应变率成像技术评价扩张型心肌病患者左房功能的研究

目的应用应变率成像（SRI）技术评价扩张型心肌病患者左房功能，探讨应变率成像技术在临床评价左房功能的应用价值。方法对19例扩张型心肌病患者（DCM组）和22例健康者（对照组），采用SRI技术测量左房各壁收缩期、舒张早期、舒张晚期应变率峰值（SSR、ESR、ASR），求各组平均值并比较分析。结果DCM组左房壁ESR、ASR、SSR均较健康对照组减低，差异均有统计学意义（P〈0．05）。结论SRI可定量评估扩张型心肌病患者左房功能的改变。     

应变、应变率成像对非梗阻性肥厚型心肌病病人左心房功能的评估价值分析

目的探究应变、应变率成像对非梗阻性肥厚型心肌病病人左心房功能的评估价值。方法选择50例非梗阻性肥厚型心肌病病人,根据左心房有无增大分为左心房增大组(HCM组,29例)和左心房正常组(HCM-C组,21例),另选取同期体检的健康人30名作为对照组。获取心尖四腔观、左室长轴及两腔观组织速度图像,应变、应变率模式下获得收缩期峰值(SSR)、舒张早期峰值(ESR)、舒张晚期峰值(ASR)、舒张晚期峰值达峰应变率(TASR),计算舒张晚期应变率峰值达峰心率校正时间值(TASRc)。结果 HCM组、HCM-C组左心室收缩末期左心房前后径(LA)、舒张末期左室后壁厚度(LVPW)、舒张末期室间隔厚度(IVS)、左室肌重量(LVW)、左室肌重量指数(LVMI)高于对照组(P0.05);HCM组左室射血分数(LVEF)明显低于HCM-C组及对照组(P0.05);HCM组、HCM-C组ESR低于对照组(P0.05);HCM组ESR低于HCM-C组(P0.05);HCM组、HCM-C组ASR高于对照组(P0.05),HCM组ASR高于HCM-C组(P0.05);HCM组TASR、TASRc高于HCM-C组与对照组(P0.05)。结论应变和应变率成像能准确地反映非梗阻性肥厚型心肌病病人局部心肌收缩和舒张功能异常,在左心房功能的全面评估方面具有重要的临床应用价值。     

应变率成像技术评价酒精性心肌病患者左心房功能

目的:研究应变率成像技术在评价酒精性心肌病患者左心房功能改变方面的应用价值。方法:对30例酒精性心肌病患者(ACM组)和相匹配年龄30例正常人(正常对照组),分别进行左心房常规二维参数及应变率参数测量。常规参数包括:左心房最小容积（LAVmin）、左心房最大容积（LAVmax）、左心房p容积（LAVp）、左心房最大直径（LAMD）、左心房主动射血分数(LAAEF)及左心房被动射血分数(LAPEF)。应变率测量指标包括:左心房间隔、侧壁、下壁及前壁收缩期的应变率（SSR）、舒张早期应变率（ESR）及舒张晚期应变率（ASR）。结果:与正常对照组相比,ACM组常规参数LAMD、LAVmax、LAVmin、LAVp及LAAEF增高,LAPEF减低,差异均具有统计学意义（均P<0.05）。ACM组ASR增高,而SSR及ESR减低,差异具均有统计学意义(均P<001)。结论:应变率成像可以准确评价酒精性心肌病患者左心房功能。     

