先天性心脏病心外大血管畸形73例16层螺旋CT诊断分析

目的探讨16层螺旋CT(MSCT)对先天性心脏病心外大血管畸形的诊断价值。方法对73例经手术证实的心脏MSCT和超声心动图(TTE)资料进行回顾性分析,并与手术结果对照。结果 73例患者MSCT显示动脉导管未闭23例,肺动脉狭窄17例,主动脉骑跨9例,肺静脉异位引流8例,主动脉缩窄2例,右位主动脉弓、降主动脉7例,肺动脉缺如2例,主动脉异位1例,主动脉-肺动脉异位引流1例,永存动脉干1例,左侧上腔静脉2例,经手术证实畸形92处,其中MSCT、TTE的诊断准确率分别为为100%、83.3%。结论 MSCT对先心病心外大血管畸形具有重要的诊断价值,其与TTE联合应用可提高先心病的诊断准确率。     

急诊主动脉夹层超声心动图和多层螺旋CT诊断对比分析

目的探讨超声心动图和多层螺旋CT在急诊主动脉夹层中的诊断价值。方法 51例经临床及经胸超声心动图(TTE)诊断为AD的患者进行多层螺旋CT(MSCT)检查,与手术结果进行对照。结果 TTE诊断符合率为92.2%(47/51),其中Debakey I型诊断符合率为100%(29/29)。MSCT诊断符合率100%(51/51),两者比较差异无统计学意义(P>0.05)。TTE评估主动脉弓部是否受累诊断符合率94.6%(35/37),MSCT诊断符合率100%(37/37),两者比较差异无统计学意义(P>0.05)。TTE评估主动脉瓣结构及功能受累程度诊断准确度优于MSCT,两者比较差异有统计学意义(P<0.05);而MSCT评估胸、腹主动脉分支血管及冠状动脉受累程度诊断准确度优于TTE,两者比较差异有统计学意义(P<0.05)。结论 TTE作为一种无创性心血管检查,其便利、重复性强,可准确诊断AD及其分型、主动脉弓部是否受累、主动脉瓣受累程度,而MSCT可进一步明确胸、腹主动脉分支血管及冠状动脉受累程度。     

彩色多普勒超声对小儿法洛四联症手术的指导意义

目的探讨彩色多普勒超声(CDE)对法洛四联症(TOF)的诊断价值及对手术及恢复的指导意义.方法对72例TOF患者CDE检查结果与手术测量结果进行比较.结果 CDE对TOF的诊断符合率为95.8%.超声测量左室舒末容积指数大小及左右肺动脉内径之和与膈水平降主动脉内径[(LPA RPA)/DAO]的比值可反映左室及肺动脉发育情况.结论 CDE对TOF的诊断具有较高的准确性,左室舒末容积指数及(LPA RPA)/DAO比值对TOF手术方式的选择及判断恢复过程具有参考价值.     

彩色多普勒超声对法洛四联症手术指导意义的评价

目的　探讨彩色多普勒超声对法洛四联症 (TOF)的诊断价值和对手术的指导意义。方法　 94例TOF均行根治或姑息性手术 ,术前行彩色多普勒超声心动图检查 ,结果与手术或心血管造影检查对照。结果　超声心动图可很好的显示TOF的病理特征 ,包括室间隔缺损的位置及大小、主动脉骑跨率、右室结构、肺动脉及其分支的发育情况 ;超声心动图测量的降主动脉内径与左右肺动脉内径之和的比值 [(RPA LPA) /DAO] ,与心血管造影检查的McGoon比有良好的相关性 ;超声计算的左室舒张末期容积指数可反映左室发育情况。结论　彩色多普勒超声心动图检查能显示TOF全部畸形 ,左室舒张末期容积指数和 [(RPA LPA) /DAO]值可作为选择TOF手术方式的参考值。     

法洛四联症产前超声诊断及其新的认识

目的 总结产前超声筛查法洛四联症(TOF)的经验并分析其声像图特征,以期提高产前检出率.方法 回顾复习了我院近6年产前诊断的10例TOF胎儿,并与尸检和(或)产后超声心动图检查的结果进行比较.结果 10例TOF,其中7例为单纯性,产前超声诊断全部正确;3例为复合性,合并有肺动脉闭锁、右位主动脉弓及肺动脉瓣缺如,产前只正确诊断1例TOF合并肺动脉闭锁,其他两例合并畸形皆漏诊.结论 左、右室流出道断面能够显示法洛四联症的声像图特征,对单纯性TOF诊断很有用;三血管及三血管气管断面对于诊断TOF合并肺动脉瓣缺如及右位主动脉弓(复杂型TOF)极其重要.TOF常合并心内或心外畸形或染色体异常,必须全面地进行超声检查,以免漏诊.     

