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[EuroPCR 2010]Michael Hennerici教授谈ESC大会热点及无创超声进展
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 关键字:Michael Hennerici教授 ESC  大会热点  无创超声 

  《国际循环》:您在影像学检查方面开展了大量研究。最近,在无创超声领域有很大进展。无创超声有哪些优点?这一领域最近有哪些进展?

    <International Circulation>: You have done a lot of work in the area of imaging examination and recently there has been a lot of progress in the advancement of noninvasive ultrasound techniques. What are the advantages of using these and what is the latest research progress regarding these techniques?
 

    Hennerici教授:目前可以明确的是,无创超声有两个用途。首先,超声可以观察接受溶栓治疗的急性卒中患者的脑灌注情况。此外,还有CT、MRI和超声灌注扫描等其他检查方法。这些技术的优点在于能够得到不同层次、互补的信息。另外,只有超声检查能够快速得到信息。超声检查的特点决定了我们能在毫秒内得到图像。CT和MRI扫描则需要等待几分钟或几小时才能拿到结果。超声检查能够发现血管运动(收缩和舒张)的变化。通过诱导心率变化,我们能够得到血管收缩和舒张的灌注图像,而其他方法无法做到。超声还可以用来监测接受溶栓治疗的患者,比如在血栓溶解过程中可能出现快速再灌注所致的再灌注损伤。超声的第二个用途是它不但能够用于诊断,还能用来治疗。目前,我们也应用超声治疗大脑中动脉血栓。向静脉内注入微气泡,这些分隔的微气泡直径为3、4或5 μ,破裂后可以破碎血栓,同时不会影响到大脑中动脉。这是一个很好的方法,能够避免组织型纤溶酶原激活物(tPA)的应用或免疫活性药物的不良反应,两者都可能继发出血并发症,而超声使用得当的话,不会继发出血。

    Prof. Hennerici: We are now convinced we can do two things with these techniques. We can now use ultrasound to measure perfusion in the acute stroke situation in patients who have been treated with thrombolytics. We also have alternatives such as CT (Computerized Tomography) perfusion measurements, MRI (Magnetic Resonance Imaging) perfusion measurements and we have ultrasound perfusion measurements. The nice thing about these techniques is that you get different findings which are not identical but complimentary to each other. In addition, the ultrasound technique is the only technique that can give you quick data, because of the nature of ultrasound you can get an image within milliseconds. However, for the CT and for the MRI you sometimes need to wait minutes and hours to get the results. With this advantage the ultrasound can identify changes of vessel borne movements, diastolic and systolic changes, and you can also trigger part of the heart beat and identify systolic versus diastolic parts of the perfusion image, which you cannot do with any other technique. Ultrasound can also be used to monitor patients during recovery from thrombolytic therapy, for instance during thrombolysis of the clot there may be rapid reperfusion which can lead to reperfusion injury. The second point is that ultrasound not only can be used for diagnostic purposes but also for treatments. We also use ultrasound nowadays to focus exactly the origin of the middle cerebral artery where a clot can be identified. We can inject micro bubbles into the vein and insulate these small bubbles which are less than 3,4,5μ in diameter which will cause a small explosion leading to a fragmentation of the clot in the middle cerebral artery without changing anything in the environment. This is a very elegant method avoiding TPAs (ti

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