Greenwood Simon, Deane Colin, Rees Oliver L, Freedman Ben, Kumar Suresh, Ben Ramadan Naser, Wilkinson Sarah, Marais Grant, Lord Julie, Chakravorty Subarna, Height Susan E, Gardner Kate, Rees David C
Vascular Laboratory, King's College Hospital, London, United Kingdom.
Imperial College Medical School, London, United Kingdom.
PLoS One. 2017 Jul 25;12(7):e0181681. doi: 10.1371/journal.pone.0181681. eCollection 2017.
Sickle cell disease (SCD) is a common cause of cerebrovascular disease in childhood. Primary stroke prevention is effective using transcranial Doppler (TCD) scans to measure intracranial blood velocities, and regular blood transfusions or hydroxycarbamide when these are abnormal. Inadequate TCD scans occur when it is not possible to measure velocities in all the main arteries. We have investigated the prevalence and significance of this in a retrospective audit of 3915 TCD scans in 1191 children, performed between 2008 and 2015. 79% scans were normal, 6.4% conditional, 2.8% abnormal and 12% inadequate. 21.6% of 1191 patients had an inadequate scan at least once. The median age of first inadequate scan was 3.3 years (0.7-19.4), with a U-shaped frequency distribution with age: 28% aged 2-3 years, 3.5% age 10 years, 25% age 16 years. In young children reduced compliance was the main reason for inadequate TCDs, whereas in older children it was due to a poor temporal ultrasound window. The prevalence of inadequate TCD was 8% in the main Vascular Laboratory at King's College Hospital and significantly higher at 16% in the outreach clinics (P<0.0001), probably due to the use of a portable ultrasound machine. Inadequate TCD scans were not associated with underlying cerebrovascular disease.
镰状细胞病（SCD）是儿童脑血管疾病的常见病因。使用经颅多普勒（TCD）扫描测量颅内血流速度，并在异常时进行定期输血或使用羟基脲，一级卒中预防是有效的。当无法测量所有主要动脉的血流速度时，TCD扫描就不充分。我们在一项对2008年至2015年间1191名儿童进行的3915次TCD扫描的回顾性审计中，调查了其发生率和意义。79%的扫描结果正常，6.4%为有条件正常，2.8%异常，12%不充分。1191名患者中有21.6%至少有一次扫描不充分。首次扫描不充分的中位年龄为3.3岁（0.7 - 19.4岁），随年龄呈U形频率分布：2 - 3岁的占28%，10岁的占3.5%，16岁的占25%。在幼儿中，依从性降低是TCD扫描不充分的主要原因，而在大龄儿童中则是由于颞部超声窗不佳。在国王学院医院的主要血管实验室，TCD扫描不充分的发生率为8%，在外展诊所显著更高，为16%（P<0.0001），这可能是由于使用了便携式超声仪。TCD扫描不充分与潜在的脑血管疾病无关。
