Cardim Danilo, Robba Chiara, Schmidt Eric, Schmidt Bernhard, Donnelly Joseph, Klinck John, Czosnyka Marek
Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Policlinico San Martino IRCCS, Genoa, Italy.
Ultrasound Med Biol. 2019 Jun;45(6):1435-1445. doi: 10.1016/j.ultrasmedbio.2019.02.003. Epub 2019 Apr 2.
Transcranial Doppler (TCD) ultrasonography allows continuous non-invasive monitoring of cerebral blood flow velocity in a variety of clinical conditions. Recently, signal processing of TCD signals has provided several comprehensive parameters for the assessment of cerebral haemodynamics. In this work, we applied a TCD multimodal approach in patients with acute liver failure undergoing orthotopic liver transplant (OLT) to assess the clinical feasibility of using TCD for cerebral haemodynamics assessment in this setting. We retrospectively studied six patients undergoing OLT with continuous monitoring of arterial blood pressure and blood flow velocity in the middle cerebral artery. The main cerebral haemodynamic parameters assessed were non-invasive intracranial pressure, cerebral perfusion pressure, cerebral autoregulation, pulsatility index, critical closing pressure and diastolic closing margin. TCD monitoring revealed marked alterations of these parameters in the OLT setting, which could provide relevant clinical information when there is imminent risk of neurologic impairment.
经颅多普勒（TCD）超声检查可在多种临床情况下对脑血流速度进行连续无创监测。最近，TCD信号的信号处理为评估脑血流动力学提供了几个综合参数。在这项研究中，我们对接受原位肝移植（OLT）的急性肝衰竭患者应用了TCD多模态方法，以评估在这种情况下使用TCD进行脑血流动力学评估的临床可行性。我们回顾性研究了6例接受OLT的患者，持续监测动脉血压和大脑中动脉的血流速度。评估的主要脑血流动力学参数包括无创颅内压、脑灌注压、脑自动调节、搏动指数、临界关闭压和舒张期关闭幅度。TCD监测显示，在OLT过程中这些参数有明显变化，当存在即将发生神经功能损害的风险时，这些变化可提供相关临床信息。
