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发泡试验的操作方法及临床应用
$76.37
发泡试验(又称对比增强经颅多普勒)是临床筛查隐源性卒中、偏头痛等疾病病因的重要手段,具有操作简便、经济实用、可重复性强等优点。本书由国内发泡试验临床及科研领域经验丰富的专家共同编写,旨在对这一目前已被国内各级医疗单位广泛应用的技术进行规范化操作的指导与推广。全书系统阐释了发泡试验的发展史、基本原理、操作方法及临床应用,内容实用,重点突出,不仅图文并茂,还辅以视频演示,全方位介绍操作细节,便于神经内科临床医师、超声科医师、心血管专业医师、功能科室医技人员和护理人员直观理解与学习。
发泡试验(又称对比增强经颅多普勒)是临床筛查隐源性卒中、偏头痛和减压病等疾病病因的重要手段。此项技术具有操作简便、经济实用、可重复性强等优点,目前已被国内各级医疗单位广泛应用,但尚缺乏统一的操作标准,其应用也需要规范化。本书是国内关于发泡试验操作和应用的专业图书,由发泡试验临床及科研领域经验丰富的专家共同编写。全书共分为 11 章,系统阐释了发泡试验的发展史、基本原理、操作方法及临床应用,重点介绍了其在右心声学造影诊断、经皮卵圆孔封堵术治疗,以及典型隐源性卒中、偏头痛、减压病和其他右向左分流相关疾病诊疗中的应用,并且对发泡试验的常见问题进行了答疑,同时推荐了适合发泡试验的应用软件。本书内容实用,重点突出,适合神经内科临床医师、超声科医师、心血管专业医师、功能科室医技人员和护理人员阅读和参考。
邢英琦 主任医师,教授,博士研究生导 师。首都医科大学宣武医院血管超声诊断科 副主任,《中风与神经疾病杂志》编辑部主任。 中国超声医学工程学会颅脑与颈部血管超 声专业委员会副主任委员,中国医师协会神 经内科分会神经超声专业委员会副主任委员, 国家卫健委卒中防治工程委员会血管超声专 委会副主任委员。主持国家自然科学基金 2 项,获国家发明专利 1 项,国家软件著作权 1 项。获 2020 年吉林省科学技术进步奖一等奖, 2018 年康缘杯“中国杰出神经内科青年医师” 荣誉称号。主编专著 1 部,副主编教材 1 部, 主译专著 2 部。以责任作者发表 SCI 收载文 章 50 余篇,发表中文核心期刊论文近 200 篇。林 攀 福建省龙岩市第二医院神经内科 副主任医师。中国卒中学会脑血流与代谢分 会委员,中国超声医学工程学会颅脑与颈部 血管超声专业委员会委员,国家卫健委卒中 防治工程委员会血管超声专委会委员,福建 省海峡医药卫生交流协会神经病学分会常务 理事、副秘书长,福建省医学会神经病学分 会青年委员。主持福建省卫健委青年科研课 题 1 项。获省部级科技进步三等奖 1 项(完成 人之一),国家发明专利 1 项(第二发明人), 2018 年度中国脑卒中大会血管超声论坛疑难 病例竞赛二等奖。参译专著 1 部,以责任作者 发表学术论文 20 余篇。
目 录第 1 章 总论一、发泡试验的定义二、发泡试验的发展简史第 2 章 解剖与原理一、右向左分流二、微栓子监测第 3 章 发泡试验操作流程一、基本要求和参数设置 二、操作流程三、成败原因分析及探讨 四、右向左分流的分级和诊断模板 第 4 章 超声心动图诊断右向左分流 一、概述 二、对比剂的选择及操作方法三、右心声学造影临床应用 四、右心声学造影应用新进展第 5 章 右向左分流的治疗一、卵圆孔未闭 二、房间隔缺损三、肺动静脉瘘 第 6 章 隐源性卒中与右向左分流一、隐源性卒中与反常性栓塞二、典型病例第 7 章 偏头痛与右向左分流 一、偏头痛与右向左分流 二、偏头痛与脑损伤 三、典型病例 第 8 章 减压病与右向左分流 一、减压病及其病因、机制 二、减压病临床表现和分类 三、减压病诊断和治疗 四、高空减压病与飞行员白质脑病 五、预防和展望第 9 章 右向左分流与其他可能相关疾病 一、斜卧呼吸 - 直立性低氧血症 二、正常冠状动脉心肌梗死及其他外周动脉栓塞三、不明原因的晕厥 四、睡眠呼吸暂停低通气综合征 五、突发听力丧失 六、精神异常七、脑脓肿八、眩晕 九、急性高原肺水肿 十、体温调节第 10 章 发泡试验“问与答”问 1:TCD 发泡试验的适应人群和禁忌证是什么? 问 2:颞窗不好的患者可以做发泡试验吗? 问 3:为什么使用混血激活生理盐水做气泡对比剂?问 4:注射激活生理盐水有无风险和禁忌?问 5:监测方式采用单通道还是双通道? 问 6:为什么使用双深度模式?需要注意什么?问 7:发泡试验时体位有没有选择问 8:为什么选用 18G 套管针进行注射? 问 9: Valsalva 动作 CVM 在发泡试验中重要吗?如何完成有效的 VM ?问 10:为什么 VM 后的微泡数量比静息时的微泡数量多? 问 11:为什么部分患者 VM 后的微泡数量反而比静息时的微泡数量少?问 12:VM 具体是如何执行的?问 13:VM 在什么时机执行? 问 14:发泡试验监测的时间窗是多久?问 15:发泡试验阴性,如何解释? 问 16:发泡试验阳性,如何解释? 问 17:急性脑梗死患者在发病多长时间可以做发泡试验?发泡试验有什么不良反应或风险?如何处理?检查前需要先签知情同意书吗? 问 18:发泡试验提示大量右向左分流,但 cTTE 阴性或少量分流,两种检查结果不一致,如何解释?问 19: cTTE 提示大量右向左分流,但发泡试验阴性或分流量小,两种检查结果不一致,如何解释?问 20:发泡试验大量分流,TEE 却阴性,肺部 CTA 也是阴性,检查结果不一致如何解释? 第 11 章 XL2 智慧型发泡试验软件 一、XL2 智慧型发泡试验软件解决的技术问题 二、使用 XL2 智慧型发泡试验软件的操作流程三、相关证书附录 术语名词汉英对照
第 1 章 总 论一、发泡试验的定义(一)定义发泡试验,全名“经颅多普勒(transcranial Doppler,TCD)发泡试验”,又名“对比增强经颅多普勒”(contrast-enhanced TCD, c-TCD),还可简称为“增强 TCD”。国内的医务工作者为了方便交流和加深印象,习惯上使用“发泡试验”这个名称。发泡试验主要用于检测右向左分流(right-to-left shunt,RLS)。TCD 可以实时检测微栓子(图 1-1),TCD 发泡试验主要是采用微栓子监测的原理,当使用 TCD 设备监测脑血流的时候,通过从受检者的肘静脉注射微泡对比剂,即“激活生理盐水”,若受检者存在 RLS,就可在较短时间内探及微泡信号。若存在微泡信号,具有微栓子监测功能的 TCD 设备上能识别(气体)微栓子事件,计算微栓子个数。安装智慧型发泡试验软件的 TCD 设备还可以对发泡试验的结果自动进行诊断和量化分级。
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