脑动静脉畸形手术前后血流灌注的TCD研究

对脑AVM患者手术前后进行TCD检查以及激光多普勒监测,以探讨脑AVM患者血流动力学指标与手术后局部脑皮层血流量指标变化的相关性,从而为预测正常灌注压突破综合征提供依据.结果显示AVM患者高流量组与低流量组之间手术后rCBF值存在显著差异(P<0.05),并且不同流量AVM供血动脉的血流动力学指标差异性于手术后消失.因此,通过对AVM患者手术前后TCD监测,有助于为预测术后局部脑皮层血流量变化提供依据.     

Narcotrend监测下右美托咪定对冠心病患者麻醉诱导期血流动力学的影响

观察Narcotrend监测下右美托咪定联合丙泊酚靶控输注用于冠心病患者非心脏手术麻醉诱导时对血流动力学的影响.合并冠心痛行非心脏手术患者40例,随机分为两组：Dex组（n=20,患者在诱导前静脉泵注右美托咪定0.5μg/kg,15min内输注完毕）,对照组（n=20,等量生理盐水,方法同Dex组）.记录给药前后及诱导期间患者的血流动力学变化.对照组在气管插管即刻以及气管插管3min后血流动力学指标值均高于插管前,气管插管5min后平均动脉压（MAP）低于插管前（P＜0.05）,Dex组无明显差异.麻醉诱导前15min静脉注射0.5μg/kg右美托咪定可以使冠心病患者丙泊酚靶控输注诱导期间血流动力学更加平稳.     

不同年龄患者左旋布比卡因硬膜外麻醉药效学和安全性

探讨不同年龄患者左旋布比卡因硬膜外麻醉的药效学和安全性。60例行下肢手术患者,按年龄分为三组,每组20例。左旋布比卡因用量1．8mg·kg^-1。观察并记录注药后感觉及运动阻滞情况、评价麻醉效果、监测麻醉期间血流动力学和心电图变化及不良反应发生情况。结果是最大感觉阻滞平面工组高于Ⅲ组,感觉及运动阻滞维持时间Ⅰ组均长于Ⅲ组（P〈0．05）;三组麻醉优良率均达100％;麻醉期间血流动力学变化均较稳定;不良反应发生率均较低。结论为不同年龄患者0．75％左旋布比卡因硬膜外麻醉安全有效,年龄对其药效学有明显影响。     

脑出血后智力障碍与局部脑血流量相关性研究

作者用长谷川智力测定量表法测定了６１例脑出血患者的智力,用ＳＰＥＣＴ定量测定法测定了双侧大脑半球各１５个脑区的局部血流量,并计算其比值。分析了脑出血、局部脑血流量、局部脑血流量比值与长谷川分数的关系。结果提示脑出血时,除由于病变直接破坏与智力有关的结构外,左半球（特别是左颞叶及左缘上回和角回）局部脑血流量下降,缘上回和角回、颞上回后部、颞中回后部、颞下回局部脑血流量比值失衡亦可能是造成智力下降的原因。     

不同年龄患者左旋布比卡因硬膜外麻醉药效学和安全性

探讨不同年龄患者左旋布比卡因硬膜外麻醉的药效学和安全性.60例行下肢手术患者,按年龄分为三组,每组20例.左旋布比卡因用量1.8mg·kg-1.观察并记录注药后感觉及运动阻滞情况、评价麻醉效果、监测麻醉期间血流动力学和心电图变化及不良反应发生情况.结果是最大感觉阻滞平面I组高于Ⅲ组.感觉及运动阻滞维持时间I组均长于Ⅲ组(P<0.05);三组麻醉优良率均达100%;麻醉期间血流动力学变化均较稳定;不良反应发生率均较低.结论为不同年龄惠者0.75%左旋布比卡因硬膜外麻醉安全有效,年龄对其药效学有明显影响.     

