超声预测支架置入术后颈动脉扩张效果的价值

目的探讨术前超声预测缺血性脑卒中患者颈动脉支架置入术(CAS)后颈动脉狭窄改善情况的方法与价值。方法回顾性分析CAS患者64例临床基线资料及术后1年颈动脉狭窄改善率(IRS)与术前12项颈动脉超声检测指标的皮尔逊积矩相关系数,并建立CAS后IRS的超声预测模型。结果术后1年无1例死亡。Pearson相关性分析显示,术后1年IRS与临床转归明显相关(P0.01)。不稳定斑块积分比值(r=-0.520,P=0.000)、斑块最大偏心比值(r=-0.668,P=0.000)、最大责任斑块长度(r=-0.620,P=0.000)、最大责任斑块厚度(r=-0.563,P=0.000)、狭窄处收缩期峰值流速(r=-0.785,P=0.016)、阻力指数(r=-0.327,P=0.008)、颈动脉僵硬度指数(r=-0.811,P=0.000)与IRS呈负相关,搏动指数(r=0.363,P=0.003)、扩张系数(r=0.331,P=0.008)、顺应系数(r=0.306,P=0.014)与IRS呈正相关。逐步回归分析显示,患侧颈动脉僵硬度指数、狭窄处收缩期峰值流速及最大责任斑块厚度与CAS后IRS呈线性关系(P0.01)。结论超声多指标联合对术前评估CAS后1年颈动脉狭窄改善情况有积极作用。     

症状性颈动脉狭窄支架置入术患者不同疗效的术前超声指标分析

目的探讨症状性颈动脉狭窄支架置入术患者不同疗效的术前超声指标的差异及其与年龄的关系。方法选择2008年1月~2016年6月在河南科技大学第一附属医院住院的症状性颈动脉狭窄支架置入术患者57例,根据年龄分为青年组7例,中年组25例,老年组25例。又根据术后美国国立卫生研究院卒中量表评分改善率≥75%为显效组18例,25%~74%为有效组33例,25%为无效组6例。比较和分析各组患者术前3d内颈动脉超声指标的差异性。结果显效组、有效组及无效组不稳定斑块积分比值、斑块最大偏心比值、狭窄处峰值流速、搏动指数、阻力指数、颈动脉僵硬度指数、扩张系数及顺应系数比较,差异有统计学意义(P0.01)。老年组颈动脉僵硬度指数明显高于青年组和中年组(3.762±1.048 vs 2.313±0.409,2.707±0.656,P0.01)。颈动脉僵硬度与年龄呈正相关(r=0.670,P=0.000),且两者存在线性回归方程(y=0.075x-1.537,R2=0.448,F=44.727,P=0.000)。结论不同疗效患者术前颈动脉不稳定斑块积分比值、斑块最大偏心比值、狭窄处峰值流速、阻力指数、搏动指数、颈动脉僵硬度指数、扩张系数及顺应系数存在差异,颈动脉僵硬度指数与患者年龄存在线性关系。     

超声评分量表术前评估颈动脉狭窄支架置入术疗效的价值

目的探讨颈动脉支架置入术(CAS)对颈动脉狭窄患者疗效的术前超声量化评估方法与价值。方法选择颈动脉狭窄行CAS的患者77例,分别于CAS前3d和术后30d行颈动脉超声检查,根据手术前后狭窄部位与近段颈总动脉流速比值判断疗效,其中疗效欠佳(改善率50%)17例和疗效理想(改善率≥50%)60例。对术前不稳定斑块积分比、斑块最大偏心比、溃疡斑、斑块最大长度和厚度、面积狭窄率、血管重构、僵硬度指数、狭窄处峰值流速和阻力指数等10项超声指标不同水平测值赋值0、1、2和3分,建立超声量化评分量表(SUS)评价CAS疗效,并绘制ROC曲线判断疗效理想与否的最佳切割值。结果 77例患者CAS前10项超声指标的SUS值为2~23(9.34±4.50)分。CAS后的改善率为19%~93%,平均改善率为(60.67±19.77)%;SUS值与改善率极强度相关(r=0.802,P=0.000)。ROC曲线获得的SUS疗效最佳界值为10.5分,该量表信度系数为0.822,建构的效度检验KMO值为0.868,10项指标分析Extraction值为0.639~0.841,均0.5(χ2=162.588,P=0.000)。SUS预测CAS疗效的敏感性为88.2%,特异性为86.7%。结论术前SUS可能对评估CAS疗效有重要作用。     

