上矢狀竇引流橋靜脈和腦靜脈顱外回流通道的彩色多普勒超聲檢查

1、上矢狀竇引流橋靜脈和腦靜脈顱外回流通道的彩色多普勒超聲檢查        【中文摘要】目的結合課題組的前期顯微解剖研究結果,利用彩色多普勒超聲觀察上矢狀竇引流橋靜脈以及體位和呼吸運動對腦靜脈顱外回流通道的影響,為后續(xù)的腦靜脈血活動力學研究提供新的參考數(shù)據(jù),并為相關疾病機理的探討提供形態(tài)學和血活動力學依據(jù)。方法1、選取20例因顱外傷或腦腫瘤行神經(jīng)外科開顱手術,術后一年擬行顱骨修補術且一般狀況良好的患者,采用彩超經(jīng)術后骨窗觀測上矢狀竇引流橋靜脈的形態(tài)學和血活動力學參數(shù)。2、選取20例青年健康志愿者,采用彩超觀測頸內靜脈

2、不同部位(最低點、中點和最高點)、不同側別(左側、右側)的血活動力學參數(shù);觀測頸內靜脈(中點)和椎靜脈在不同體位和不同中心靜脈壓(呼吸運動)影響下的血活動力學參數(shù)變化情況。結果1、上矢狀竇引流橋靜脈的彩色多普勒超聲檢查:橋靜脈集中分布在上矢狀竇的前段和后段,冠狀縫四周的上矢狀竇少見橋靜脈注進。將橋靜脈分為前段組和后段組兩組,其中前段橋靜脈數(shù)目為3.1±1.4支,直徑為2.7±0.7 mm,注進角度為96±33°,均勻血流速度為10.0±2.8 cm/s,血流量為28.21±14.88 ml/min;后段組橋靜脈均勻數(shù)目為5.8

3、7;1.0支,直徑為3.2±1.2 mm,注進角度為41±24°,均勻血流速度為11.4±2.8 cm/s,血流量為48.12±38.13 ml/min。與前段組相比較,后段組橋靜脈的數(shù)目較多,直徑較大,注進角度較小,血流速度較快,血流量較大。與課題組前期顯微解剖結果比較,所測橋靜脈數(shù)目較少,直徑較大;與前期最敏感的影像學檢查手段DSA觀測結果比較,差異無統(tǒng)計學意義。橋靜脈逆行注進硬腦膜竇時,注進處四周的上矢狀竇和橋靜脈內局部出現(xiàn)湍流。2、腦靜脈顱外回流通道的彩色多普勒超聲檢查:頸內靜脈最低點的橫截面積、血流速度和血流量均較中點和最高點大,頸內

4、靜脈在頸內動脈起始處(中點)及其水平面以上部分的血流量差異不明顯。臥位時,65%的頸內靜脈為右上風型;坐位時,45%的頸內靜脈為右上風型;臥位和坐位時右側頸內靜脈血流量分別比左側高91%和41%。平靜呼吸時,臥位頸內靜脈血流量占頸內靜脈和椎靜脈血流量總和的94%。坐位頸內靜脈的橫截面積減小,血流速度變化不明顯,血流量下降;椎靜脈橫截面積增加,血流速度加大,血流量增加,椎靜脈血流占總流出量的45%,78%的病例頸內靜脈不是腦靜脈顱外回流的主要途徑。加壓呼吸時,臥位頸內靜脈血流量稍有增加,椎靜脈無明顯變化;坐位頸內靜脈橫截面積和血流量急劇增加超過臥位水平,椎靜脈血流速度和血流量急劇下降。結論彩色多

5、普勒超聲檢查技術能夠通過術后骨窗觀測到上矢狀竇引流橋靜脈的形態(tài)學和血活動力學參數(shù),為后續(xù)的腦靜脈血活動力學研究提供了新的參考數(shù)據(jù),并為神經(jīng)外科術后監(jiān)測提供了新的方法。在頸內動脈起始處觀察頸內靜脈內的血活動力學狀況最為合適,檢查方便、數(shù)據(jù)正確;頸內靜脈存在左右差異,臥位以右上風型為主。健康人群中,平靜呼吸時,頸內靜脈和椎靜脈叢分別是臥位和坐位時腦靜脈顱外回流的主要通道。加壓呼吸時,頸內靜脈是臥位和坐位時腦靜脈顱外回流的主要通道。研究結果為顱內腫瘤、感染和栓子向顱外蔓延到脊柱、盆腔和胸壁等處提供了依據(jù)。');【Abstract】 Objectives Based on the propha

6、se result of cadavers of the coworkers, the cerebral bridging veins (BVs) entering superior saggital sinus (SSS) and cerebral venous outflow were observed by color-coded duplex sonography, in order to provide new hemodynamic reference data for further hemodynamic study of the cerebral venous, and to

7、 provide morphologic and hemodynamic basis for related desease.Methods 1. Twenty patients undergoing selective craniotomy one years ago and having a good recovery underwent color-coded duplex sonography. The morphologic and hemodynamic data were measured through the surgical bone window. 2. Twenty v

8、olunteer underwent color-coded duplex sonography. The hemodynamic data in the lower-most point, the middle point, the upper-most point and the right or the left side of the internal jugular vein (IJV) were measured. The chang of the hemodynamic data in the IJV and vertebral vein (VV) under different

9、 body position and central venous pressure were measured in the middle point of IJV.Results 1. Color-coded duplex sonography of BVs entering SSS:The BVs formed two clusters along the SSS: anterior group and posterior group. The number of the anterior group BVs was 3.1±1.4, the diameter was 2.7&

10、#177;0.7 mm, the angle was 96±33°, the mean flow velocity was 10.0±2.8 cm/s, and the blood flow volume was 28.21±14.88 ml/min. The number of the posterior group BVs was 5.8±1.0, the diameter was 3.2±1.2 mm, the angle was 41±24°, the mean flow velocity was 11.4

11、±2.8 cm/s, and the blood flow volume was 48.12±38.13 ml/min. The number, diameter, the mean flow velocity, and the blood flow volume of the posterior group BVs were larger than anterior group.C ompared to observation in cadavers, the number of BVs was less, and the diameter of BVs was larg

12、er. There was no defference in DSA and sonography.When the BV entering SSS with less than 90 degree, the turbulent flow was found in the SSS and BV besides dural entreance. 2. Color-coded duplex sonography of the cerebral venous outflow:The cross section area, velocity, and the blood flow volume in

13、the lower-most point of IJV were more than the middle and the upper-most point of IJV. There were no difference between IJV besides the onset of internal carotid artery and the superior part of IJV.65% and 45% of the IJV was right side advantages in supine position and sitting position separately. T

14、he blood flow volume in the right side were 91% and 41% more than left side in supine position and sitting position respectively.Quient breathing, the outflow of IJV was 94% of total outflow in supine position. In sitting position, the cross section area and the blood flow volume in IJV dropped, and

15、 the velocity, and the blood flow volume in VV increased. In sitting position, the outflow of VV was 45% of total outflow, and 78% of the cerebral venous outflow were extra-jugular venous system.Pressure breathing, the outflow of IJV increased lightly in supine position. In sitting position, the cro

16、ss section area and the blood flow volume in IJV increased rapidly, and exceeded the outflow in supine position. The velocity, and the blood flow volume in VV decreased rapidly.Conclusion 1. The morphological and hemodynamic feature of BVs entering into SSS can be measured through the surgical bone window by color-coded duplex sonography. 2. There are bilateral difference of the IJV. The measurment of IJV besides the onset of internal carotid artery is e