产前超声诊断胎儿法洛四联症的价值及体会

目的探讨胎儿超声心动图对单纯及复杂法洛四联症(TOF)的产前诊断价值。方法回顾性分析23例经超声心动图诊断为胎儿TOF的声像图表现及随访资料。结果单纯TOF 19例,表现为室间隔缺损、肺动脉狭窄和主动脉骑跨。复杂TOF 4例,包括:①TOF合并肺动脉闭锁2例:表现为右室流出道为盲端,肺动脉细窄、不易显示,肺动脉及动脉导管内逆向血流;②TOF合并肺动脉瓣缺如2例:表现为肺动脉主干、分支瘤样扩张,肺动脉瓣反流等。结论超声心动图产前诊断胎儿TOF及其分型具有较大的临床价值,并可动态观察其右室流出道梗阻、肺动脉及其瓣膜的发育及进展情况。     

64层螺旋CT诊断小儿法洛四联症

目的探讨64层螺旋CT心血管成像技术对小儿法洛四联症(TOF)的诊断价值,并与超声心动图(ECG)对比。方法对26例临床诊断TOF患儿进行64层螺旋CT增强心脏检查,并用多平面重建(MPR)、最大密度投影(MIP)及容积成像(VR)进行图像重建。所有病例均作ECG对照,以24例手术为金标准比较64层螺旋CT和ECG对心血管畸形的诊断准确率。结果手术证实的心血管畸形152处,64层螺旋CT的诊断准确率93.42%,明显高于ECG的诊断准确率69.74%(χ2=14.18,P<0.01)。对手术证实的18例小儿TOF,64层螺旋CT的诊断准确率达到100%。64层螺旋CT对TOF伴发畸形的诊断准确率为86.67%,ECG为33.33%(χ2=17.78,P<0.01)。结论64层螺旋CT对心血管畸形的诊断准确率优于ECG,能准确诊断小儿TOF,同时能评价肺动脉和冠状动脉,对术前手术方案的制定具有重要价值。     

超声心动图和螺旋CT诊断复杂型先天性心脏病的对比分析

目的 探讨超声心动图和螺旋CT在复杂型先天性心脏病诊断中的价值.方法 对97例经临床及经胸超声心动图(TTE)诊断为复杂型先心病的患者进行64排螺旋CT检查,与导管法心血管造影检查和手术结果进行对照.结果 97例患者中,TTE诊断符合率90.2%,螺旋CT诊断符合率92.5%,两者比较差异无统计学意义(P>0.1);TTE对心内畸形的诊断准确率为99.2%,高于螺旋CT的87.5%,两者比较差异有统计学意义(P<0.005);而螺旋CT对心外及大血管与房室连接的诊断准确率为99.0%,优于TTE的78.6%,两者比较差异有统计学意义(P<0.005).TTE与螺旋CT两者结合,可将诊断准确率提高为99.1%.结论 TTE对复杂型先天性心脏病有重要的诊断价值,尤其对心内畸形诊断准确率高,而螺旋CT对心外及大血管与房室连接关系诊断准确率较高.将TTE和螺旋CT相结合,可大大提高对各种复杂先心病的诊断准确率.     

超声心动图和螺旋CT诊断复杂型先天性心脏病的对比分析

目的 探讨超声心动图和螺旋CT在复杂型先天性心脏病诊断中的价值.方法 对97例经临床及经胸超声心动图(TTE)诊断为复杂型先心病的患者进行64排螺旋CT检查,与导管法心血管造影检查和手术结果进行对照.结果 97例患者中,TTE诊断符合率90.2%,螺旋CT诊断符合率92.5%,两者比较差异无统计学意义(P>0.1);TTE对心内畸形的诊断准确率为99.2%,高于螺旋CT的87.5%,两者比较差异有统计学意义(P<0.005);而螺旋CT对心外及大血管与房室连接的诊断准确率为99.0%,优于TTE的78.6%,两者比较差异有统计学意义(P<0.005).TTE与螺旋CT两者结合,可将诊断准确率提高为99.1%.结论 TTE对复杂型先天性心脏病有重要的诊断价值,尤其对心内畸形诊断准确率高,而螺旋CT对心外及大血管与房室连接关系诊断准确率较高.将TTE和螺旋CT相结合,可大大提高对各种复杂先心病的诊断准确率.     