颈动脉彩色多普勒对老年冠心病患者颈动脉粥样硬化斑块的评估价值

目的 探讨颈动脉彩色多普勒对老年冠心病患者颈动脉粥样硬化斑块的评估价值。方法 颈动脉粥样硬化冠心病老年患者102例根据冠状动脉造影结果分为冠脉单支病变组71例、冠脉多支病变组31例。所有患者进行颈动脉彩色多普勒，评估颈动脉粥样硬化斑块性质、斑块面积、颈动脉内膜中层厚度、颈动脉狭窄程度、颈动脉血流参数。比较不同斑块性质、不同颈动脉狭窄程度患者的1年内不良预后情况。结果 冠脉多支病变组中不稳定型斑块率(64.52%)显著高于冠脉单支病变组(32.39%,P<0.05)。冠脉多支病变组颈动脉粥样硬化斑块面积、颈动脉分叉处和颈内动脉的内膜中层厚度均显著大于冠脉单支病变组(P<0.05)。冠脉单支病变组轻度狭窄占52.11%,中度狭窄占28.17%,重度狭窄占19.72%;冠脉多支病变组轻度狭窄占19.35%,中度狭窄占51.61%,重度狭窄占29.03%;两组差异显著(Z=9.683,P<0.05)。冠脉多支病变组颈动脉收缩期峰值流速(Vs)、阻力指数(RI)均显著大于冠脉单支病变组(P<0.05)。冠脉多支病变、不稳定型斑块、颈动脉重度狭窄患者1年内心肌梗死再发、短暂...     

颈动脉超声检查斑块及其相关因素的分析

目的通过对颈动脉超声检查,探讨颈动脉斑块与相关因素之间的关系。方法运用多普勒超声对113例颈动脉硬化患者进行超声分型:脂质沉积,粥样斑块,斑块合并狭窄。测量内膜-中层厚度(IMT),阻力指数(RI),最大流速(VP)并收集资料,了解与相关因素之间的关系,指出危险因素。结果 IMT随颈动脉硬化增厚,颈动脉硬化随斑块形成而加重,管腔变窄,狭窄处阻力指数增加,流道变细流速加快。结论提出颈动脉超声检查及危险因素调查可作为老年人筛选预测脑血管疾病的高危人群的无创伤检查方法。     

超声在老年颈动脉粥样硬化狭窄诊断中的应用

目的探讨彩色多普勒超声在颈动脉粥样硬化狭窄诊断及治疗中的意义。方法选择382例缺血性脑血管病患者,有脑卒中史1 71例,无脑卒中史41例,头晕170例。彩色多普勒超声检查斑块大小、斑块回声、是否合并溃疡;测量并记录颈动脉狭窄近端、狭窄处收缩期峰值流速(PSV),舒张末期流速(EDV)。计算颈动脉狭窄率,用颈动脉狭窄率与颈动脉狭窄处PSV、EDV、颈动脉狭窄处与狭窄近端PSV/PSV行直线回归分析,推算颈动脉狭窄的彩色多普勒血流参数分级标准。结果有脑卒中史患者在低回声斑块、等回声斑块、强回声斑块、不均匀回声斑块分别为39、10、41、81例,无脑卒中史患者分别为6、6、27、2例。血管造影和超声检查对斑块溃疡诊断分别为87、94例。颈动脉狭窄处PSV≥1 45 cm/s、EDV≥45 cm/s、颈动脉狭窄处与狭窄近端PSv/PSV≥2.0和颈动脉狭窄处PSV≥260 cm/s、E)V≥88 cm/s、颈动脉狭窄处与狭窄近端PSV/PSV≥3.6可以分别作为颈动脉狭窄≥50%和颈动脉狭窄≥70%的血流参数临界点。结论超声可以作为颈动脉狭窄的第一筛选手段,PSV、EDV、颈动脉狭窄处与狭窄近端PSV/PSV是评估颈动脉狭窄程度准确的多普勒血流动力学参数。     

