扩张型心肌病超声心动图诊断价值

目的?探讨扩张型心肌病患者二维超声心动图及多普勒超声心动图的表现.方法?选取30例扩张型心肌病患者行超声检查的超声表现资料进行分析.结果?扩张型心肌病超声心动图可见心腔扩大、普遍性弥漫性室壁运动减弱、瓣膜反流、射血分数下降,偶见心腔内血栓.结论?正确评估病变的程度、心功能状态、疾病的预后和治疗效果.     

介入治疗缺血性卒中的冠心病患者危险因素研究

目的:研究经皮冠状动脉介入治疗合并缺血性卒中史的冠心病患者发生不良事件的危险因素.方法:选择收治的合并缺血性卒中史的冠心病患者40例作为研究组,另选择同期收治的40例不合并缺血性卒中史的冠心病患者作为对照组.对比发生不良事件的危险因素进行Logistic分析.结果:左室射血分数降低、吸烟是合并缺血性卒中史冠心病患者发生不良事件的主要危险因素,差异具有统计学意义(P<0.05).结论:经皮冠状动脉介入治疗合并缺血性卒中史的冠心病患者发生不良事件的主要危险因素是左心室射血分数降低、吸烟,所以临床应结合具体情况,予以针对性的预防措施.     

超声心动图与心脏磁共振对心肌病的诊断价值

目的 比较超声心动图和心脏磁共振成像(MRI)诊断肥厚型心肌病的价值.方法 以137例肥厚型心肌病疑似患者作为研究对象,患者先接受三维超声心动图评价,随后接受心脏MRI检查,比较超声心动图和心脏MRI对肥厚型心肌病确诊病例的检出率.结果 根据病例纳入和排除标准,最终共有96例肥厚型心肌病患者纳入本研究,其中男性70例(...     

超声心动图诊断心尖肥厚型心肌病的价值

目的 分析心尖肥厚型心肌病(AHCM)患者的超声心动图声像,探讨超声心动图诊断AHCM的价值.方法 AHCM组20例和健康对照组20例分别进行超声心动图检查,分析比较心尖部心肌厚度,左房径、左室径和左室射血分数等参数.结果 与对照组相比,AHCM患者心尖部心肌显著增厚,左房径增大(P＜0.05),左室径与射血分数与对照组相比差异无统计学意义.结论 超声心动图是诊断AHCM准确、易行的无创方式.     

实时三平面成像技术对酗酒者左室结构和功能的研究

目的应用实时三平面成像技术评价无明显症状酗酒者左室的结构和功能状态。方法酗酒组31例及对照组30例。常规超声心动图测量左室舒张末期室间隔厚度(IVS)、左室后壁厚度(LVPW)及左室内径(LV),收缩末期左房内径(LA)、左室射血分数(LVEF),左室短轴缩短率(LVFS),每搏输出量(SV)、心输出量(CO);应用实时三平面成像测量左室舒张末容积指数(EDVI),左室收缩末容积指数(ESVI)、左室射血分数(LVEF)。结果左心功能结果分析LVEF酗酒组与对照组间无明显差异,EDVI,ESVI均较对照组增大,两组间差异有统计学意义。结论无症状酗酒者虽然其左室射血分数得以保持,但早期已经出现左室的轻微扩张。应用实时三平面成像技术评价酗酒者左心功能异常较传统超声更敏感。     

心酰胺治疗老年心力衰竭的临床观察

目的 讨论心酰胺在治疗老年心力衰竭的临床疗效.方法 将102例心力衰竭患者随机分为两组.对照组采用常规治疗;治疗组在常规治疗的基础上加用心酰胺120～150 mg加入5%葡萄糖注射液200 ml中静脉输注,1次/d,10～15 d为1个疗程.结果 治疗组治疗后每搏输出量、射血分数、心排指数均较治疗前明显改善(P<0.01);与对照组治疗后比较每搏输出量、射血分数差异有统计学意义(P<0.05).结论 心酰胺能明显增强心力衰竭患者的左室收缩功能和泵血功能.     

超声心动图对急性肺栓塞诊断的临床应用价值

目的 观察超声心动图在急性肺栓塞诊断中的临床应用价值.方法 应用超声心动图观察34例急性肺栓塞患者(研究组)右房室内径、主肺动脉内径、左肺动脉内径、右肺动脉内径、右室舒张末期容积、右室射血分数、三尖瓣返流量和速度、肺动脉收缩压等指标,并以34例同年龄的心血管疾病及其危险因素相似的志愿者作为对照组.结果 研究组患者中直接检出右房、右室附壁血栓各1例,主肺动脉及左、右肺动脉主干血栓7例.研究组患者右房长径、右房横径、右室横径、主肺动脉内径、右肺动脉内径、左肺动脉内径及右室舒张末期容积均大于对照组(P＜0.01);其肺动脉收缩压高于对照组,而右室射血分数低于对照组(P＜0.01).结论 超声心动图可无创评估急性肺栓塞患者的右心负荷,能检出肺动脉内大块血栓.     

