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OBJECTIVE@#To observe the characteristics of carotid intima-media thickness (IMT) and cerebral blood flow velocity in patients with mild-to-moderate hypertension, and to evaluate the effects of acupuncture on carotid IMT and blood flow velocity of middle cerebral artery and vertebral-basilar artery.@*METHODS@#A total of 240 patients with mild-to-moderate hypertension who met the inclusion criteria were treated with acupuncture method proposed by academician . The acupoints of Renying (ST 9), Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3) were selected. The treatment was given once a day, five times a week for 3 months. The carotid ultrasonography and transcranial color Doppler were performed before treatment and 3 months after treatment to evaluate the improvements of carotid IMT and brain blood flow velocity.@*RESULTS@#Among 175 patients, 94.3% suffered from impaired carotid IMT. After acupuncture intervention, 7.7%-10.9% patients had improved IMT but 4.6%-6.3% had aggravated carotid IMT. There was no significant difference of carotid IMT before and after treatment (>0.05). About 50% patients had abnormal intracranial blood flow velocity; after acupuncture intervention, 27.4%-33.3% patients who had the abnormal blood flow velocity had normal one, but 27.0%-52.5% patients who had normal blood flow velocity had abnormal one. After acupuncture intervention, the low-speed blood flow of MCA, VA and BA in female patients aged 41-60 years and the low-speed blood flow of MCA and VA in female patients aged 61-70 years were significantly improved (all <0.05); the high-speed blood flow of MCA and VA in male patients aged 61-70 years and the high-speed blood flow of VA and BA in female patients aged 41-60 years were significantly decreased (all <0.05).@*CONCLUSION@#Nearly 95% of patients with mild-to-moderate hypertension had carotid IMT, and about 50% had abnormal blood flow velocity of intracranial artery. The present study failed to found significant effects of acupuncture on carotid IMT, but it shows acupuncture can generally improve the low blood flow velocity in women with mild-to-moderate hypertension.
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Adult , Aged , Female , Humans , Male , Middle Aged , Acupuncture Therapy , Blood Flow Velocity , Carotid Intima-Media Thickness , Cerebrovascular Circulation , HypertensionABSTRACT
Objective To observe the effects of Bushen Huoxue Decoction on clinical symptom, vertigo degree and cognitive function for elderly patients with chronic cerebral circulation insufficiency (CCCI); To explore its possible mechanism. Methods Totally 70 cases were randomly divided into observation group and control group according to the random digits table method, with 35 cases in each group. The two groups were given Western medicine consisting of blood pressure control, glucose control and blood lipid control. Based on this, the control group was given Flunarizine Hydrochloride capsules, 5 mg once a day orally before sleeping. The observation group was given Bushen Huoxue Decoction, one dose a day and taken twice a day. The treatment lasted for 30 days. The TCM symptom score, Chinese version of dizziness handicap inventory (DHI) and Montreal cognitive assessment (MoCA) score were observed. The mean blood flow velocity (Vm) of basilar artery (BA), bilateral vertebral artery (VA), bilateral middle cerebral artery (MCA) and the content of plasma acid phospholipid (AP) were detected, and the clinical efficacy was evaluated. Results The total effective rate of the observation group was 94.3％ (33/35), which was significantly higher than that of 82.9％ (29/35) in the control group, with statistical significance (P<0.05); after treatment, the TCM symptom score, DHI score, and the content of plasma AP were significantly lower than those of pre-treatment in the same group (P<0.05); the MoCA score and the Vm of VA, LBA, RBA, LMCA, RMCV were significantly higher than those of pre-treatment in the same group (P<0.05); the TCM symptom score, DHI score, MoCA score, the Vm of LVA, LMCA, RMCA and the content of plasma AP in the observation group were improved better than those in the control group, with statistical significance (P<0.05). Conclusion Bushen Huoxue Decoction has an obvious therapeutic effects for elderly patients with CCCI, which can improve clinical symptom, vertigo degree and cognitive level, which possible mechanism is related to increasing the cerebral blood flow velocity and reducing the content of plasma AP.