应用超声定量组织速度成像评价慢性心力衰竭病人左心房功能

目的应用超声定量组织速度成像技术评价慢性心力衰竭病人的左心房功能。方法共纳入48例慢性心力衰竭病人(心衰期)和41名健康人(对照组)。行常规超声心动图检查,应用二维超声测量左房内径,应用定量组织速度成像技术测量二尖瓣频谱E峰值流速(Ve)、A峰流速(Va)、二尖瓣舒张期血流峰值速度比值(Ve/Va);利用定量组织速度成像技术测量二尖瓣环舒张早期运动峰值速度(E’)、舒张晚期运动峰值速度(A’)及二尖瓣环舒张期运动峰值速度比值(E’/A’),并与二尖瓣频谱血流速度各指标做相关性分析。结果与对照组比较,心衰组左房内径、左房内径指数、左房容积指数、左房每搏量、左房射血分数均有统计学意义;与对照组比较,心衰组二尖瓣血流频谱E峰、A峰峰值流速及Ve/Va比值无统计学意义。心衰组E’、A’及E’/A’均显著低于对照组。结论心衰组二尖瓣环舒张期运动速度低于正常人,提示心衰病人左心房功能减低;应用定量组织速度成像技术可评价心衰病人左心房功能。     

二维斑点追踪技术评价射血分数保留性心力衰竭患者的左房功能研究

目的应用二维斑点追踪技术评价射血分数保留性心力衰竭患者的左房功能。方法选取成都市第三人民医院心内科2018年1—12月的射血分数保留性心力衰竭住院患者31例及正常体检者32例。常规超声心动图测量两组的左室舒张末期内径、左室质量指数、室间隔厚度、左室后壁厚度、左室射血分数、左房容积指数、E峰、A峰、计算E/A值;组织多普勒测量二尖瓣环间隔侧的e’值,计算E/e’值;应用斑点追踪技术获取左房纵向应变曲线,分别记录两组的心室收缩期左房峰值应变、舒张早期左房峰值应变及心房收缩期左房峰值应变。结果与正常对照组相比,射血分数保留性心力衰竭患者的左室质量指数、左房容积指数及E/e’值均显著增加;而心室收缩期左房峰值应变、舒张早期左房峰值应变及心房收缩期左房峰值应变均显著降低;射血分数保留性心力衰竭患者心室收缩期左房峰值应变与血浆脑钠肽及左房容积指数呈明显负相关。结论二维斑点追踪技术能无创定量评估射血分数保留性心力衰竭患者的左房功能障碍,为临床诊断与治疗提供有价值的信息。     

心肌应变率在射血分数正常的心力衰竭合并心房纤颤患者心功能评价中的应用

目的分析心肌应变率(SR)在射血分数(EF)正常的心力衰竭(CHF)合并心房纤颤(房颤)患者心功能评价中的应用。方法 102例CHF患者左室EF(LVEF)均正常,其中,房颤组52例,非房颤组50例,同期50例查体健康者为对照组。观察3组左心房内径(LA)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、LVEF、心肌质量指数(LVMI)、心率(HR)、E峰、A峰、E/A、基底段、中间段和心尖段的心肌收缩期峰值应变、左室收缩期左房应变率峰值(SRS)、左室舒张早期左房应变率峰值(SRE)和左室舒张晚期左房应变率峰值(SRA)差异变化。结果 3组超声心动图指标变化差异有统计学意义(P<0.05)。房颤组LA、LVEDV、LVESV、LVMI、HR、E峰和E/A显著高于非房颤组及对照组,而A峰则明显低于非房颤组及对照组(P<0.05)。3组LVEF差异无统计学意义(P>0.05),与病理生理改变不符;3组心肌收缩期峰值应变差异显著(P<0.05)。房颤组左心室后间隔和侧壁的基底段、中段和心尖段明显低于非房颤组及对照组,3组SRS、SRE、SRA在各节段差异变化明显,房颤组后间隔和侧壁SRS、SRE、SRA在左心室各节段显著低于非房颤组及对照组(P<0.05)。结论 SR技术作为一种无创定量方法在EF正常CHF合并房颤患者的心功能评价中优于超声心动图指标。     