不同应激范式对大鼠行为和脑神经颗粒素含量的影响

为探讨慢性情绪应激、生理应激对大鼠旷场行为和脑神经颗粒素（Neurogranin,NG）含量的不同作用,以及NG含量变化与应激性行为效应之间的相互关系。分别以不确定性空瓶刺激和饮水剥夺,建立情绪应激和生理应激动物模型。将40只雄性SD大鼠随机分为情绪应激组（ES）、生理应激组（PS）、定时饮水组（C1）和正常对照组（C2）（n=10）。以旷场行为任务来评定大鼠应激后的行为变化,Western blotting方法测定海马和前脑皮层中的NG含量。结果表明：应激后四组大鼠海马的NG含量差异无显著性;ES组前脑皮层的NG含量低于C2组,差异具有显著性,p<0.01;PS组的前脑皮层NG含量也下降,但与C2组相比差异无显著性; 应激后ES组、PS组修饰行为多于C2组,差异具有显著性,分别为p<0.01,p<0.05;前脑皮层NG含量与修饰行为之间的相关达显著水平。提示慢性情绪和生理应激均能导致前脑皮层NG含量下降,修饰行为增加,情绪应激作用更显著。修饰行为可能是反映情绪状态的较敏感行为指标,前脑皮层NG水平可能是预测情绪应激所致焦虑或抑郁行为的较敏感生物学指标。     

单独持续输注瑞芬太尼用于纤维支气管镜检术清醒镇静的临床探讨

观察单独输注瑞芬太尼用于支气管纤维镜检术的临床效果和安全性.120例患者随机分为瑞芬太尼单用组（A组）和瑞芬太尼、异丙酚联用组（B组）.记录不同时间点的血流动力学指标与脑电双频指数数值以及不良反应.B组患者诱导时间较A组明显缩短、呼吸抑制几率较高、T1~T4各时间点平均动脉压、心率和脑电双频指数较T0时均明显下降（P＜0.05）,而A组各指标则均无明显变化（P＞0.05）;两组操作满意度均较高（P＞0.05）.单独瑞芬太尼0.1μg/（kg min）持续输注用于支气管镜清醒插管,临床效果良好.     

甲状旁腺激素联合检测在急性心力衰竭诊断中的价值研究

本文选取了2016年4月~2017年2月于海口市人民医院急诊和门诊首诊的急性心力衰竭组100例,和健康查体中心健康组100例,分别符合纳入标准进行分组比较。心力衰竭临床诊断标准符合《2016年欧洲心脏病学会急性心力衰竭指南》。进行ELISA法检测两组血清PTH、NT-pro BNP,分别检测和联合检测两组的血清PTH和NT-proBNP。同时超声心动监测心脏血流动力学指标,再以不同左心室射血分数下分组,分别统计单独检测血清PTH和NT-proBNP和联合检测两者的敏感度、特异度。结果显示:单独检测血清PTH和NT-proBNP,急性心力衰竭组与健康组比较,统计有差异(P0.05)。分别比较两组的联合检测血清PTH和NT-proBNP,急性心力衰竭组在左心室射血分数LVEF≥50%时既表现出统计学差异(P0.05),且敏感度和特异度高。以上说明血清PTH和NT-proBNP联合检测提高心衰实验室检查敏感性,并结合超声血流动力学指标可提高早期未出现血流动力学障碍时急性心力衰竭诊断准确性。可有效判读临床结果并便于急诊分级系统管理,尤其是社区门诊监测中射血分数尚在代偿范围的心力衰竭患者,降低心力衰竭患者的漏诊和误诊。从心功能和体内电解质代谢角度及早进行多维度整体判断心力衰竭患者病理生理变化,具有一定的临床应用价值。     

