超声对前列地尔并罂粟碱治疗下肢动脉硬化闭塞症的临床疗效评价

目的通过超声对老年下肢动脉硬化闭塞症患者采用前列地尔与罂粟碱联合治疗前后的血流动力学参数对比,评价前列地尔联合罂粟碱治疗老年下肢动脉硬化闭塞症的疗效。方法下肢动脉硬化闭塞症患者45例,治疗前应用超声测量股、腘、胫前、胫后动脉的舒张期内径,观察血管壁回声强度、血管走行及腔内彩色血流分布,脉冲多普勒定量计算血流峰值速度及血流量。经前列地尔联合罂粟碱治疗后,应用超声观察上述指标的变化。结果治疗后股、腘、胫后、足背动脉的舒张期内径,血流峰值速度及血流量治疗后较治疗前均有明显改善,差异有统计学意义。结论前列地尔联合罂粟碱治疗老年下肢动脉硬化闭塞症临床效果好,值得推广。     

冠心病患者冠状动脉造影与肠系膜上动脉超声多普勒血流显像的相关性研究

目的提高对冠心病患者并发肠缺血的认识,完善冠心病防治规则。方法选择经临床和数字减影血管造影（DSA）检查确诊的47例老年冠心病患者（观察组）与28例中青年冠心病患者（对照组）的肠系膜上动脉彩色多普勒血流显像结果进行对比,分析年龄与肠系膜上动脉之间以及冠状动脉病变程度与肠系膜上动脉病变之间的关系。结果观察组47例中29例（61.7％）发现肠系膜上动脉病变,对照组28例中有7例（25.0％）,两组比较差异有统计学意义（P〈0.05）。观察组冠状动脉多支血管病变27例（57.4％）,对照组有8例（28.6％）,两组比较差异有统计学意义（P〈0.05）。冠状动脉多支血管病变35例,合并肠系膜上动脉病变31例（88.6％）;单支血管病变40例,合并肠系膜上动脉病变5例（12.5％）（P〈0.05）。结论冠心病患者的年龄越大,肠系膜上动脉患病概率越大;冠状动脉病变程度越重,肠系膜上动脉病变程度越高。     

彩色多普勒超声诊断2型糖尿病患者下肢动脉病变

目的分析彩色多普勒超声用于诊断2型糖尿病患者下肢动脉病变的价值。方法对800例2型糖尿病患者的3组下肢动脉：胫前动脉（ATA）、胫后动脉（PTA）和足背动脉（DPA）行彩色多普勒超声检查,从管径、斑块及血流动力学方面进行比较。结果糖尿病患者下肢动脉出现斑块最多、狭窄最严重的是ATA远心端和DPA,PTA斑块相对较少,狭窄较轻。糖尿病包括糖尿病足双侧下肢动脉在管径、管腔最大狭窄率及血流动力学方面差异无统计学意义,病变程度相当。结论彩色多普勒超声在诊断糖尿病下肢动脉病变中具有重要价值,有助于了解血管狭窄程度及血流动力学方面的信息,指导临床治疗。     

高分辨超声检测老年人颈动脉粥样硬化的临床价值

目的应用高分辨超声技术研究老年人颈动脉粥样硬化及血液动脉力学改变,评价其临床意义。方法使用彩色超声诊断仪检测老年人颈动脉硬化及血流状态。结果随年龄增大,粥样硬化程度加重,冠心病、高血压、糖尿病及脑梗死患者粥样硬化明显,且与病变程度密切相关。结论高分辨超声对诊断颈动脉粥样硬化具有较好的临床实用价值,可广泛应用于颈动脉粥样硬化病例的普查工作。     

颈动脉狭窄与失语症发病关系的临床研究

目的通过检测颅内外血管狭窄程度,探讨颈动脉狭窄与失语症发病的关系,推测失语症可能的发病机制,为临床选择实施治疗方案提供客观依据。方法对10例脑梗死失语症且经头颅CT或MRI证实为左侧半球病变的患者,均行北京医科大学第一附属医院汉语失语成套测验中的亚项利手评定和判断失语症类型,采用Frenchy构音障碍评定标准进行构音障碍评定。并对颅内外血管的血流速度进行分析。结果10例患者利手评定均为右利手,8例运动性失语,1例感觉性失语,1例混合性失语。Frenchy构音障碍评定均无构音障碍。超声检查8例患者左侧颈内动脉中-重度狭窄或闭塞．颅内动脉处于低灌注状态;1例左侧大脑中动脉重度狭窄;1例左侧颈内动脉窦部斑块形成。10例患者中5例行全脑数字减影血管造影（DSA）,结果与经颅多普勒、颈动脉超声检查结果一致。结论颈动脉系统中－重度狭窄或闭塞,使颅内动脉灌注压下降,狭窄远端血流速度减低,语青中枢的低血流灌注可能为失语症的发病机制。     

