate the occurrence of haemodynamic strokeafter cardiac surgery.

《Effects of Batroxobin with Continuous TranscranialDoppler Monitoring in Patients with Acute CerebralStroke: A Randomized Controlled Trial》
（Echocardiography.2014 Nov;31(10):1283-92）
作者：He Yitao, M.D；Guo Yi, M.D., Ph.D., Department of Neurology, ShenzhenPeople’s Hospital

Our objective was to determine whether continuous transcranial Doppler (TCD) 【(EMS-9UA*2P, Shenzhen DelicaElectronics Co., Ltd., Shenzhen, Guang DongProvince, China)】monitoring could safelyenhance the effificacy of batroxobin, a thrombin-like enzyme extracted from Bothrops atrox moojenivenom, in the treatment for acute cerebral stroke beyond the thrombolytic time window. Ninetypatients suffering an acute cerebral stroke were recruited into the study within 12 hours after the onsetof symptoms. Patients were randomized to receive batroxobin with (target group) or without 1 hour ofcontinuous TCD monitoring (control group). Clinical evaluation of stroke was based on the NationalInstitutes of Health Stroke Scale (NIHSS) score, Barthel index (BI), Thrombolysis in Brain Ischemia score(TIBI), the incidence of advancing stroke, and the recurrence of cerebral infarction. The patients receiving continuous TCD monitoring showed signifificant improvement in NIHSS score at 57 days post treatment compared with the control. Similarly, patients receiving continuous TCD monitoring also showedsignifificant improvement in BI at 3 months compared with the controls. Consistently, both the incidence of advancing stroke after 1 week and the incidence of stroke recurrence after 3 months were signifificantly lower in TCD monitored group than control group. Moreover, the safety of the employmentof TCD monitoring in the treatment of these patients was confifirmed as there was no signifificant difference of the incidence of intracranial hemorrhage at 1 week after the treatment between the target andcontrol groups. Taken together, our study showed that batroxobin, in combination with continuousTCD monitoring at the middle cerebral artery, reduced the incidence of advancing stroke and strokerecurrence after treatment without adverse effects in terms of poststroke intracranial hemorrhage.(Echocardiography 2014;00:1–10)

《２型糖尿病合并急性腦梗死ＴＣＤ微栓子監(jiān)測及炎性因子檢測的意義》
（中國組織化學(xué)與細(xì)胞化學(xué)雜志第22卷第４期2013年８月）
作者：陸首玲梅志忠李龍宣彭蘭芬

〔摘要〕
目的探討ＴＣＤ微栓子（ＭＥＳ）監(jiān)測及超敏Ｃ反應(yīng)蛋白和白介素－６檢測在２型糖尿病合并急性腦梗死發(fā)病中的意義。
方法序貫收集２０１１年１月至２０１２年６月在我院神經(jīng)內(nèi)科住院的首次前循環(huán)腦梗死患者９０例，根據(jù) 是否合并２型糖尿病分為糖尿病合并腦梗死組（觀察組）４５例，單純急性腦梗死組４５例（腦梗死組），另外，隨機收集同期我院內(nèi)分泌科首次住院的單純２型糖尿病患者４５例（糖尿病組），監(jiān)測三組患者病灶側(cè)大腦中動脈（ＭＣＡ）微栓子陽性率及微栓子數(shù)目，血清超敏Ｃ反應(yīng)蛋白及白介素－６值，分析三組患者中微栓子及相關(guān)炎性因子檢測的意義。
結(jié) 果 觀察組腦血管微栓子監(jiān)測數(shù)量和Ｈｓ－ＣＲＰ血清檢測水平較腦梗死組和糖尿病組均顯著增高（Ｐ＜０．０５和Ｐ＜０．０１）。觀察組和腦梗死組血清白介素－６檢測水平與糖尿病組相比顯著增高（Ｐ＜０．０５），但觀察組與腦梗死組相比無統(tǒng)計學(xué)意義（Ｐ＞０．０５）。
結(jié)論 糖尿病合并急性腦梗死患者微栓子數(shù)目和血清Ｈｓ－ＣＲＰ、白介素－６水平明顯增高，提示糖尿病腦梗死患者血管內(nèi)炎性斑塊不穩(wěn)定程度增加，再發(fā)卒中的風(fēng)險明顯增高。

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