心电图联合超声心动图在区分心肌病类型中的临床应用价值研究

目的探讨心电图联合超声心动图在区分心肌病类型中的临床应用价值。方法选取我院收治的60例扩张型心肌病患者（A组）及56缺血性心肌病患者（B组）为研究对象,均予以心电图联合超声心动图检查,对比超声数值差异、形态变化差异及瓣膜返流情况。结果 1A组各腔室扩大较B组明显,且A组左心室射血分数、二尖瓣E点至室间隔间距及每搏量等指标下降程度均高于B组患者,组间对比差异明显（P〈0.05）;2A组RV6/RMAX为（3.25±0.72）,明显高于B组的（1.10±0.53）,组间对比差异明显（P〈0.05）;3A组形态变化重点表现于弥漫性运动障碍、左室球形,其百分比分别为100.0%和95.0%;B组形态变化重点表现为室壁节段性运动障碍、室壁矛盾运动及左室圆拱门形,其百分比分别为89.3%、94.6%和87.5%,对比差异明显（P〈0.05）;4A组存在多重瓣膜返流情况,B组返流则集中于二尖瓣膜,主动脉瓣膜、肺动脉瓣膜及三尖瓣等返流率较低,对比具有统计学意义（P〈0.05）。结论心电图联合超声心动图对提高心肌病诊断准确性具有积极意义,值得临床推广使用。     

超声诊断心肌致密化不全心肌病的价值

目的探讨彩色多普勒超声心动图诊断心肌致密化不全心肌病的价值。方法采用philipsHD11-XE彩色多普勒超声及IE33彩色多普勒超声心动图诊断仪,探头频率为3.5~7.0MHz,重点观察心肌过度隆突的肌小梁、心肌厚度、心腔大小、射血分数等。结果 39例心肌致密化不全心肌病均经超声心动图确诊,均为左心室单独受累。彩色多普勒均显示心内膜面由突出心室腔的多发、粗大、交错排列的肌小梁及小梁隐窝组成,均有不同程度的舒张及/或收缩功能减退。1例合并小梁隐窝内血栓。结论超声心动图诊断心肌致密化不全心肌病具有重要临床价值。     

超声心动在缺血性心肌病与扩张性心肌病鉴别诊断中应用价值

目的 通过对缺血性心肌病与扩张性心肌病超声资料分析,探讨超声心动在这两种疾病鉴别诊断中的应用价值.方法 利用超声心动图对43例患者进行检查:其中扩张性心肌病组(n=20),缺血性心肌病组(n=23),分别获得心脏结构、血流和功能的多项参数.结果 上述两组疾病超声心动检查均有一定的相似之处,同时它们又有显著性差异.结论 超声心动检查对这两组疾病的鉴别诊断以及评价预后上都提供了重要的临床价值.     

“How many times must a man look up before he can really see the sky?” Rheumatic cardiovascular disease in the era of multimodality imaging

Cardiovascular involvement in rheumatic diseases (RD) is the result of various pathophysiologic mechanisms including inflammation, accelerated atherosclerosis, myocardial ischemia, due to micro- or macro-vascular lesions and fibrosis. Noninvasive cardiovascular imaging, including echocardiography, nuclear techniques, cardiovascular computed tomography and cardiovascular magnetic resonance, represents the main diagnostic tool for early, non-invasive diagnosis of heart disease in RD. However, in the era of multimodality imaging and financial crisis there is an imperative need for rational use of imaging techniques in order to obtain the maximum benefit at the lowest possible cost for the health insurance system. The oligo-asymptomatic cardiovascular presentation and the high cardiovascular mortality of RD necessitate a reliable and reproducible diagnostic approach to catch early cardiovascular involvement. Echocardiography remains the routine cornerstone of cardiovascular evaluation. However, a normal echocardiogram can not always exclude cardiac involvement and/or identify heart disease acuity and pathophysiology. Therefore, cardiovascular magnetic resonance is a necessary adjunct complementary to echocardiography, especially in new onset heart failure and when there are conflicting data from clinical, electrocardiographic and echocardiographic evaluation of RD patients.     