肠系膜上动脉狭窄的血管腔内治疗

目的探讨介入治疗肠系膜上动脉狭窄的安全性及临床疗效。方法对12例肠系膜上动脉狭窄的患者行选择性肠系膜上动脉造影,然后行球囊扩张或支架植入治疗,评价疗效。结果 12例肠系膜上动脉狭窄的患者技术成功率100%,其中单纯球囊扩张2例,球囊扩张+内支架植入术10例。对所有患者随访6~24个月,平均16个月,其中10例无明显症状,2例有腹痛症状,经再次腔内治疗,症状得到明显改善。随访中所有患者均未出现肠坏死、死亡等严重并发症。结论血管腔内介入治疗肠系膜上动脉狭窄是一种安全、有效的方法。     

362例缺血性脑血管病脑血管狭窄与侧支循环特点分析

目的分析脑动脉狭窄的病变特点及侧支循环的模式,探讨脑动脉闭塞或严重狭窄时侧支循环代偿建立的情况与患者神经功能的关系。方法回顾性分析362例缺血性脑血管病患者资料,全部患者均接受DSA检查。对脑血管狭窄病变的特点及侧支循环与神经功能缺损的关系进行分析。结果 362例缺血性脑血管病患者中,334例共存在716处脑动脉狭窄病变;其中单纯颅内动脉狭窄143例（42.81%）,单纯颅外动脉狭窄84例（25.15%）,颅内、颅外动脉均存在狭窄107例（32.04%）;单纯前循环病变173例（51.80%）,单纯后循环病变58例（17.37%）,前、后循环联合病变103例（30.84%）。300处颅外动脉狭窄中,颈内动脉颅外段狭窄185处（61.67%）,椎动脉颅外段狭窄96处（32.00%）;416处颅内动脉狭窄中,大脑中动脉狭窄171处（41.11%）。脑动脉闭塞且有侧支循环的患者与无侧支循环的患者间NIHSS评分差异有统计学意义。脑梗死与TIA患者责任血管狭窄程度差异无统计学意义（P〉0.05）。结论颅外动脉狭窄好发于颈内动脉颅外段,颅内动脉狭窄好发于大脑中动脉。TIA患者发展为脑梗死的可能性大。     

老年人肠系膜上动脉和腹腔动脉的血流观测

目的 :测量正常老年人和心脑血管供血不足的老年人肠系膜上动脉 (SMA)和腹腔动脉 (CA)的血流参数 ,并观察心脑血管疾病对腹腔血流的影响。方法 :采用美国Diasonics 2DGATEWAY FX型彩色多普勒仪对 30例正常老年人和 30例心脑血管供血不足的老年人的血流情况进行观测。结果 :有心脑血管供血不足的老年人的SMA的血流量和舒张末期流速 (EDV)比正常老年人相应参数明显减小 ,搏动指数 (PI)和阻力指数 (RI)明显增大 (P <0 .0 5 ) ,血管直径和收缩峰值流速 (PSV)也减小 ;CA的EDV明显减小 ,PI明显增大 (P <0 .0 5 ) ,血流量、血管直径和PSV减小 ,PI增大。结论 :提出了正常老年人肠系膜上动脉和腹腔动脉的血流参数 ,并指出有心脑血管供血不足的老年人肠系膜上动脉和腹腔动脉的供血也相应不足。     

支架成形术治疗症状性脑供血动脉狭窄及其并发症分析

目的探讨应用颈动脉支架成形术治疗症状性脑供血动脉狭窄的安全性、临床疗效及其并发症的防治。方法对经彩色多普勒超声检查筛选,并经脑血管造影确诊的104例症状性脑供血动脉狭窄患者实施支架成形术治疗。分析围手术期及术后随访期相关并发症的发生情况。结果 1例术中出现严重血管痉挛,致手术失败,全组技术成功率99.04%(103/104)。术前平均狭窄率为82.23%,术后残余狭窄率均20.00%。术后1周内患者症状及神经功能缺损体征均有不同程度改善。24例术后3天发生心率减慢,其中20例出现血压下降;1例介入术后第9天脑出血死亡,1例术后10天靶病变部位急性血栓形成。随访2个月～3年,死亡2例,其中82例复查经颅多普勒(TCD)示血流速度正常,12例复查DSA未发现再狭窄、支架移位及缺血性脑卒中。结论颈动脉支架成形术是治疗症状性脑供血动脉狭窄较为安全、有效的方法,严格掌握适应证和熟练操作并规律服药可降低术中及术后风险。     