超声检查对脑梗死患者颈动脉粥样硬化的诊断价值分析

目的探讨超声检查对脑梗死患者颈动脉粥样硬化的诊断价值。方法选取2014年9月—2015年11月荆州市第一人民医院收治的脑梗死患者85例为观察组,同期在本院体检的健康人85例为对照组。两组受试者均进行颈动脉超声检查,观察其颈总动脉内膜-中层厚度(IMT)、颈总动脉血流指标、颈动脉斑块类型及颈动脉狭窄程度。结果观察组患者左、右侧颈总动脉IMT高于对照组,颈总动脉最大血流速度(Vmax)、最小血流速度(Vmin)、左颈总动脉收缩期峰值流速(SPV)、舒张末期容积(EDV)低于对照组,阻力指数(RI)、颈总动脉(CCA)厚度及颈动脉分叉处(BIF)厚度、搏动指数(PI)高于对照组(P0.05)。两组受试者颈动脉斑块类型比较,差异有统计学意义(P0.05);观察组患者颈动脉狭窄程度重于对照组(P0.05)。结论脑梗死患者颈动脉粥样硬化程度较重,表现为颈总动脉IMT增厚、颈总动脉血流变化,超声检查具有很好的诊断价值。     

颈动脉粥样硬化超声检查在脑梗死患者诊治中的应用

目的探讨颈动脉粥样硬化超声检查在脑梗死患者诊治中的应用。方法选择临沂市人民医院2017年10月至2019年12月期间确诊的脑梗死患者70例为超声组,选择同期体检健康者70例为对照组,对两组进行颈动脉粥样硬化超声检查,比较两组斑块检出情况,并对两组斑块形状、血流参数、颈动脉狭窄程度进行比较。结果超声组患者检测出斑块51例,对照组患者检测出斑块11例。超声组患者发病率(87.14%)明显高于对照组患者(17.14%),差异有统计学意义(P0.05)。超声组扁平斑块、软斑块、硬斑块、溃疡斑块比例显著高于对照组(P0.05)。超声组患者颈总动脉长度(CCA)、斑块长度(BIF)、搏动指数(PI)、阻力指数(RI)多于对照组,而收缩期最高流速(SPV)、舒张末期最低流速(EDV)少于对照组,差异有统计学意义(P0.05)。超声组患者颈动脉狭窄程度高于对照组患者,差异有统计学意义(P0.05)。结论颈动脉粥样硬化超声检查在脑梗死患者诊治中准确率高,可及早发现颈动脉粥样硬化,值得临床进一步推广研究。     

三维超声血管斑块定量分析诊断颈动脉斑块性质的临床价值

目的分析三维超声血管斑块定量分析诊断颈动脉斑块性质的临床价值。方法选取2019年2月—2020年6月我院超声科行颈动脉斑块性质超声检查的门诊和住院病人114例,根据术前6个月内是否为首发缺血性脑卒中病人分为缺血组(72例)和非缺血组(42例)。所有病人均接受三维超声血管斑块定量分析,并于超声检查后24 h内进行颈动脉内膜剥脱术和病理学诊断,之后对不同性质、不同狭窄程度血管斑块定量分析结果进行探讨,比较缺血组与非缺血组易损斑块与稳定斑块分布情况,并对标化壁指数(NWI)和灰阶中位数(GSM)诊断颈动脉易损斑块的临床价值进行分析。结果114例病人共发现121个颈动脉斑块,经病理组织学诊断显示,易损斑块64个,稳定斑块57个。易损斑块NWI高于稳定斑块,易损斑块GSM低于稳定斑块,差异有统计学意义(P<0.001)。不同狭窄程度病人NWI比较,差异有统计学意义(P=0.004);中度狭窄NWI高于轻度狭窄,重度狭窄NWI高于轻度狭窄和中度狭窄,差异有统计学意义(P<0.05)。缺血组易损斑块检出率(89.5%)高于非缺血组的(4.4%),差异有统计学意义(P<0.001)。颈动脉斑块NWI和GSM诊断易损斑块的临床价值结果显示:以GSM>34为易损斑块的截断值,诊断易损斑块的灵敏度为78.1%,特异度为80.7%,正确指数为58.8%,阳性预测值为82.0%,阴性预测值为76.7%,ROC曲线下面积为0.794。以NWI≥0.645为易损斑块的截断值,诊断易损斑块的灵敏度为64.1%,特异度为78.9%,正确指数为43.0%,阳性预测值为77.4%,阴性预测值为66.2%,ROC曲线下面积为0.715。结论三维超声血管斑块定量分析技术中的NWI和GSM可辅助诊断斑块性质及狭窄程度,对易损斑块的诊断价值较高。     