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@#Objective To study the effect of electroencephalograph (EEG) bionic electrical stimulation at Wangu (GB12), Tianzhu (BL10), Neiguan (PC6) on cerebral blood flow and metabolism in patients with persistent vegetative state (PVS). Methods 60 patients with PVS were divided into observation group (n=30) and control group (n=30) according to the random number table. The control group received routine treatment, including basic management, hyperbaric oxygen therapy, awaking medicine, sensory stimulation, and so on; while the observation group received EEG bionic electrical stimulation at bilateral Tianzhu, Wangu (cheif electrodes) and Neiguan (auxiliary electrodes) in addition. They were treated for 30 days. They were assessed with the PVS score, and observed with transcranial Doppler ultrasound (TCD) and magnetic resonance spectroscopy (MRS) one day before and one day after treatment. Results The incidence of improvement was 86.67% in the observation group, more than 60.00% in the control group (P<0.05). The difference of blood flow velocity before and after treatment (ΔVm) of anterior-middle cerebral artery was more in the observation group than in the control group respectively (P< 0.001), as well as those of posterior cerebral-vertebral-basilar artery (P<0.01). The N-acetyl aspartic acid/creatine (NAA/Cr) increased more in the observation group than in the control group respectively (P<0.01), and the choline/creatine (Cho/Cr) decreased more (P<0.01), after treatment. Conclusion EEG bionic electrical stimulation can improve the cerebral circulation and metabolism in patients with PVS, which may associate with the wake promoting.
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Objective To study the effect of electroencephalograph (EEG) bionic electrical stimulation at Wangu (GB12), Tianzhu (BL10), Neiguan (PC6) on cerebral blood flow and metabolism in patients with persistent vegetative state (PVS). Methods 60 patients with PVS were divided into observation group (n=30) and control group (n=30) according to the random number table. The control group re-ceived routine treatment, including basic management, hyperbaric oxygen therapy, awaking medicine, sensory stimulation, and so on;while the observation group received EEG bionic electrical stimulation at bilateral Tianzhu, Wangu (cheif electrodes) and Neiguan (auxiliary elec-trodes) in addition. They were treated for 30 days. They were assessed with the PVS score, and observed with transcranial Doppler ultra-sound (TCD) and magnetic resonance spectroscopy (MRS) one day before and one day after treatment. Results The incidence of improve-ment was 86.67%in the observation group, more than 60.00%in the control group (P<0.05). The difference of blood flow velocity before and after treatment (ΔVm) of anterior-middle cerebral artery was more in the observation group than in the control group respectively (P<0.001), as well as those of posterior cerebral-vertebral-basilar artery (P<0.01). The N-acetyl aspartic acid/creatine (NAA/Cr) increased more in the observation group than in the control group respectively (P<0.01), and the choline/creatine (Cho/Cr) decreased more (P<0.01), after treatment. Conclusion EEG bionic electrical stimulation can improve the cerebral circulation and metabolism in patients with PVS, which may associate with the wake promoting.
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@#Objective To analyze the blood flow velocities in middle cerebral artery with Rasmussen encephalitis. Methods8 patients with Rasmussen encephalitis were detected bilateral middle cerebral artery in both period of onset and intermission during simple partial seizures with Transcranial Doppler. ResultsThe mean velocity variance between focus side and non-focus side was minimums among the 3 indexes observed. The mean velocity of MCA displayed uneven increase during seizures. ConclusionThe mean velocity was the most stable index for judging.
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Objective To observe the effects of propofol or sevoflurane combined with remifentanil on cerebral blood flow (CBF) and cerebral autoregulation in patients undergoing gynecologic laparoscopic surgery. Methods Forty patients were randomly divided into two groups: the propofol group (group P, n=20) and the sevoflurane group (group S, n=20). Anaesthesia was induced with target-controlled infusion (TCI) of propofol and remifentanil in group P, with an inhaled induction of sevoflurane and TCI of remifentanil in group S, respectively. The depth of anesthesia was regulated according to bispectral index (BIS). The pressure of end-tidal carbon dioxide (P_(ET)CO_2) was kept at 35-40 mmHg by mechanical ventilation. The mean arterial pressure (MAP), heart rate (HR), pressure of arterial carbon dioxide (PaCO_2), P_(ET)CO_2, time-averaged peak flow velocity (TAP) and the transient hyperaemic response ratio (THRR) were recorded at 7 different time points: supine position (T_1) and supine lithotomy position before induction (T_2), the instant and 5 min after tracheal intubation (T_3,T_4), the instant and 15 min after abdominal CO_2 insufflation and trendelenburg-lithotomy position (T_5,T_6), and 10 min after the deflation abdomen (T_7), respectively. Results Compared with the baseline values at T_1, TAP was not significantly changed at T_2, T_5, or T_6 in group P, but was markedly decreased at T_3, T_4 and T_7. TAP in group S only decreased at T_4 and T_7, while it was much higher than that in group P at T_3. In group S, THRR was markedly lowered at T_3 compared with that at T_1; but in group P, it showed a significant increase at T_3. Conclusions Combined with remifentanil, propofol decreased CBF, but has no effect on the brain self-regulation. When inhaled in high concentrations, sevoflurane significantly reduces the brain self-regulation. Intraoperation pneumoperitoneum and postural factor significantly increase CBF, playing a stronger role than the narcotic drugs in clinical dosage (propofol, sevoflurane), without any influence on the brain self-regulation.
