de Goede Annika A, Loef Bert G, Reidinga Auke C, Schaafsma Arjen
Department of Clinical Neurophysiology, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Technical Medicine, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Intensive Care Unit, Martini Ziekenhuis, Groningen, The Netherlands.
Ultrasound Med Biol. 2017 Nov;43(11):2591-2600. doi: 10.1016/j.ultrasmedbio.2017.06.027. Epub 2017 Aug 2.
To investigate the effects of fluid resuscitation on cerebral hemodynamics in sepsis, the following set of transcranial Doppler (TCD) parameters was used: maximal change in flow velocity (FV) during stroke onset (acc), maximal FV during first (sys1) or second (sys2) phase of systole and mean diastolic FV (dias@560). We aim to evaluate changes in cerebral hemodynamics that result from (i) sepsis and (ii) adequate fluid resuscitation in critically ill septic patients. In the majority of 16 septic patients sys2 was initially absent but reappeared during the period of fluid resuscitation; whereas sys2 absence was never seen in healthy controls. Second, adequate fluid resuscitation resulted in a significant increase of the systolic FV components (acc, sys1, sys2 and systolic blood pressure); whereas the diastolic components (dias@560 and diastolic blood pressure) remained unchanged. Sys2 absence and reappearance in sepsis suggests that TCD could become a non-invasive alternative for hemodynamic monitoring.
为研究液体复苏对脓毒症患者脑血流动力学的影响，采用了以下经颅多普勒（TCD）参数集：卒中发作期间流速（FV）的最大变化（acc）、收缩期第一阶段（sys1）或第二阶段（sys2）的最大FV以及平均舒张期FV（dias@560）。我们旨在评估（i）脓毒症和（ii）重症脓毒症患者充分液体复苏所导致的脑血流动力学变化。在16例脓毒症患者中，大多数患者最初不存在sys2，但在液体复苏期间重新出现；而在健康对照中从未观察到sys2缺失。其次，充分的液体复苏导致收缩期FV成分（acc、sys1、sys2和收缩压）显著增加；而舒张期成分（dias@560和舒张压）保持不变。脓毒症中sys2的缺失和重新出现表明，TCD可能成为血流动力学监测的一种非侵入性替代方法。