硝普钠联合硝酸甘油治疗缺血性心肌病心衰疗效观察

目的:观察硝普钠联合硝酸甘油对缺血性心肌病所致心衰患者的疗效及不良反应。方法:将60例住院缺血性心肌病心衰患者随机分为两组,A组40例在心衰常规治疗基础上加用硝普钠和硝酸甘油静滴治疗,共3天;B组20例为心衰常规治疗加用硝普钠静滴治疗,共3天,观察治疗前后各组及组间心功能分级、血压、心率及超声心动图变化。结果:各组治疗后较治疗前心功能均有不同程度的改善,但硝普钠联合硝酸甘油组更为明显,差异有显著性,联合治疗组除个别患者出现头痛外,其余无明显不适。结论:硝普钠联合硝酸甘油能更迅速改善缺血性心肌病心衰患者心功能且副作用少。     

小儿感染性心内膜炎69例临床分析及超声心动图的临床应用价值

目的:探讨小儿感染性心内膜炎(IE)的临床特点及血培养、超声心动图在IE中的诊断价值。方法:回顾分析吉林大学第一医院儿科1998年1月～2007年12月确诊的69例IE患儿的临床特点。结果:①69例IE患儿中,52例发生在先天性心脏病的基础上,5例发生在风湿性心脏病的基础上,3例发生在扩张性心肌病的基础上,1例发生在肥厚性心肌病的基础上,8例无基础心脏病。②临床主要表现:发热(67例,97.1%)、心功能不全(46例,66.7%)、镜下血尿(33例,47.8%)、脾肿大(26例,37.7%)。③血培养23例阳性,阳性率35.4%,致病微生物中以草绿色链球菌(9例)及β溶血性链球菌(5例)为最多见,条件致病菌5例。超声心动图检查64例患儿(92.7%)发现赘生物,阳性率仅次于发热表现。结论:小儿发生IE的基础心脏病中,先天性心脏病较多见,其次为风湿性心脏病。血培养、超声心动图有助于IE的诊断,且超声心动图更具有临床实用意义。     

Left ventricle hydatid cyst mimicking acute coronary syndrome

Cardiac echinococcosis rarely mimics acute coronary syndrome. The diagnosis of cardiac hydatid cyst might be difficult on account of varying clinical presentations and nonspesific symptoms.?A 75-year-old female was admitted to our hospital with typical chest pain. The patient had no history of previous cardiac symptoms or any illness leading to heart disease. Her ECG revealed ischemic changes. However, her coronary angiography revealed noncritical plaques in the left anterior descending artery. The diagnosis of cardiac echinococcosis was identified using echocardiography, computed tomography and magnetic resonance imaging. The patient was referred to cardiac surgery for resection of the cyst; however, she refused surgery. Albendezol 800 mg/day was prescribed.     

脑血流灌注显像与磁共振灌注显像在早期短暂性脑缺血发作诊断中的对比研究

目的:探究脑血流灌注显像与磁共振灌注显像在早期短暂性脑缺血发作(TIA)中诊断效果的对比。方法:选取在医院检查确诊的120例早期TIA患者,测量患者血压、脉搏、血氧饱和度以及血常规检查,并对其分别进行磁共振灌注显像及脑血流灌注显像,比较两种灌注显像方法的阳性检出率、病灶主要分布以及TIA早期卒中风险预测工具(ABCD2量表)评分。结果:脑血流灌注显像阳性检出率为92.50%,其中单侧和双侧病变阳性检出率分别为90.32%和94.83%;磁共振灌注显像阳性检出率为72.50%,其中单侧和双侧病变阳性检出率分别为74.19%和70.69%,单侧和双侧病变两种诊断方法阳性检出率比较差异有统计学意义(x^2=3.245,x2=6.582;P<0.05)。脑血流灌注显像病灶主要分布在额叶、颞叶、顶叶、枕叶及基底节和丘脑,磁共振灌注显像病灶主要分布在额叶、颞叶、顶叶和枕叶部位;在阴性患者中,脑血流灌注显像ABCD2评分和磁共振灌注显像相比,差异无统计学意义(t=2.846,P=0.064);在阳性患者中,脑血流灌注显像较磁共振灌注显像ABCD2评分高,且差异有统计学意义(t=3.547,P<0.05)。结论:脑血流灌注显像比磁共振灌注显像对早期TIA的诊断更具优势。     