球囊扩张在股腘及膝下分支动脉硬化性缺血治疗中的应用

目的初步总结单纯球囊扩张治疗下肢动脉硬化性狭窄和闭塞病变的近期疗效。方法30例下肢动脉硬化性病变接受单纯球囊扩张治疗的患者,其中股浅动脉病变19例次,胭动脉以远病变12例次（4例次同时合并股浅动脉病变,1例球囊扩张,另3例行膝上股胭搭桥）;行普通球囊3例次,切割球囊16例,膝下小球囊12例。结果成功完成所有操作,股浅动脉扩张中6例（31．6％）出现夹层。扩张后即时造影示病变处管径明显改善,血流通畅,夹层对血流影响不明显,未行特殊处理。平均跟踪随访6个月（1—17个月）,除1例（3．3％）合并足趾坏疽的患者疼痛无缓解,1个月后因足部坏疽感染行膝上截肢外,其他患者症状体征均有显著改善,超声示病变处血流通畅。结论球囊扩张对下肢动脉硬化性狭窄和闭塞有一定疗效和近期通畅率。     

Use of hemodynamic parameters in the diagnosis of mesenteric insufficiency

To evaluate the hemodynamic characteristics of the normal mesenteric circulation, five parameters of the velocity waveforms were measured in 15 normal subjects in the celiac and superior mesenteric arteries (SMA) in the pre- and postprandial periods. It was noted that changes in celiac artery flow after eating was minimal, indicating that this vessel's major supply function is not to the gut. SMA parameters showing the most significant and consistent changes after a meal were the diastolic reverse flow and diastolic forward flow (DFF). Four patients referred with symptoms of intestinal angina underwent scanning and subsequent angiography of their mesenteric circulation. All four exhibited loss of reverse flow in the SMA. The change in DFF in the SMA was statistically significant (p = 0.01). Change in peak systolic velocity in the celiac artery was marginally significant (p = 0.05). Angiography revealed that three patients had greater than 90% stenosis of both vessels. The fourth patient had a 90% celiac artery and 65% SMA stenosis. The technique described offers the first noninvasive means of identifying mesenteric insufficiency. It is an effective screening method for a disease entity difficult to verify without selective arteriography. The use of velocity waveform parameters giving good discrimination between normal subjects and those with stenoses of the visceral arteries should reduce both the incidence of missed diagnosis and unnecessary angiography.     

Das Kompressionssyndrom des Truncus coeliacus

A total of 61 patients suffering from weight loss and epigastric pain were screened by color flow Duplex imaging (CFDJ) of the abdominal vessels. Criteria for diagnosis were (1) peak flow in the celiac axis (CA) of more than 200 cm/s; (2) fixing of the CA stenosis during expiration and inspiration, and (3) steal phenomenon and reversal of flow in the superior mesenteric artery (SMA). Results: Of 61 patients 21 (34.4%) fulfilled the criteria; 38 (62.3%) were excluded, and 2 patients could not be evaluated. Of 21 patients 10 were operated on after confirming diagnosis by angiography of CA and SMA. All patients survived. After a follow-up of 28 months 80% of the operated patients were free of symptoms, 10% improved, and 10% showed no change. Conclusion: Successful operative treatment of CA compression includes (1) CFDJ of CA and SMA proving stenosis persisting in inspirational position of the diaphragm; (2) angiography of CA and SMA showing a steal phenomenon including blood flow reversal in SMA; (3) triad of symptoms: epigastric pain, postprandial pain and weight loss; and (4) exclusion of other causes, i.e. pancreatic cancer, pancreatitis etc.     

增强CT诊断孤立性肠系膜上动脉夹层

目的分析增强CT诊断孤立性肠系膜上动脉(SMA)夹层的价值。方法分析22例孤立性SMA夹层的CT特征,提出新的分型方法,并结合文献进行分析。结果 22例夹层均累及SMA弯曲部前壁,其中21例(21/22,95.45%)经增强CT确诊;夹层近端距SMA开口平均(10.31±8.67)mm(0~32.03mm),夹层长度平均(73.37±42.69)mm(15.96~205.91mm)。按症状分组,无症状组(4例)夹层近端距SMA开口平均距离为(16.21±10.97)mm(1.00~32.03mm),有症状组(18例)平均为(9.17±6.15)mm(0~25.98mm);无症状组夹层长度平均为(34.81±44.01)mm(15.96~73.84mm),有症状组平均为(83.46±41.90)mm(26.40~205.91mm)。无症状组真腔狭窄率平均为44.16%±12.33%,有症状组为74.35%±22.37%(P=0.042)。随着夹层向SMA远、近端延展,保守治疗效果变差。结论增强CT是诊断SMA夹层的有效方法。孤立性SMA夹层均累及SMA弯曲部前壁,临床症状及疗效与夹层长度和真腔狭窄度有关。本研究提出的新分型方法有助于全面描述SMA夹层的影像学特征,进而确定治疗方案。     