应用应变率成像技术对尿毒症患者左心室功能的评价

目的 应用应变率成像技术评价尿毒症患者左室的局部收缩与舒张功能。方法 40例尿毒症患者,左室肥厚(LVH)组25例,非左室肥厚(NLVH)组15例及30例正常对照组。取心尖四腔、心尖两腔、心尖左室长轴切面测量左室各室壁心肌收缩期、舒张早期、房缩期的峰值速度(VS、VE、VA)、峰值应变率(SRS、SRE、SRA)、最大应变及位移。结果 速度Vs、VA:尿毒症患者较正常对照组无显著性差异,VE:尿毒症患者NLVH组后间隔、下壁较正常对照组显著性减低,LVH组除后壁外余左室各壁较正常对照组显著性减低。尿毒症患者两组间仅在前间隔有显著性差异。应变率SRS:尿毒症患者LVH组左室侧壁较正常对照组显著性减低。SRE:尿毒症患者NLVH组左室侧壁、下壁、后壁较正常对照组显著性减低,LVH组除后间隔外左室各壁较正常对照组显著性减低。LVH组前间隔及前壁的SRE较NLVH组显著性减低。SRA:尿毒症患者较正常对照组无显著性差异。应变S:尿毒症患者NLVH组仅有左室侧壁较正常对照组有显著性差异,LVH组除后间隔外其余左室壁较对照组显著性减低。LVH组前壁的应变较NLVH组显著性减低。位移D:尿毒症患者NLVH组仅在后间隔较正常对照组显著性减低,LVH组后间隔、后壁、前间隔、下壁较正常对照组显著性减低(分别P<0.05和0.01)。结论 应变率成像技术能够早期评尿毒症患者左室的心肌运动功能。     

左心房追踪技术评价心肌梗死患者的左心房功能

目的 应用左心房追踪技术评价心肌梗死患者左心房功能及其与左心室功能的相关性.方法 选取30例正常人、30例心肌梗死患者,分别测量左房最大容积(LAVmax)、最小容积(LAVmin)、收缩期左房充盈速率峰值(dv/dtS)、舒张早期左房排空速率峰值(dv/dtE)及舒张晚期左房排空速率峰值(dv/dtA)、左室Tei指数,并计算左房整体排空分数(LAEF).结果 与正常对照组相比,陈旧性心肌梗死患者Tei指数、dv/dtA、LAVmin、LAVmax明显升高.LAEF、dv/dtS、dv/dtE明显减低(均P<0.05).心肌梗死患者左室Tei指数与dv/dtA呈正相关(r=0.85).结论 陈旧性心肌梗死患者左房存储及管道功能显著减低,左房辅泵功能显著增强;左房辅泵功能与左室整体功能相关性良好.左房追踪技术能很好地反映心肌梗死患者的左房功能.     

肺心病患者左心室功能的应变率成像分析

目的 探讨应变率成像(SRI)技术评价慢性肺心病患者左室功能的价值. 方法 选取慢性肺心病患者64例(其中代偿组30例,失代偿组34例)及健康对照组30例,应用SRI技术测量左室各壁基底段、中段的心肌收缩期峰值应变率(SRs)、舒张早期峰值应变率(SRe)和舒张晚期峰值应变率(SRa),计算左室平均峰值应变率(mSR),并与常规超声心动图指标进行对比研究. 结果与健康对照组相比,慢性肺心病组mSRs、mSRe、mSRe/mSRa均降低,mSRa均增高(均P=0.000).且与代偿组比较,失代偿组mSRs、mSRe、mSRe/mSRa降低,mSRa增高(P=0.000、0.038、0.015、0.001).慢性肺心病组左室射血分数(LVEF)与mSRs呈高度负相关(r=0.75、0.82,P=0.000).结论 慢性肺心病组LVEF与mSRs具有高度相关性,利用慢性肺心病患者左心室mSRs可以反映LVEF的状况.SRI技术较常规超声心动图更敏感、快速地定量评价慢性肺心病患者左心功能.     

