Department of Medical and Surgical Specialties, Radiological Sciences and Public Health. Division of Anesthesiology, Intensive Care and Emergency Medicine, University of Brescia at Spedali Civili Hospital, Brescia, Italy; Division of Anesthesiology, Intensive Care, and Emergency Medicine, University of Brescia at Spedali Civili Hospital, Brescia, Italy.
Division of Anesthesiology, Intensive Care, and Emergency Medicine, University of Brescia at Spedali Civili Hospital, Brescia, Italy.
J Cardiothorac Vasc Anesth. 2019 Aug;33 Suppl 1:S38-S52. doi: 10.1053/j.jvca.2019.03.040.
Transcranial Doppler is a bedside procedure that measures linear cerebral blood flow velocity (CBFV) and the pulsatility index through the intracranial circulation. Transcranial color-coded duplex Doppler (TCCD) provides both CBFV and B-mode functions. In this review they are both referred to as brain ultrasound TCCD. Brain ultrasound can be applied in various environments, including out-of-hospital, emergency room, surgery, intensive care, and ward settings. The most common neurologic disease processes evaluated with TCCD are subarachnoid hemorrhage, traumatic brain injury, and ischemic and hemorrhagic stroke. However, TCCD also is used outside the neuroenvironment for diseases such as sickle cell anemia or for cerebral hemodynamic assessment during the cardiovascular perioperative period. In these applications, TCCD can be used for the detection of cerebral vessel occlusion, estimation of cerebrovascular reactivity, right-to-left cardiac shunts, noninvasive estimation of cerebral perfusion and intracranial pressure, optic nerve sheath diameter, midline shift, hydrocephalus, and the presence of foreign objects. Finally, TCCD has a high accuracy in confirming total cerebral circulatory arrest and has been used as an ancillary test to support clinical diagnosis of brain death. Other indications for TCCD include assessment of collateral blood flow and embolization during carotid endarterectomy, assessment of patterns and extent of collateral circulation in severe stenosis or occlusion, assessment of patent foramen ovale/paradoxical embolism, assessment of arteriovenous malformations and studying their supply arteries and flow patterns, assessment of noncardiac right-to-left shunts, assessment of severe stenosis in the arteries of the circle of Willis, and assessment of vertebral artery dissection.
经颅多普勒是一种床边检测方法，通过颅内循环测量线性脑血流速度 (CBFV) 和搏动指数。经颅彩色双功多普勒 (TCCD) 提供 CBFV 和 B 型模式功能。在本综述中，它们均被称为脑超声 TCCD。脑超声可应用于各种环境，包括院外、急诊室、手术室、重症监护室和病房环境。TCCD 最常用于评估的神经疾病过程包括蛛网膜下腔出血、创伤性脑损伤以及缺血性和出血性中风。然而，TCCD 也可用于神经科以外的疾病，如镰状细胞贫血，或用于心血管围手术期的脑血流动力学评估。在这些应用中，TCCD 可用于检测脑血管闭塞、估计脑血管反应性、右向左心分流、无创估计脑灌注和颅内压、视神经鞘直径、中线移位、脑积水和异物存在。最后，TCCD 在确认全脑循环停止方面具有很高的准确性，并已被用作辅助测试以支持脑死亡的临床诊断。TCCD 的其他适应证包括颈动脉内膜切除术期间评估侧支血流和栓塞、评估严重狭窄或闭塞时的侧支循环模式和程度、评估卵圆孔未闭/反常栓塞、评估动静脉畸形并研究其供血动脉和血流模式、评估非心源性右向左分流、评估 Willis 环动脉的严重狭窄以及评估椎动脉夹层。