急性情绪应激对大鼠行为和脑神经颗粒素磷酸化水平的影响

为探讨急性情绪应激对大鼠旷场行为的影响,以及脑神经颗粒素（Neuroganin,NG）变化与应激性行为效应之间的相互关系。以急性不确定性空瓶刺激,建立情绪应激动物模型。将40只雄性SD大鼠随机分为情绪应激组1（ES1,接受情绪应激和旷场测试）、情绪应激组2（ES2,只接受情绪应激）、正常对照组1（C1,无情绪应激,但接受旷场测试）和正常对照组（C2,无情绪应激,也无旷场测试）（n=10）。以旷场行为和高架十字迷宫任务来评定大鼠应激后的行为变化,Western印迹杂交法（Western blotting）测定海马和前脑皮层中的NG含量和磷酸化水平。结果表明：（1） 应激后ES1组的水平活动增加,与C1组比较,差异有显著性, p<0.01;（2）ES1组海马和前脑皮层的NG磷酸化水平高于C1和C2组,差异有显著性, 均为p<0.05; ES2组的前脑皮层NG的磷酸化水平高于C1组,差异有显著性,为p<0.05;（3） 海马的NG磷酸化水平与水平活动之间的相关达显著水平。提示急性情绪应激能导致动物明显的行为改变如焦虑,这种行为改变可能与脑内NG磷酸化水平的变化有关。水平活动可能是反映急性情绪应激的较敏感行为指标,海马NG磷酸化水平可能是预测急性情绪应激所致焦虑或抑郁行为的较敏感生物学指标     

靶控输注舒芬太尼复合丙泊酚在老年直肠癌根治术合并2型糖尿病患者围术期指标的影响

探究靶控输注(TCI)舒芬太尼复合丙泊酚在老年直肠癌根治术合并2型糖尿病患者围术期指标的影响。选取自2015年9月～2016年9月间我院收治的老年直肠癌根治术且合并2型糖尿病患者78例,采用随机数字表法将研究对象分为A组(TCI舒芬太尼复合丙泊酚注射)和B组(多次舒芬太尼复合丙泊酚注射)。观察两组患者围手术期血气指标、血糖指标、麻醉效果和不良反应。TCI舒芬太尼复合丙泊酚对行直肠癌根治术的老年直肠癌合并2型糖尿病患者的麻醉效果较佳,能够稳定血流动力学和血糖指标,减少围手术期不良反应的发生,值得推广应用。     

Psychometry and regional cerebral blood flow (rCBF) measurements

Summary The relationship between psychometric performance and regional cerebral blood flow (rCBF) measurement in a series of patients suffering from presenile dementia is discussed. An evaluation of central concepts in the late Professor A.R. Luria's dynamic localization model for behavior determination is made. A new indirect measurement of regional cerebral metabolism (rCBF) is used. In general, support is obtained from Luria's model for the interpretation of the relation between psychometric results and the rCBF data.     

Blood flow velocity changes in anterior cerebral arteries during cognitive tasks performance

Objective

Transcranial Doppler sonography (TCD) enables monitoring of blood flow velocities (BFVs) in basal cerebral arteries during different cognitive tasks performance with great temporal resolution. So far, BFVs changes during mental activity were monitored primarily in middle cerebral arteries (MCAs) and little is known about these changes in anterior cerebral arteries (ACAs).

Aim

To determine the effect of different cognitive tasks performance on BFV changes and hemispheric dominance in ACAs and to assess the most suitable activation test for monitoring of BFV changes in ACAs.

Methods

Fourteen right-handed, healthy subjects aged 20–26 were included in the study. BFVs in both ACAs were recorded simultaneously during performance of cognitive tasks designed to activate frontal lobes: phonemic verbal fluency test (pVFT), Stroop tests and Trail Making Tests (TMTs).

Results

A statistically significant BFV increase was recorded in both ACAs during performance of all cognitive tasks. Statistically significant right ACA dominance was found during performance of pVFT and TMTB. The most significant BFV increase was obtained during performance of TMTB.

Conclusion

Our result addressed cognitive tests with great activation potential for monitoring of ACAs that might be used in distinguishing of healthy individuals and patients with neurovascular or neurodegenerative diseases.     