肝硬化病人左室舒张期应变率参数变化与终末期肝病模型评分的关系

目的:研究肝硬化病人左心舒张功能应变率参数与终末期肝病模型(MELD)评分的相关性。方法:入选山西医科大学第一医院2021年11月—2022年4月住院肝硬化病人90例为肝硬化组,对照组为同期山西医科大学第一医院健康体检者40名。肝硬化病人根据MELD评分分为轻度组(MELD评分≤9分)、中度组(10分≤MELD评分≤19分)和重度组(MELD评分≥20分)。对肝硬化各组和对照组进行超声心动图检查,测得左室射血分数(LVEF)、左室舒张期末容积(LVEDV)、左室收缩期末容积(LVESV)、左房舒张期最大容积(LAV)、左心房容积指数(LAVI)、二尖瓣舒张早期血流峰值速度(E)、二尖瓣舒张晚期血流峰值速度(A)、二尖瓣瓣环间隔侧及侧壁侧瓣环的平均运动速度(e′),并计算E/e′比值;运用Auto Strain LV分析软件获取左心室收缩期整体纵向应变(GLS)、收缩期纵向峰值应变率(GSRs)、舒张早期纵向峰值应变率(GSRe),并计算E/GSRe比值。结果:收缩功能参数,对照组和MELD评分各组间比较,LVEF差异均无统计学意义(P>0.05);与对照组相比,MELD评分各组G...     

Echocardiographic strain and strain rate imaging--clinical applications

Echocardiographic strain and strain rate imaging is a new technology enabling more reliable and comprehensive assessment of myocardial function. The spectrum of potential clinical applications is very wide due to its ability to differentiate between active and passive movement of myocardial segments, to quantify intraventricular dyssynchrony and to evaluate components of myocardial function, such as longitudinal myocardial shortening, that are not visually assessable. The high sensitivity of both tissue Doppler (TDI) derived and two-dimensional (2D) speckle tracking derived strain and strain rate data for the early detection of myocardial dysfunction recommend these new non-invasive diagnostic methods for routine clinical use. In addition to early detection of myocardial dysfunction of different etiologies, assessment of myocardial viability, detection of acute allograft rejection after heart transplantation and early detection of patients with transplant coronary artery disease, strain and strain rate measurements are helpful in the selection of different therapies and follow-up evaluations of myocardial function after different medical and surgical treatment. Strain and strain rate data also provide important prognostic information. This Review explains the fundamental concepts of strain and strain rate for both TDI-derived and speckle tracking 2D-strain derived deformation imaging and discusses the clinical applicability with all the major advantages and limitations of these new echocardiographic methods, which recently have become a subject of great interest for clinicians.     

Muscle strain injuries

Muscle injuries--lacerations, contusions or strains--are by far the most common injuries in sports. After first aid following the RICE principle (Rest, Ice, Compression and Elevation), therapy must be tailored according to the severity of the injury and based on the knowledge gained from experimental studies on regeneration of injured muscle. Most muscle injuries can be treated conservatively with excellent recovery, but complete ruptures with complete loss of function should be managed surgically. Immediately after the injury, a short period of immobilization is needed to accelerate formation of the scar between the stumps of the ruptured myofibers, to which the stumps adhere. The optimal length of immobilization depends on the grade of the injury, and should not be longer than needed for the scar to bear the pulling forces without rerupture. Early mobilization is required to invigorate adhesion, orientation of the regenerating muscle fibers, revascularization and resorption of the connective tissue scar. Another important aim of early mobilization, especially in clinical sports medicine, is to minimize inactivity-induced atrophy as well as loss of strength and extensibility, which are rapidly appearing adverse sequelae of prolonged immobilization.     

Repetitive strain injury

Repetitive strain injury remains a controversial topic. The term repetitive strain injury includes specific disorders such as carpal tunnel syndrome, cubital tunnel syndrome, Guyon canal syndrome, lateral epicondylitis, and tendonitis of the wrist or hand. The diagnosis is usually made on the basis of history and clinical examination. Large high-quality studies using newer imaging techniques, such as MRI and ultrasonography are few. Consequently, the role of such imaging in diagnosis of upper limb disorders remains unclear. In many cases, no specific diagnosis can be established and complaints are labelled as non-specific. Little is known about the effectiveness of treatment options for upper limb disorders. Strong evidence for any intervention is scarce and the effect, if any, is mainly short-term pain relief. Exercise is beneficial for non-specific upper limb disorders. Immobilising hand braces and open carpal tunnel surgery release are beneficial for carpal tunnel syndrome, and topical and oral non-steroidal anti-inflammatory drugs, and corticosteroid injections are helpful for lateral epicondylitis. Exercise is probably beneficial for neck pain, as are corticosteroid injections and exercise for shoulder pain. Although upper limb disorders occur frequently in the working population, most trials have not exclusively included a working population or assessed effects on work-related outcomes. Further high-quality trials should aim to include sufficient sample sizes, working populations, and work-related outcomes.     

