磁共振成像诊断先天性心脏病的研究

磁共振成像（MRI）技术的快速发展，为评价先天性心脏病提供了一种崭新的无创手段。心电门控技术、快速成像技术以及磁共振血管成像等新技术的出现，使MRI能够准确地诊断先天性心脏病的形态学异常，包括心脏大血管位置及连接关系、心内结构异常、肺血管和主动脉畸形等；相位编码技术以及电影成像的应用，使MRI可以进行血流动力学评价，包括血液流速、压力阶差、血流分布比例以及瓣膜反流情况等。该文就MRI对先天性心脏病的形态学诊断以及相关的血流动力学检测两方面进行综述。     

磁共振成像在儿童肿瘤中的应用与进展

磁共振成像(MRI)具有无电离辐射、高度软组织分辨率及多平面成像的特点,已广泛应用于儿童肿瘤诊断。常规MRI成像技术主要提供肿瘤的大体形态学信息,无法显示肿瘤的生理及病理变化。近年来随着MRI硬件及软件的快速发展,一些功能成像技术开始应用于临床,并成为儿童肿瘤MRI应用的一个重要发展方向。这些功能成像技术包括MR灌注成像、弥散加权成像、波谱成像技术、磁敏感加权成像技术。这些新技术可以提供肿瘤微观结构信息,结合常规MRI技术,将会对儿童肿瘤的诊治及随访带来更多的帮助。     

磁共振弥散张量成像评价新生儿脑损伤

磁共振弥散张量成像技术（diffusion tensor imaging,DTI）是一种无创性的磁共振成像方法,通过计算表观弥散系数、各向异性系数、相对各向异性系数、纵向弥散系数等参数能够定量评价脑组织正常结构、脑发育状况与脑损害,是目前唯一可在活体上观察脑白质纤维走行及微结构变化的成像技术.本文对其在评价新生儿脑损伤与脑发育中的应用进展予以介绍.     

儿童暴发性心肌炎的早期诊断及治疗进展

暴发性心肌炎是一种以急性血流动力学障碍为主要表现的心肌炎,临床表现多样且病死率极高。暴发性心肌炎早期诊断需依靠血清学指标、心电图、超声心动图等进行综合分析,心脏磁共振成像检查在心肌炎诊断中也具有很好的应用价值。传统的暴发性心肌炎治疗,包括对症支持、抗病毒及免疫疗法等,但对危重患儿往往难以奏效。体外膜肺氧合技术(ECMO)的开展,大大提高了儿童暴发性心肌炎的抢救成功率,成为救治儿童暴发性心肌炎的可靠手段。文章综述目前儿童暴发性心肌炎的诊断及最新治疗进展。     

小儿肺隔离症的临床诊疗进展

肺隔离症是一种先天性肺畸形,从解剖学的角度进行分类,包括叶内型肺隔离症和叶外型肺隔离症。影像学检查在肺隔离症的诊断中起着非常重要的作用,包括X线片、支气管碘油造影、彩色多普勒超声、磁共振成像和数字减影血管造影,而CT检查是目前最为常见且首选的诊断方式。手术仍然是肺隔离症的首选治疗方案。随着微创外科理念的普及,三孔胸腔镜、单孔胸腔镜以及机器人辅助肺叶或肺段切除术已在逐步探索和实践的过程中。本文就近年来小儿肺隔离症临床诊治进展作一综述,以期为小儿肺隔离症的临床诊疗提供参考。     

InSurE技术在新生儿的临床应用进展

肺表面活性物质缺乏及肺结构发育不成熟可引起新生儿呼吸窘迫综合征.肺表面活性物质、非侵袭性通气方式如经鼻正压通气及二者联合的InSurE技术(气管插管-肺表面活性物质-拔管)是目前新生儿呼吸窘迫综合征防治的重要方法.该文对三者在新生儿呼吸窘迫综合征的应用概况及研究进展,尤其是InSurE技术的临床应用优势及发展进行综述.     

儿童癫(癎)的磁共振成像研究进展

随着MRI技术的进展,MRI在儿童癫(癎)的定位、定性诊断以及术前脑功能评估等方面发挥越来越重要的作用.MRI研究进展主要表现在以下几个方面:1.传统MRI形态学成像中高场强MR仪、相控阵线圈以及定量技术的应用;2.MRI波谱成像、弥散成像和弥散张量成像以及血氧水平依赖成像等功能、代谢水平成像;3.MRI与正电子发射断层成像以及脑磁图等技术的联合应用等.     