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BACKGROUND: Moderate hypothermic cardiopulmonary bypass (CPB)has commonly been used in cardiac surgery.Several cardiac centers recently practice normothermic CPB in cardiac surgery.However,the clinical effect and safety of normothermic CPB on cerebral metabolism are not established and not fully understood.This study was prospectively designed to evaluate the clinical influence of normothermic CPB on brain metabolism and to compare it with that of moderate hypothermic CPB. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to receive normothermic(nasopharyngeal temperature>34.5 degrees C,n=18)or hypothermic (nasopharyngeal temperature 29~30 degrees C,n=18)CPB with nonpulsatile pump.Middle cerebral artery blood flow velocity(VMCA), cerebral arteriovenous oxygen content difference (CAVO2),cerebral oxygen extraction (COE),modified cerebral metabolic rate for oxygen (MCMRO2),cerebral oxygen transport (TEO2),cerebral venous desaturation (oxygen saturation in internal jugular bulb blood < or =50 %),and arterial and internal jugular bulb blood gas analysis were measured during six phases of the operation:Pre-CPB (control),CPB-10 min,Rewarm-1 (nasopharyngeal temperature 34 degrees Cin the hypothermic group),Rewarm-2 (nasopharyngeal temperature 37 degrees Cin the both groups),CPB-off and Post-CPB (skin closure after CPB-off). Postoperaitve neuropsychologic complications were observed in all patients.All variables were compared between the two groups. RESULT: VMCA at Rewarm-2 was higher in the hypothermic group (153.11 +/-8.98%)than in the normothermic group (131.18 +/-6.94%) (p<0.05).CAVO (2) (3.47 +/-0.21 vs 4.28 +/-0.29 mL/dL,p<0.05),COE (0.30 +/-0.02 vs 0.39 +/-0.02,p<0.05)and MCMRO (2) (4.71 +/-0.42 vs 5.36 +/-0.45,p<0.05)at CPB-10 min were lower in the hypothermic group than in the normothermic group.The hypothermic group had higher TEO (2) than the normothermic group at CPB-10 (1,527.60 +/-25.84 vs 1,368.74 +/-20.03, p<0.05),Rewarm-2 (1,757.50 +/-32.30 vs 1,478.60 +/-27.41,p<0.05)and Post-CPB (1,734.37 +/-41.45 vs 1,597.68 +/-27.50,p<0.05).Internal jugular bulb oxygen tension (40.96 +/-1.16 vs34.79 +/-2.18 mmHg,p<0.05),saturation (72.63 +/-2.68 vs 64.76 +/-2.49 %,p<0.05)and content (8.08 +/-0.34 vs 6.78 +/-0.43 mL/dL,p<0.05)at CPB-10 were higher in the hypothermic group than in the normothermic group.The hypothermic group had less incidence of postoperative neurologic complication (delirium)than the normothermic group (2 vs 4 patients,p<0.05). Lasting periods of postoperative delirium were shorter in the hypothermic group than in the normothermic group (60 vs160 hrs,p<0.01). CONCLUSION: These results indicate that normothermic CPB should not be routinely applied in all cardiac surgery,especially advanced age or the clinical situations that require prolonged operative time. Moderate hypothermic CPB may have beneficial influences relatively on brain metabolism and postoperative neuropsychologic outcomes when compared with normothermic CPB.
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Adult , Humans , Blood Gas Analysis , Brain , Cardiopulmonary Bypass , Cerebral Arteries , Delirium , Hypothermia , Incidence , Metabolism , Operative Time , Oxygen , Prospective Studies , Thoracic SurgeryABSTRACT
PURPOSE: Alterations in cerebral blood flow are very important for understanding the neurological consequences of all varieties of perinatal asphyxia. The purpose of this study is to measure the change of cerebral blood flow velocity and resistance index (RI) of middle cerebral artery (MCA) according to the time in asphyxiated infants. METHODS: We studied 7 asphyxiated term infant and 27 normal term infant who were born at Ewha Womans University Hospital from January 1996 to August 1997. Using the Doppler ultrasound, we examined blood flow velocity and RI of the middle cerebral artery. RESULTS: Clinical characteristics were not significantly different in both groups. Peak systolic flow velocity (PSFV) in asphyxiated infants significantly decreased than control (P<0.05). End diastolic flow velocity (EDFV) was not significantly different in both groups. RI in asphyxiated infants significantly decreased for 24 hours (P<0.05). No control infant ever had a RI value of 0.55 or below, three (42.9%) asphyxiated infants had a RI value of 0.55 or below. The changes of the systemic BP and heart rate were not significant. Two (28.6%) asphyxiated infants were proven periventricular white matter ischemia by ultrasonography. CONCLUSION: It is therefore very important to monitor RI in asphyxiated infants even if the degree of asphyxia is mild.