成年人心血管外科术后并发缺血性脑卒中的诊疗

目的 探讨成年人心血管外科术后并发缺血性脑卒中的早期诊断和治疗方法.方法 回顾性分析24例心血管外科术后并发缺血性脑卒中患者的临床资料.在循环、呼吸稳定的前提下,尽早检查以判定缺血性脑卒中类型,密切监测生命体征,注意意识、瞳孔、呼吸深浅及频率、四肢活动的变化.给予降温、脱水、抗凝、调脂、营养脑神经、β受体阻滞剂等药物治疗.治疗过程中维持水、电解质及酸碱平衡.结果 24例患者中男性占66.7％（16/24）.术后早发性缺血性脑卒中6例,术后迟发性缺血性脑卒中18例.冠状动脉旁路移植术12例,单纯瓣膜手术8例,夹层手术2例,其他手术2例.在院死亡2例,病死率8.3％（2/24）.结论 成年人心血管外科术后具有缺血性脑卒中临床表现者应尽早明确诊断,严密的监护与及时全面的治疗是缺血性脑卒中治疗的关键.     

Percutaneous closure of patent foramen ovale, as secondary prevention of cryptogenic cerebral event

In patients with patent foramen ovale and cryptogenic stroke, the risk of recurrent event is about 4-5% yearly, despite of the antithrombotic treatment. Transcatheter closure of patent foramen ovale has been shown to decrease risk of recurrence. This report summarizes the first experiences in Hungary and the medium term follow up of our patients. Thirty-three patients were selected for closure. All the patients had at least one ischemic stroke, transitory ischemic attack or peripheral embolus. In 31 of them the stroke was confirmed by computer tomographic or magnetic resonance imaging. Patent foramen ovale with right-to-left shunt was diagnosed by transesophageal echocardiography. Transcatheter closure was performed under fluoroscopic and transesophageal echocardiographic control. Closure was successful in 31 patients. Passage of atrial septum did not succeed in two cases. An AV fistula at puncture site was the only early complication. There was no late complication. No device dislocation, periprocedural arrhythmia or embolic event was detected. No residual shunt could be found. During follow up of 11.3 (1-30) months no recurrent embolus was detected. Transcatheter closure of patent foramen ovale is a safe and efficient procedure to decrease the risk of recurrent ischemic events.     

子宫腺肌病的磁共振成像诊断研究

目的:研究分析磁共振成像应用子宫腺肌病的诊断效果。方法:30例子宫腺肌病患者均在本院手术治疗(2017年2月~2018年2月),同时已经得到手术病理确认,将以上所有患者的磁共振影像结果进行回顾性分析。结果:①17例弥漫型,磁共振影像为:子宫内膜结合范围存在弥漫型增厚现象,另外子宫显现存在明显增大,T1WI信号为等信号,而T2WI则显示为雪花状;②13例局灶型,磁共振影像为:子宫体以及宫底存在局限性增大,T1WI信号为等信号,而T2WI则显示为斑点形态高信号影;③30例患者增强扫描后发现,强化的程度和时间都迟于正常子宫肌层,另外,在病灶中心以囊样体现,同时出血位置不强化。结论:磁共振成像技术在鉴别子宫腺肌病中具有诊断结果可靠性、准确性等优势,尤其在鉴别和区分其他内膜疾病中的优势更加显著,对提升医生的诊断准确性、治疗方向有积极重要的意义。     

Adult height and the risk of cardiovascular disease among middle aged men and women in Japan

An inverse association between height and risk of cardiovascular disease has been reported, but the evidence is limited for stroke subtypes, in particular in Asian populations. Further, few studies have examined how socioeconomic status in adulthood influence the relationship between height and risk of cardiovascular disease. This study examined the association between height and risks of stroke and coronary heart disease, and whether education level, an indicator of adult socioeconomic status, modify the effect of height on those risks, within a cohort of the Japan Public Health Center-based Prospective Study (JPHC Study). The hazard ratios for the incidence of cardiovascular disease associated with height were calculated by a 16-year follow-up of 15,564 Japanese men and women, aged 40–59. The hazard ratios were adjusted for age, gender, area, education, occupation and cardiovascular risk factors. Height was inversely associated with risks of total stroke, either hemorrhagic or ischemic stroke but not with coronary heart disease. The adjusted hazard ratios (95% confidence interval (CI)) of total stroke, hemorrhagic stroke, and ischemic stroke for a 1 SD height increments were 0.82 (95% CI: 0.74, 0.90), 0.80 (95% CI: 0.70, 0.92), and 0.83 (95% CI: 0.73, 0.95), respectively. No multiplicative interaction was observed between height and education level on stroke risk. Short stature was associated with increased risk of total stroke, either hemorrhagic or ischemic stroke, independent of adult socioeconomic status and cardiovascular risk factors, but not with risk of coronary heart disease in Japanese men and women.