Recent research on extracorporeal carbon dioxide removal北大核心CSCD

体外二氧化碳去除技术是基于肺外气体交换的人工肺辅助技术,可有效清除二氧化碳,并提供有限的氧合,是近年来继机械通气、体外膜肺氧合等技术之后发展起来的治疗高碳酸血症的有效技术之一,具有广泛的应用前景。该文具体阐述体外二氧化碳去除技术的发展、工作原理及优势、分类、并发症及临床应用等,旨在为临床上进行体外二氧化碳去除提供一种新选择。     

小儿单肺通气技术新进展

正单肺通气是防止术侧肺分泌物或血液进入健侧肺,术中支气管导管只利用一侧肺(非手术侧)进行通气的方法,可确保气道通畅及防止双肺交叉感染,同时为手术创造良好的视野条件。目前随着胸外科手术的发展,单肺通气技术的提高和纤维支气管镜的普及,单肺通气这项技术在小儿中的应用越来越广泛,甚至应用在婴幼儿和新生儿胸科手术中~([1])。目前小儿单肺通气的技术主要有4种:单腔支气管     

儿童急性暴发性心肌炎诊治进展

急性暴发性心肌炎(acute fulminant myocarditis,AFM)起病急骤,可在短期内进展为心力衰竭与心源性休克而致死.儿童AFM早期诊断困难,临床首发以心外消化道与呼吸系统症状多见,主要表现为腹痛、呕吐、咳嗽、气促等,易误诊与漏诊.新型的心肌损伤标志物和心肌磁共振成像技术在早期诊断AFM有一定的临床价值.紧急床旁临时心脏起搏、体外膜肺氧合和床旁连续血液净化等生命支持技术的发展降低了儿童AFM的病死率.     

Monitoring of Regional Lung Ventilation Using Electrical Impedance Tomography After Cardiac Surgery in Infants and Children

Electrical impedance tomography (EIT) is a noninvasive method to monitor regional lung ventilation in infants and children without using radiation. The objective of this prospective study was to determine the value of EIT as an additional monitoring tool to assess regional lung ventilation after pediatric cardiac surgery for congenital heart disease in infants and children. EIT monitoring was performed in a prospective study comprising 30 pediatric patients who were mechanically ventilated after cardiac surgery. Data were analyzed off-line with respect to regional lung ventilation in different clinical situations. EIT data were correlated with respirator settings and arterial carbon dioxide (CO₂) partial pressure in the blood. In 29 of 30 patients, regional ventilation of the lung could sufficiently and reliably be monitored by means of EIT. The effects of the transition from mechanical ventilation to spontaneous breathing after extubation on regional lung ventilation were studied. After extubation, a significant decrease of relative impedance changes was evident. In addition, a negative correlation of arterial CO₂ partial pressure and relative impedance changes could be shown. EIT was sufficient to discriminate differences of regional lung ventilation in children and adolescents after cardiac surgery. EIT reliably provided additional information on regional lung ventilation in children after cardiac surgery. Neither chest tubes nor pacemaker wires nor the intensive care unit environment interfered with the application of EIT. EIT therefore may be used as an additional real-time monitoring tool in pediatric cardiac intensive care because it is noninvasive.     

早产儿脑损伤的诊断与治疗

脑损伤是导致早产儿远期神经系统伤残和预后不良的主要原因.早产儿脑损伤临床表现不典型、症状缺乏特异性,甚至无明显临床症状,诊断主要依赖颅脑影像学检查和脑功能测定.本文对早产儿脑损伤的诊治要点进行了较为详尽的介绍,以有助于临床医师加强对该病的认识、改善患儿预后.     

Assessment of lung function in children by cross-sectional imaging: techniques and clinical applications

Imaging techniques are indispensable for diagnosis and follow-up of paediatric pulmonary diseases. In the past, interest was focused on morphological aspects of pulmonary tissue. With the development of novel CT and MRI techniques, functional pulmonary imaging became available. In this review, the new techniques of cross-sectional functional imaging of the lung are presented and the value of these methods for investigating paediatric pulmonary diseases and their potential clinical applications are discussed.     

Clinical applications of pulmonary function and graphics

Pulmonary function and mechanics testing are emerging as a valuable tool to aid clinical decision making in the management of ventilated infants. Although there are as yet no published randomized controlled trials to suggest that pulmonary mechanics testing reduces mortality or morbidity, it has – in conjunction with clinical, radiological, and blood gas monitoring – changed neonatal ventilation from ‘good judgement’ to ‘informed judgement’. It is not surprising that pulmonary graphics are increasingly being used as a tool for assessment of patient status, therapeutic evaluation, and management guidance of infants who become dependent on ventilator. A working knowledge of pulmonary graphics also improves understanding of pulmonary physiology and pathophysiology, and their responses to mechanical ventilatory support. Recent advances in microprocessor technology for on-line analysis of pulmonary mechanics have made such evaluations easily available for bedside clinical application.     