颈动脉粥样硬化及血流动力学变化与脑梗死的关系

目的应用双功能彩色多普勒超声观察脑梗死患者颈动脉粥样硬化斑块和颈动脉各部位的血流动力学变化及其相互关系。方法经头颅CT和(或)MRI检查确诊的58例脑梗死患者(脑梗死组)及45例健康体检者(对照组),采用多普勒超声检测颈动脉内膜中层厚度(IMT),并同时检测颈总动脉及颈内动脉血流动力学指标。结果脑梗死组颈总动脉、颈内动脉及颈总动脉分叉部IMT均明显高于对照组(P<0.01);脑梗死组颈动脉粥样斑块检出率显著高于对照组(P<0.01);脑梗死组颈总动脉收缩期峰值流速、舒张末期流速及最大剪切率明显低于对照组,搏动指数、阻力指数高于对照组,脑梗死组颈内动脉舒张末期流速及最大剪切率明显低于对照组,阻力指数高于对照组;颈总动脉最大剪切率与颈总动脉IMT及颈总动脉分叉部IMT呈负相关,颈内动脉最大剪切率与颈内动脉IMT呈负相关。结论颈动脉IMT、斑块的部位和性质及血流动力学变化与脑梗死的发生密切相关。     

Beta blocker overdose with propranolol and with atenolol

During a one-month period, two cases of beta-adrenergic blocker overdose were treated by the emergency staff at our hospital. One case of propranolol intoxication demonstrated profound cardiovascular collapse and generalized tonic-clonic seizures. The condition failed to respond to high-dose intravenous pressor agents, but did improve significantly with IV glucagon infusion. The second overdose involved atenolol. Although the blood levels reported were very high, the patient showed no cardiovascular compromise and required only inhaled bronchodilators for an exacerbation of her asthma.     

Antihypertensive therapy with diltiazem and comparison with hydrochlorothiazide

Fourteen hypertensive patients with a mean sitting systolic and diastolic blood pressure (BP) of 153 +/- 16/100 +/- 4 mm Hg were treated successively with hydrochlorothiazide and diltiazem for 8 weeks each. The BP response and changes in heart rate, left ventricular size and function, and plasma catecholamine concentrations and renin activity were monitored. The 2 drugs had comparable antihypertensive effects, with mean decreases of 14, 9 and 11 mm Hg for the sitting, standing and supine diastolic BP, respectively, during hydrochlorothiazide treatment and mean decreases of 16, 18 and 12 mm Hg during diltiazem treatment. Heart rate was unchanged, although plasma norepinephrine concentrations increased significantly during diltiazem treatment. Plasma renin activity increased slightly, from 0.6 to 0.9 ng/ml/hour during diltiazem treatment, but the change was not significant (p less than 0.10). Left ventricular ejection fraction and end-diastolic volume were not affected by either agent. In conclusion, diltiazem is an effective antihypertensive agent, which because of its benign side effect profile, may be useful as a step 1 agent.     