超声心动图顺序分段诊断法与64排螺旋CT诊断肺动脉闭锁合并室间隔缺损

目的 探讨TTE顺序分段诊断法和64排螺旋CT术前诊断肺动脉闭锁(PA)伴室间隔缺损(VSD)的准确性。方法 对45例PA/VSD患儿于术前进行TTE和心脏MSCT检查, 以手术结果为金标准, 按心脏及大血管各解剖节段分别与手术所见对照, 分析比较二者诊断效能的差异性。结果 与手术结果对照, TTE和MSCT对腔静脉、肺静脉与心房连接、心室位置与房室连接、心室水平分流、心室与大动脉连接的诊断准确率均为100%;TTE与MSCT诊断肺动脉发育情况及动脉导管未闭的敏感度、特异度及准确率差异均无统计学意义(P均 >0.05);而在诊断心房水平分流方面、侧支血管及冠状动脉异常起源方面, 二者差异均有统计学意义(P均 <0.05)。结论 TTE顺序分段诊断法及MSCT均能较准确诊断PA/VSD。TTE在心内分流方面的诊断准确度优于MSCT;而在诊断主-肺动脉间侧支血管及冠状动脉起源方面, MSCT优于TTE。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia

Objective. Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia.Methods. We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n=10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 µg/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidalPco ₂ of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, andPco ₂ (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia.Results. The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter.Conclusions. Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.     

吗啡、氯胺酮联合用于术后镇痛临床观察

目的 :比较吗啡、氯胺酮联合与吗啡单独使用用于术后镇痛的临床效果。方法 :30例ASAⅠ～Ⅱ的腹部手术全麻病人随机分为两组 ,术后使用吗啡静脉自控镇痛并分别加氯胺酮静脉输注 (氯胺酮组 )和生理盐水静脉输注(生理盐水组 )。观察两组的视觉模拟评分 (VAS) ,吗啡消耗量和发生的     

达芬奇机器人和传统胸腔镜手术治疗肺部疾病的疗效

目的 评价达芬奇机器人手术（robot assisted thoracic surgery, RATS）和胸腔镜手术（video assisted thoracic surgery, VATS）治疗肺部疾病的疗效。方法 对收治的218例行达芬奇机器人和传统胸腔镜手术诊治肺部疾病的临床资料进行回顾性分析。患者自愿选择手术方式,其中RATS组98例,VATS组120例。结果 RATS组手术时间较VATS组长（P<0.01）,手术费用（P<0.05)和住院总花费（P<0.01）较VATS组多。RATS组术中失血量更少（P<0.01）,术后住院时间更短（P<0.05）。两组在中转开胸手术、总引流量、术后引流时间差异均无统计学意义（P>0.05）。肺癌患者中RATS组术后住院时间更短（P<0.01）,住院总花费更高（P<0.01）。非肺癌患者RATS组手术时间更长（P<0.01）,住院总花费更高（P<0.01）;RATS组术中失血量更少（P<0.05）,术后住院时间更短（P<0.05）。结论 达芬奇机器人辅助胸腔镜手术是安全有效的,其在术中出血量和术后住院时间具有明显的优势,而其他指标在机器人手术中无明显优势。     

内镜超声弹性成像的原理与临床应用

内镜超声（endoscopic ultrasound, EUS）已成为消化系统疾病的重要诊断手段之一。内镜超声弹性成像（EUS Elastography, EUS E）能够实现胃肠道及其毗邻器官的可视化弹性评估,提高了EUS对消化道疾病诊断能力。此外,EUS E还可为内镜超声引导下细针穿刺（EUS fine needle aspiration, EUS FNA）技术提供辅助信息,从而提高疾病诊断和组织学获取的准确性。本文主要就EUS E的原理、方法和临床应用作一综述。