过度担忧和广泛性焦虑障碍与rCBF关系的SPECT脑显像研究

目的：探查过度担忧者和GAD病人的r CBF变化,更好地了解导致病理性焦虑和GAD的神经病理生理学基础。方法：回顾性分析18例过度担忧者和61例GAD病人SPECT脑显像的结果。GAD患者再按病程分为3个亚组。计算各组患者特定脑区r CBF损伤的百分比及损伤的脑区数。结果：12例（66.7%）过度担忧者可见前额叶、基底节、扣带回、颞叶和枕叶r CBF增加（11例）和/或减少（9例）。58例（95.1%）GAD患者可见r CBF减少,主要累及中和下前额叶、中和下颞叶、前扣带、海马旁回、基底节和丘脑。大多数GAD患者累及的主要脑区等于或大于3个。GAD病人的r CBF损伤和病程之间存在一定的相关性。结论：结果支持GAD患者r CBF的变化是一个与担忧和焦虑等心理和情绪改变密切相关的慢性和渐进的过程。GAD的局部脑功能障碍是病理性焦虑产生的先决条件,并出现在局部脑结构异常之前。     

Transcranial Doppler Ultrasonography Monitoring of Cerebral Hemodynamics During Performance of Cognitive Tasks: A Review

The examination of blood flow velocity (BFV) changes during the performance of mental tasks is one of the applications of transcranial Doppler (TCD) ultrasonography. The purpose of this review is to summarize the results of the functional TCD literature, to investigate the effects of methodological differences between studies, and to provide guidelines for future research. It is concluded that larger series of more homogeneous groups concerning age and handedness, and stricter criteria for subject selection and laboratory setting are required. The implication of quantitative and qualitative performance measures and psychological parameters (motivation, anxiety, and task anticipation) could also yield important information. We recommend future agreement upon a more standardized methodology. TCD promises to be a useful tool to provide further insight into the cerebral organization and temporal reactivity of the human brain.     

Left orbital frontal activation in pathological anxiety

Twelve patients with anxiety disorder were studied with respect to regional cerebral blood flow (rCBF) using a 32-detector system with the 133 Xe inhalation technique. Measurements were taken during a rest condition and during anxiety induction. Anxiety relevant to the patient's psychological disorder was induced with a projective test, the meta-contrast technique (MCT). Increased blood flow in the orbital frontal region of the left hemisphere was observed in each of the 11 subjects who showed evidence of experiencing anxiety during the procedure. In a second study four additional anxiety patients were studied with a high-resolution (254-detector)Xe rCBF system. In addition to the anxiety and resting conditions, a neutral verbalization condition was added to control for the verbal aspects of the anxiety induction procedure. The results again showed the experience of anxiety to be accompanied by increased blood flow in the left orbital frontal region, with the patients showing this flow increase to be greater in the posterior, paralimbic, areas of the region. These results are consistent with previous suggestions of left hemisphere involvement in anxiety. They also suggest that imaging methods may allow research into what appears to be exaggerated corticolimbic activity in this disorder.     

Regional cerebral blood flow patterns during verbal and nonverbal auditory activation

Current views of the relationship between audition and cerebral function suggest that increases in regional cerebral blood flow (rCBF) would occur in the superior, mid, and posterior portions of the temporal lobes, and that these changes would be more lateralized to the left hemisphere for a verbal than a nonverbal auditory task. We measured rCBF using the xenon inhalation technique in a group of healthy subjects during three conditions: (1) resting baseline, (2) auditory verbal activation (listening for word meaning), and (3) auditory nonverbal activation (listening for reduction of intensity in a series of noise bursts). Both verbal and nonverbal conditions produced highly significant increases in rCBF over the left posterior Sylvian region with a trend for verbal activation to evoke a wider area of flow increase than the nonverbal task.     