Right colectomy with simultaneous vascular reconstruction for celiac and superior mesenteric arterial occlusion

INTRODUCTIONIdentification of the primary feeding vessel and its removal with corresponding lymphatics is crucial for oncologic bowel resection for colon cancer. However, this notion would be challenged if we encountered abnormal mesenteric vascular anatomy. We report a case of colon cancer with abnormal mesenteric circulation, for whom we performed oncologic colectomy with vascular reconstruction.PRESENTATION OF CASEA 61-year-old man presented with obstructing transverse colon cancer. A contrast-enhanced computed tomography (CT) scan showed complete occlusion at the root of the superior mesenteric artery (SMA) and the celiac artery (CA), with evidently dilated marginal artery (MA). An X-ray angiography revealed retrograde arterial blood flow originating from the inferior mesenteric artery (IMA) via the MA, the SMA, and to the CA.At laparotomy, we found remarkably dilated MA with the mid-transverse colon cancer. There were no other communicating vessels between the IMA and the SMA. Right colectomy with proper lymph node dissection was completed, following vascular anastomosis between the MA to the SMA. His postoperative course was uneventful. A postoperative CT angiography showed revascularization of the areas where the SMA and the CA supplied.DISCUSSIONIn this patient, if the abberant mesenteric circulation remained unrecognized at the time of surgery, and the MA were divided without vascular reconstruction, severe ischemia and subsequent gangrene of large part of the visceral organs would have occurred.CONCLUSIONThis case illustrates the fundamental importance of assessment for vascular anatomy in patients undergoing oncologic abdominal surgery which associates with division of major mesenteric arteries.     

Screening for mesenteric vascular insufficiency and follow-up of mesenteric artery bypass procedures

Duplex ultrasonography is the preferred noninvasive screening test for superior mesenteric artery (SMA) and celiac artery (CA) stenosis. Although postprandial increases in SMA peak systolic velocity (PSV) are known to occur, the principal duplex criteria for hemodynamically significant SMA and CA stenosis are based on fasting flow velocities. In the SMA, a PSV > or =275 cm/s predicts a > or =70% angiographic stenosis with a sensitivity of 92% and a specificity of 96%, whereas a CA PSV of > or =200 cm/sec predicts a > or =70% stenosis with a sensitivity of 87% and a specificity of 80%. Patients with appropriate symptoms of chronic visceral ischemia and a duplex scan showing high-grade stenosis of the SMA, especially when combined with CA stenosis, should have a confirmatory mesenteric angiogram. This approach will facilitate prompt intervention in these patients. If the duplex examination indicates widely patent mesenteric arteries, alternative diagnoses should be investigated. Other applications of mesenteric duplex scanning include evaluation of median arcuate ligament syndrome and postoperative surveillance of mesenteric artery revascularizations.     

Radioxenon washout for the diagnosis of low-flow mesenteric ischemia

Angiogram is accepted as one of the investigations necessary to establish the diagnosis of acute mesenteric ischemia. Unfortunately, the changes seen in the mesenteric arteriogram of patients with low-flow intestinal ischemia are not always clear and easily interpreted. In this study the washout of an intraarterial injection of radioxenon (¹³³Xe), from nonocclusive ischemic bowel, was recorded to determine if it might aid in the diagnosis of low-flow ischemia. For these investigations, a model of low-flow mesenteric ischemia was produced by infusion of noradrenalin into the dog's superior mesenteric artery (SMA). Under experimental conditions of normal and low mesenteric blood flow, the percentage disappearance at 2 min (washout), from the bowel, of a bolus intraarterial (SMA) injection of radioxenon was recorded to determine if this gave a measure of the intestinal blood flow. It was found that Xe washout and the corresponding SMA blood flow, measured with an electromagnetic flow probe, correlated well in the normal and nonocclusive ischemic bowel (r = 0.924). Measurement of the washout of an intraarterial injection of ¹³³Xe to the bowel may be a helpful adjunct to arteriogram for the clinical diagnosis of low-flow mesenteric ischemia.     