The development of functional imaging in the diagnosis, management and understanding of childhood brain tumours

Imaging plays a fundamental role in the management of children with brain tumours. A series of new techniques, commonly grouped under the heading functional imaging, promise to give information on the properties and biological characteristics of tissues thereby adding to the structural information available from current imaging. The EPSRC funded a workshop to bring together clinicians from the UK Children's Cancer Study Group and scientific experts in the field to identify clinical problems in childhood brain tumours that may be addressed by functional imaging and to develop a clinical test bed for applying, evaluating and developing this new technology. The presentations and discussion sessions from the workshop are summarised and a review of the current 'state of the art' for this rapidly developing area provided. A key output of the workshop was agreement on a series of hypotheses which can be tested in carefully designed clinical studies.     

电磁导航技术在现代儿科介入呼吸病学的应用

电磁导航支气管镜技术凭借其具有实时导航、精准定位的优势在外周病变的活检、纵隔和肺门淋巴结病变的活检及需要肺部、气道、纵隔精确定位的呼吸介入术中具有很高的临床应用价值,经过十多年的临床实践,认为该技术具有安全、可靠、微创、高效等优点,更重要的是适合儿童使用。该技术在儿科呼吸领域的引入和推广,将推动儿科呼吸介入诊疗的进一步发展。     

体外循环对先天性心脏病术后患儿脑认知功能的影响

先天性心脏病(CHD)是婴幼儿最常见的先天性畸形疾病。随着医疗水平显著提高,CHD患儿出生后的生存率明显提升。然而,CHD术后患儿诸多并发症又是另一种挑战,如心力衰竭、心律失常、肺动脉高压及脑认知功能发育障碍等,其中关于脑认知功能障碍的这一并发症逐渐得到广大学者的认识和重视。目前,已经通过细胞分子学方法、磁共振成像技术、光学成像技术、脑电活动监测技术及神经发育量表等研究方法来探索体外循环对CHD患儿脑认知功能的影响。患儿心脏术后会出现不同程度的脑认知功能障碍,这与体外循环相关的全身炎性反应、脑缺血再灌注损伤、体外循环时间、主动脉阻断时间、深低温停循环时间、温度的动态变化、血液稀释程度及血气管理策略等因素密切相关。现就体外循环对CHD术后患儿脑认知功能的影响进行综述,为临床诊疗提供参考,以改善CHD患儿的预后。     

Interventional magnetic resonance imaging guided aspiration and biopsy of a cystic midbrain tumor.

Interventional magnetic resonance imaging defines the intraoperative application of magnetic resonance imaging technology, permitting the surgeon to work in an open magnetic field. The application of this technology to pediatric neurosurgery allows precise intraoperative localization of pathology, real-time assessment of the anatomical consequences of surgical and anesthetic interventions, accountability of brain shifts, confirmation of the exact site of biopsy or completeness of lesion removal, and immediate identification of some intraoperative and early postoperative complications. We present the case of a young boy with a cystic left midbrain tumor who underwent interventional magnetic resonance imaging guided aspiration and biopsy to illustrate the surgical advantages of this technology.     

超声评估先天性心脏病心功能的研究进展

近年来,血流频谱多普勒、组织多普勒、应变与应变率显像、斑点追踪和速度向量成像等超声技术在先天性心脏病整体及局部心功能评估中的应用越来越广泛,其自身技术特性在不同类型先天性心脏病围手术期心功能评估中各有优势与缺陷.该文拟结合近几年国内外最新的临床研究成果对此作一综述,以期有助于小儿超声心动图技术的合理选择和应用,进一步指导临床用药、手术方案的制定和心功能的近、远期预后评估.     

经皮肺动脉瓣植入术在肺动脉瓣反流患者中的临床应用

经皮肺动脉瓣植入术(PPVI)在我国作为一种新兴的技术,开展相对较晚,但随着我国医疗水平的不断提高以及临床对于右心室流出道梗阻的先天性心脏病患者术后出现重度肺动脉瓣反流的不断重视,PPVI在我国得到了飞速发展。近十几年来,欧美国家已在临床成熟应用PPVI,相对于传统外科手术而言其具有微创、可重复性、术后疗效好等优点。现对PPVI在肺动脉瓣反流患者中的临床应用进行叙述。