经颅多普勒在小儿体外循环中应用初探.doc

经颅多普勒在小儿体外循环中应用初探 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：经颅多普勒在小儿体外循环中应用初探 1 1 资料与方法 2 2 结 果 3 3 讨 论 4 4 结 论 5 文2：经颅多普勒在小儿体外循环中的临床应用意义 5 1 手术操作对脑血流动力学的影响 7 2 心肺转流对脑血流动力学的影响 8 3 微栓子监测的意义 10 参考文摘引言： 11 原创性声明（模板） 12 文章致谢（模板） 13 正文 经颅多普勒在小儿体外循环中应用初探 文1：经颅多普勒在小儿体外循环中应用初探 Abstract: OBJECTIVE To explore the feasibility and significance of tracranial doppler(TCD) to monitor the cerebral blood flow velocity (CBFV) pattern during pediatric cardiopulmonary bypass(CPB). METHODS The CBFV was measured in 13 children with ventricular septal defect(VSD) at several time-points during CPB. Continuous monitoring was used to display the characteristic CBFV pattern intuitively in the period from the start of CPB to aorta clamping on and the period from aorta clamping off to the termination of Comparing to the CBFV pattern after induction of anesthesia, the mean CBFV was decreased significantly at the start of CPB, aorta clamping, during the CPB, aorta clamping off ,at the termination of CPB(P，P，P，P), whereas there was no difference observed during all the phase of CPB. In comparison with the values after induction of anesthesia, the CPFV was no significantly changed at the end of operation. CONCLUSION TCD can directly detect the real-time change of the CBFV pattern and determine critical cerebral perfusion with safety and convenience. Key words： Tracranial Doppler;Cardiopulmonary bypass;Cerebral blood flow;Ventricular septal defect 在体外循环(cardiopulmonary bypass, CPB)非生理状态下如何更好的进行脑保护，一直是人们关注和研究的热点;而经颅多普勒(tracranial Doppler, TCD)是对脑血流动力学变化进行无创检测的新方法，尤其适用于儿童。本研究运用TCD技术对在CPB下行先天性心脏病纠治术的患儿进行术中实时监测，探讨在CPB过程中进行TCD监测的可行性及CPB过程中TCD特征性频谱和参数变化，以期直观精确地反应CPB过程中的脑血流变化情况，更好地指导CPB过程中脑保护的实施与管理。 1 资料与方法 临床资料 选取先天性心脏病室间隔缺损(ventricular septal defect，VSD)患儿13名，男9例，女4例 ，年龄7个月～6岁(±)个月，体重～(±)kg。 仪器与检查方法 采用深圳德力凯”公司经颅多普勒脑血流分析仪，型号是EMS-9UAX2P，探头频率2MHZ,分别于术前清醒状态下、麻醉诱导后、转流开始、主动脉阻断、转流15 min、主动脉开放、转流结束等多个时间点，经右侧颞窗检测大脑中动脉(middle cerebral artery,MCA)采集完整清晰的脑血流(cerebral blood flow,CB