Cerebral hemodynamics in asymptomatic and symptomatic patients with high-grade carotid stenosis undergoing carotid endarterectomy: Soinne L,Helenius J,Tatlisumak T,et al. Stroke 2003;34:1655-61

ConclusionHemodynamic adaption to high-grade carotid stenosis is inferior in patients with symptomatic carotid stenosis compared with those with asymptomatic carotid stenosis, and there are differences in the cerebral hemodynamic response to carotid endarterectomy (CEA) in patients with symptomatic and asymptomatic carotid stenosis.SummaryThe authors used dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI ) and transcranial Doppler scanning techniques to investigate hemodynamic changes in cerebral perfusion induced by carotid stenosis and how they were affected by CEA. In addition, they sought to determine whether there were differences between patients with asymptomatic and symptomatic carotid stenosis. Finally, they examined differences between gray and white matter, and watershed regions with respect to these hemodynamic changes.Twenty three patients with asymptomatic high-grade unilateral carotid stenosis and 23 patients with symptomatic high-grade unilateral carotid stenosis were examined with DSC-MRI and transcranial Doppler ultrasound scanning before CEA and subsequently 3 and 100 days after CEA. Patients with symptomatic carotid stenosis, in comparison with patients with asymptomatic carotid stenosis, had increased preoperative transit time of the MRI contrast bolus and lower cerebral blood flow values in the hemisphere ipsilateral to the high-grade carotid stenosis. These flow abnormalities were more pronounced in white matter and watershed regions than in gray matter regions. Asymmetric flow patterns between hemispheres were abolished with CEA. Improvements over time were greater in patients with symptomatic carotid stenosis. With regard to changes with transcranial Doppler scanning, a breath-holding index, a measure of cerebrovascular reactivity, improved in the symptomatic carotid stenosis patients after CEA. There was no change in the asymptomatic patients after CEA.CommentThe improved ability of patients with asymptomatic carotid stenosis to hemodynamically adapt to the high-grade carotid lesion may partially account for a lesser benefit of surgery in patients with asymptomatic carotid disease.     

肠系膜上动脉血流变化对早产儿喂养护理的指导意义

目的探讨早产儿肠系膜上动脉(SMA)血流变化与喂养耐受性的关系,以便科学地指导早产儿喂养护理,减少并发症的发生.方法将40例单纯早产的早产儿按喂养耐受情况分为观察组(喂养耐受,11例)和对照组(喂养不耐受,29例),两组新生儿采用多普勒超声测量第1次喂养前后SMA血流动力学参数,即收缩期峰值流速(PSFV)、时间平均流速(TMFV)、舒张末期流速(EDFV)、搏动指数(PI)、阻力指数(RI),并记录足量喂养时间.结果观察组喂养前后SMA血流动力学监测结果比较,差异有显著性意义(P<0.01或P<0.05);两组喂养后TMFV、RI结果比较,差异有显著性意义(均P<0.05);两组喂养后TMFV的增加与达足量喂养时间呈显著负相关(r=-0.34,P<0.05);观察组达足量喂养时间显著短于对照组(P<0.01).结论喂养可改变早产儿SMA血流动力学参数,血流动力学参数的改变与喂养耐受密切相关,医护人员可根据第1次喂养前后SMA血流动力学参数的改变,特别是TMFV的增加来预测喂养风险,从而科学地指导早产儿喂养护理.     

CT灌注成像联合醋甲唑胺负荷观察自发性高血压大鼠脑血管储备功能

目的探讨CT灌注成像(CTPI)结合醋甲唑胺负荷试验对评价自发性高血压大鼠(SHR)脑血管储备功能变化的价值。方法取10只大鼠建立SHR模型(SHR组),另取10只作为正常对照组,对两组大鼠于醋甲唑胺灌胃前后行脑CTPI,分别测量负荷前后ROI脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)及达峰时间(TTP);光镜下观察大鼠脑小动脉管壁厚度、微循环毛细血管网情况,通过TTC染色明确各组大鼠脑组织有无脑梗死灶。结果 CTPI显示,组内比较,静息状态与负荷状态下两组4个灌注参数值间差异均有统计学意义(P均0.05),且负荷状态下CBV、CBF值增加,MTT、TTP值缩短。组间比较,静息状态下,两组间仅TTP值差异有统计学意义(P0.05),负荷状态下,两组MTT、TTP值差异有统计学意义(P0.05),且负荷状态下MTT值改变更显著。病理:两组小动脉管壁厚度差异无统计学意义(P0.05),而微循环网毛细血管数差异统计学意义(P0.05),SHR组微循环网毛细血管数增加;SHR组脑组织无明确脑梗死灶。结论 CTPI结合醋甲唑胺负荷试验可反映SHR脑血管储备功能改变。