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Female , Humans , Infant , Asphyxia , Blood Flow Velocity , Heart Rate , Ischemia , Middle Cerebral Artery , UltrasonographyABSTRACT
PURPOSE: Alterations in cerebral blood flow are very important for understanding the neurological consequences of all varieties of perinatal asphyxia. The purpose of this study is to measure the change of cerebral blood flow velocity and resistance index (RI) of middle cerebral artery (MCA) according to the time in asphyxiated infants. METHODS: We studied 7 asphyxiated term infant and 27 normal term infant who were born at Ewha Womans University Hospital from January 1996 to August 1997. Using the Doppler ultrasound, we examined blood flow velocity and RI of the middle cerebral artery. RESULTS: Clinical characteristics were not significantly different in both groups. Peak systolic flow velocity (PSFV) in asphyxiated infants significantly decreased than control (P<0.05). End diastolic flow velocity (EDFV) was not significantly different in both groups. RI in asphyxiated infants significantly decreased for 24 hours (P<0.05). No control infant ever had a RI value of 0.55 or below, three (42.9%) asphyxiated infants had a RI value of 0.55 or below. The changes of the systemic BP and heart rate were not significant. Two (28.6%) asphyxiated infants were proven periventricular white matter ischemia by ultrasonography. CONCLUSION: It is therefore very important to monitor RI in asphyxiated infants even if the degree of asphyxia is mild.
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Female , Humans , Infant , Asphyxia , Blood Flow Velocity , Heart Rate , Ischemia , Middle Cerebral Artery , UltrasonographyABSTRACT
BACKGROUND: The reduction is cerebral blood flow (CBF) caused by hypocapnia is an important element of anesthetic techniques for neurosurgery as well as for nonneurologic surgery in patients with reduced intracranial compliance. Accordingly, the impact of anesthetic agents on the CO2 responsiveness of the cerebral circulation has important implications with regard to anesthetic selection. The purpose of this study was to investigate the effects of isoflurane-N2O and propofol-N2O anesthesia on the CBF response to changes in end-tidal CO2 in healthy patients. METHODS: 19 healthy patients with nonneurological operation were selected. In group 1, anesthesia was induced with thiopental sodium 4 mg/kg, fentanyl 1 g/kg, succinylcholine 1~1.5 mg/kg and was maintained with isoflurane 0.5~1.5 vol%. In group 2, anesthesia was induced with propofol 2~2.5 mg/kg, fentanyl 1 g/kg, succinylcholine 1~1.5 mg/kg and was maintained with a propofol infusion of 10 mg/kg/h for 10 min and then 8 mg/kg/h for 10 min and then was reduced 3~6 mg/kg/h of the remainder of the study. All patients were ventilated with N2O in O2 (FIO2 0.5) and measured end-tidal CO2 (PETCO2). Mean blood flow velocity of middle cerebral artery was measured using transcranial Doppler in PETCO2 45, 40, 35, 30, 25, 20 mmHg. RESULT: CO2 reactivity of MCA flow velocity during isoflurane-N2O and propofol-N2O anesthesia was 5.1 +/- 1.8 %/mmHg, 4.4 +/- 1.0 %/mmHg respectively. CONCLUSION: The cerebral vasculature in healthy patients remains responsive to changes in PETCO2 during isoflurane-N2O and propofol-N2O anesthesia.
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Humans , Anesthesia , Anesthetics , Blood Flow Velocity , Carbon Dioxide , Carbon , Compliance , Fentanyl , Hypocapnia , Isoflurane , Middle Cerebral Artery , Neurosurgery , Propofol , Succinylcholine , ThiopentalABSTRACT
Objective To evaluate the effect of desflurane on blood flow velocity in the middle cerebral artery (VmMCA) and cerebrospinal fluid pressure (CSFP).Methods Sixty patients were randomly assigned to two groups. In group A,the anesthesia was maintained with desflurane, and in group B, with isoflurane. In either group, patients were allocated to three subgroups according to different doses(05,08,1.1MAC). CSFP was measured through a lumbar subarachnoid catheter before surgical procedures,from induction to administration of the inhalational agent for 45min.VmMCA was measured by transcranial Doppler at baseline , postintubation and administration of agent for 45min. Results As compared with baseline,CSFP increased gradually and reached to 16.90?4.01mmHg in subgroup 1.1MAC of group A (P0.05). Compared with baseline, VmMCA increased significantly at 45th min following administration of agent in subgroup 11MAC of group A(P005). In group A , a significant parallel correlation existed between the MAC levels and the values of VmMCA or CSFP (r=0.52,P