心房超声应变和应变率成像在心房颤动中的应用价值

心房颤动的患者在电除颤后往往伴有心房收缩功能减退,血流动力学的改变使之易形成血栓,因此,正确地评价左房功能有助于指导除颤后抗凝治疗时间的长短.组织多普勒成像是近年开发并迅速发展起来的一项超声心动图新技术,可定量测量室壁运动速度、加速度、位移、应变及应变率,为心肌功能的研究提供了新的超声诊断方法.本文就心房超声应变和应变率成像在心房颤动抗凝、复发预测等方面的应用价值进行简要综述.     

辽宁与四川两省嗜人按蚊细胞遗传学研究

目的　确定辽宁省可疑按蚊与嗜人按蚊的遗传关系。方法　以人工诱导法和自然交配法对辽宁省可疑嗜人按蚊与四川省嗜人按蚊进行杂交实验 ,观察杂交卵的孵化率、幼虫生长情况、化蛹率、羽化率 ,判定辽宁省可疑嗜人按蚊与四川省嗜人按蚊是否存在生殖隔离 ;按Kanda法制作幼虫唾腺染色体 ,观察杂交F1代幼虫唾腺染色体联会情况。结果　两地按蚊人工诱导杂交卵的孵化率为 72 36 % ,化蛹率 70 13% ,羽化率 92 5 4 % ;自然交配孵化率、化蛹率和羽化率分别为 87 72 %、70 99%和 95 0 9%。杂交F1代与亲本回交和自交 ,杂交F2 代均能正常发育。杂交F1代幼虫唾腺染色体完全联会。结论　两地嗜人按蚊不存在生殖隔离 ,辽宁省可疑按蚊确系嗜人按蚊无疑。     

心肌应变及应变率成像技术对心脏病的诊断价值

心肌应变及应变率成像是显示局部心肌形变特征的超声检查技术。应用应变及应变率成像技术可以确定急性心肌缺血、评价心肌功能储备并可以结合多巴酚丁胺负荷试验评价心肌缺血的程度。     

Left ventricular size determines tissue Doppler-derived longitudinal strain and strain rate

AIMS: Tissue Doppler-derived indices of strain (epsilon) and strain rate (SR) have been developed to assess regional cardiac function. However, the effect of left ventricular (LV) size on epsilon and SR has not been studied in depth. The aim of this study was to assess to what extent heart size influence epsilon or SR. METHODS AND RESULTS: In 21 anaesthetized pigs ranging from 12.5 to 70.0 kg, tissue Doppler-derived epsilon and SR, and haemodynamic parameters, were assessed during controlled heart rates and different loading conditions. dP/dt did not correlate to pig weight, suggesting constant contractility during growth. Longitudinal epsilon and SR were significantly higher in smaller compared with larger hearts. The hyperbolic correlation between pigs weight and epsilon and SR was r(2)=0.621 and 0.372, respectively, both P<0.0001. Afterload elevation induced a reduction in longitudinal epsilon (from -24.2+/-3.2 to -12.1+/-5.5%, P=0.001) and SR (from -2.3+/-0.8 to -1.3+/-2.4 s(-1), P=0.034), whereas increasing preload increased epsilon (from -26.4+/-10.3 to -38.1+/-14.3%, P=0.006) and SR (from -2.3+/-0.9 to -4.22+/-1.8 s(-1), P=0.002). CONCLUSION: Longitudinal epsilon and SR decrease with increasing LV dimensions in spite of an unaltered contractility. These results show and confirm that heart size influences epsilon and SR, which are highly load-dependent parameters.