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目的:回顾经颅多普勒(TCD)和经颅彩色编码超声(TCCS)在诊断方面的应用。方法:作者检索了以下文献证据:(1)在特殊临床情况下TCD能否提供有用的信息;(2)应用这一信息能否改进临床决策,后者通过患者转归的改善反映出来;(3)在这些临床情况下TCD是否优于其他诊断性检查。结果:在筛查2～16岁镰状细胞病患儿的卒中风险(A级推荐,Ⅰ级证据)以及检测和监测自发性蛛网膜下腔出血后的血管痉挛方面(A级推荐,Ⅰ～Ⅱ级证据),TCD具有确定的价值。在检测颅内血管狭窄闭塞性疾病(B级推荐,Ⅱ～Ⅲ级证据)、血管舒缩反应性试验(B级推荐,Ⅱ～Ⅲ级证据)、检测脑循环停止/脑死亡(A级推荐,Ⅱ级证据)、监测颈动脉内膜切除术(B级推荐,Ⅱ～Ⅲ级证据)、监测溶栓治疗(B级推荐,Ⅱ～Ⅲ级证据)和监测冠状动脉旁路移植术(B～C级推荐,Ⅱ～Ⅲ级证据)方面,TCD和TCCS可提供重要的信息并可能有价值。对于心内/心外右向左分流(A级推荐,Ⅱ级证据)、颅内血管闭塞性疾病(B级推荐,Ⅱ～Ⅳ级证据)和出血性脑血管病(B级推荐,Ⅱ～Ⅳ级证据),尽管其他技术可能更优越,但对比增强TCD/TCCS也能提供有用的信息。
Objective: To review the application of transcranial Doppler (TCD) and transcranial color coded ultrasound (TCCS) in diagnosis. METHODS: The authors searched for the following documented evidence: (1) whether TCD can provide useful information in a particular clinical setting; (2) whether the use of this information improves clinical decision-making, the latter being reflected through improvements in patient outcomes; 3) Is TCD superior to other diagnostic tests in these clinical settings? RESULTS: In the screening of stroke risk (Grade A, Grade I) in children with sickle cell disease aged 2 to 16 years and in the detection and monitoring of vasospasm following spontaneous subarachnoid hemorrhage (Grade A recommendation, Ⅱ level of evidence), TCD has a definite value. In the detection of occlusive disease of intracranial vascular stenosis (Grade B recommendation, Grade II ~ III evidence), vasoconstrictive reactivity test (Grade B recommendation, Grade II ~ III evidence), cerebral circulation arrest / brain death (Grade A recommendation, Grade II evidence), carotid endarterectomy (grade B recommendation, grade II-III evidence), thrombolytic therapy (grade B recommendation, grade II-III evidence) and monitoring of coronary artery bypass graft (B ~ C-level recommendations, and II-III-level evidence), TCD and TCCS can provide important information and may be of value. Cardiac / extracorporeal right-to-left shunt (Grade A recommendation, Level II evidence), intracranial vascular occlusive disease (Grade B recommendation, Grade II to IV evidence) and hemorrhagic cerebrovascular disease (Grade B recommendation, Level IV), contrast enhancement TCD / TCCS can provide useful information, although other techniques may be superior.