Brain perfusion and neuropsychological test scores: A correlation study in aphasics

In 26 patients suffering from the pure types of aphasias (11 total, 6 motoric, 5 sensory, and 5 amnesic), hemispheric and regional cerebral blood flow were measured and the flow values were correlated with psychological test scores including Wechsler Adult Intelligence Scale (WAIS), Token Test, Benton Test, and word fluency tests. With respect to the flow values, an overall difference between the groups of aphasics was proved by analysis of variance [regional cerebral blood flow (rCBF): F(3,22) = 13.77, p < .001]. The location of mainly impaired brain perfusion was not always confined to the centers within the speech area expected in view of the clinical disturbance, but most patients had neurologic deficits in addition to their aphasia. High correlations were found between the rCBF values within ischemic foci and WAIS subtests, as well as Token Test and word fluency tests. The correlation coefficients calculated between hemispheric flow and the psychological data indicated, in many instances, the same dependency, but did not attain the high statistical significance obtained with the regional values. The results show dependencies of several aspects of mental function upon cerebral perfusion and provide information for possible mechanisms responsible for the disturbance of nonverbal intelligence in aphasics.     

Associations of transcranial doppler velocity,age, and gender with cognitive function in children with sickle cell anemia in Nigeria

Children with sickle cell anemia (SCA) have elevated cerebral blood velocity relative to healthy peers. The primary aim of this study was to evaluate the association between cerebral blood velocity, measured by transcranial Doppler (TCD) ultrasound, age, and gender with cognitive function in children with SCA in Nigeria. Eighty-three children (M_age = 9.10, SD = 1.90 years; 55% female) with SCA in Nigeria completed cognitive assessments and a TCD ultrasound. The association between TCD velocity and measures of perceptual reasoning (Raven’s Progressive Matrices), working memory (WISC-IV Digit Span), and executive planning (Tower of London, TOL) were assessed. Results showed that elevated TCD velocity significantly predicted lower scores on TOL Time Violations and Total Problem-Solving Time when controlling for BMI, hemoglobin level, and parent education, suggesting that TCD velocity is related to the efficiency of executive function. Further, age was negatively related to children’s performance on the Ravens Matrices and TOL Total Correct, and boys showed greater deficits on the TOL Total Correct relative to girls. Moderation analyses for gender showed that there was a conditional negative association between TCD velocity and Digit Span for boys, but not for girls. Findings suggest that children with SCA in Nigeria with elevated TCD velocity are at risk for deficits in efficiency of executive planning, and boys with elevated TCD velocity are particularly at increased risk for deficits in auditory working memory. Implications of this study are important for interventions to reduce cerebral blood velocity and the use of TCD in this population.     

Regional cerebral blood flow response to recognition memory versus semantic classification tasks

Two randomly assigned groups, N = 7 each, of neurologically normal patients were composed. One group, RM, had regional cerebral blood flow measurements during a recognition memory probe test; the other group, SC, had rCBF measurements during a semantic classification task, using the same stimulus and response features as the RM task. Thus, the groups differed only in the cognitive instruction they were executing. The RM group showed a significantly lower change from resting baseline to activation, in mean left hemisphere initial slope index, than did the SC group. The RM group, but not the SC group, showed a significant inverse correlation between occipital flow and accuracy of memory performance as indicated by d′. Correlations between age and hemispheric initial slope index, and between homologous left and right hemisphere sites, were also described. The results are considered to support an anatomical basis for the distinction between episodic and semantic memory and to suggest that occipital flow may diminish with accurate memory performance because of an upstream demand of blood in the medial temporal lobes.     

Neurofunctional correlates of expressed vocal affect in social phobia

We investigated the neural correlates of expressed vocal affect in patients with social phobia. A group of 36 patients performed an anxiogenic public-speaking task while regional cerebral blood flow (rCBF) was assessed using oxygen-15 positron emission tomography. The patients’ speech was recorded and content masked using low-pass filtering (which obscures linguistic content but preserves nonverbal affective cues). The content-masked speech samples were then evaluated with regard to their level of vocally expressed nervousness. We hypothesized that activity in prefrontal and subcortical brain areas previously implicated in emotion regulation would be associated with the degree of expressed vocal affect. Regression analyses accordingly revealed significant negative correlations between expressed vocal affect and rCBF in inferior frontal gyrus, putamen, and hippocampus. Further, functional connectivity was revealed between inferior frontal gyrus and (a) anterior cingulate cortex and (b) amygdala and basal ganglia. We suggest that brain areas important for emotion regulation may also form part of a network associated with the modulation of affective prosody in social phobia.