今天,应重新考虑如何使用超声技术进行术中神经生理学监测,以改善患者预后,减少住院时间和费用.大量且快速增长的文献表明,经颅多普勒(TCD)超声神经监测(TCDNM)提供的基本血流动力学信息将为改善不同类型血管后的结局提供有效的监测方式。神经外科,骨科,心血管,心胸手术和一些血管内介入或诊断程序,比如心导管插入术或者脑血管造影.理解,避免,预防围手术期或术后并发症,包括上述手术后的神经功能缺损,血管内介入,或诊断程序,代表了对社会具有巨大公共和经济利益的领域,特别是考虑到人口老龄化。美国神经生理学监测协会和美国神经影像学协会指南委员会组成了一个联合工作组,并制定了更新的指南,以协助在外科和重症监护环境中使用TCDNM。具体来说,这些指南定义了(1)TCD监测的目标;(2)神经超声医师在监测期间的责任和行为;(3)仪器和采集参数;(4)安全考虑因素;(5)TCDNM的当代理由;(6)TCDNM观点;(7)主要建议.
Today, it seems prudent to reconsider how ultrasound technology can be used for providing intraoperative neurophysiologic monitoring that will result in better patient outcomes and decreased length and cost of hospitalization. An extensive and rapidly growing literature suggests that the essential hemodynamic information provided by transcranial Doppler (TCD) ultrasonography neuromonitoring (TCDNM) would provide effective monitoring modality for improving outcomes after different types of vascular, neurosurgical, orthopedic, cardiovascular, and cardiothoracic surgeries and some endovascular interventional or diagnostic procedures, like cardiac catheterization or cerebral angiography. Understanding, avoiding, and preventing peri- or postoperative complications, including neurological deficits following abovementioned surgeries, endovascular intervention, or diagnostic procedures, represents an area of great public and economic benefit for society, especially considering the aging population. The American Society of Neurophysiologic Monitoring and American Society of Neuroimaging
Guidelines Committees formed a joint task force and developed updated
guidelines to assist in the use of TCDNM in the surgical and intensive care settings. Specifically, these
guidelines define (1) the objectives of TCD monitoring; (2) the responsibilities and behaviors of the neurosonographer during monitoring; (3) instrumentation and acquisition parameters; (4) safety considerations; (5) contemporary rationale for TCDNM; (6) TCDNM perspectives; and (7) major recommendations.