Life Events and Stress in Patients with Functional Dyspepsia Compared with Patients with Duodenal Ulcer and Healthy Controls

Background: Life events and stress may be important for functional dyspepsia and duodenal ulcer. Methods: The perception of life events in the preceding 6 months was recorded in 100 patients with functional dyspepsia, 100 patients with duodenal ulcer, and 100 healthy controls. In addition, psychologic and social factors were assessed. Results: Patients with functional dyspepsia experienced significantly more life events than patients with duodenal ulcer and healthy controls. The difference in life events between the groups was due to the difference in stressful life events. The patients with functional dyspepsia had higher levels of state-trait anxiety, general psychopathology, and depression than patients with duodenal ulcer and healthy controls. Conclusion: Patients with functional dyspepsia had higher scores on negative life events than patients with duodenal ulcer and healthy controls. This may be causally related to the higher levels of anxiety, depression, and general psychopathology in these patients.     

Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil.

BACKGROUND: The aim of this study was to assess the efficacy of patient-controlled analgesia and sedation with propofol/alfentanil for colonoscopy compared with continuous drug infusion and conventional nurse-administered medication. METHODS: One hundred fifty patients undergoing colonoscopy on an outpatient basis were randomly assigned to 1 of 3 medication regimens. To maintain blinding, all patients were connected to an infusion pump. Group I patients could self-administer boluses of 4.8 mg propofol and 125 microg alfentanil without restriction. Group II patients received a continuous infusion with 0.048 mg/kg propofol and 0.12 microg/kg alfentanil per minute. Group III patients received intravenous premedication with 0.035 mg/kg midazolam and 0.35 mg/kg meperidine. RESULTS: There were no differences between the groups with respect to pain (visual analogue scale) and procedure time. Patient-controlled analgesia and sedation with propofol/alfentanil (group I) resulted in less of an increase in the transcutaneous partial pressure of carbon dioxide (p = 0.0004) during colonoscopy and less of a decrease in mean arterial blood pressure (p = 0.0021) during recovery, as well as more complete recovery (p = 0.0019) after 45 minutes compared with conventional administration of midazolam/meperidine. Furthermore, patient-controlled analgesia and sedation yielded a higher degree of patient satisfaction than continuous infusion of propofol/alfentanil (p = 0.0033) or nurse-administered midazolam/meperidine (p = 0.0094). CONCLUSIONS: Patient-controlled administration of propofol and alfentanil for colonoscopy may provide a better margin of safety than conventional administration of midazolam and meperidine and results in a higher level of patient satisfaction and shorter recovery.     

Refractory anemia with ring sideroblasts and RARS with thrombocytosis

Disease Overview : Ring sideroblasts (RS) are erythroid precursors with abnormal perinuclear mitochondrial iron accumulation. Two myeloid neoplasms defined by the presence of RS, include refractory anemia with ring sideroblasts (RARS) and RARS with thrombocytosis (RARS‐T). Diagnosis : RARS is a lower risk myelodysplastic syndrome (MDS) with dysplasia limited to the erythroid lineage, <5% bone marrow (BM) blasts and ≥15% BM RS. RARS‐T is a provisional entity in the MDS/MPN (myeloproliferative neoplasm) overlap syndromes, with diagnostic features of RARS, along with a platelet count ≥450 × 10(9)/L and large atypical megakaryocytes similar to those observed in BCR‐ABL1 negative MPN. Mutations and Karyotype : Mutations in the SF3B1 gene are seen in ≥80% of patients with RARS and RARS‐T, and strongly correlate with the presence of BM RS; RARS‐T patients have additional mutations such as, JAK2V617F (～60%), MPL (<5%), and CALR (<5%). Cytogenetic abnormalities are uncommon in both RARS and RARS‐T. Risk stratification : Most patients with RARS are stratified into lower risk groups by the International Prognostic Scoring System (IPSS) for MDS and the revised IPSS. Disease outcome in RARS‐T is better than that of RARS, but worse than that of essential thrombocytosis. Both RARS and RARS‐T have a low risk of leukemic transformation. Treatment : Anemia and iron overload are complications in both diseases and are managed similar to lower risk MDS. Aspirin therapy is reasonable in RARS‐T, especially in the presence of JAK2V617F, but the value of platelet‐lowering drugs is uncertain. Case reports of RARS‐T therapy with lenalidomide warrant additional studies. Am. J. Hematol. 90:550–559, 2015. © 2015 Wiley Periodicals, Inc.