64层螺旋CT肺动脉成像低管电压设置结合个体化对比剂应用的对照研究

Objective To investigate the feasibility of the low tube voltage setting and personalized contrast agent application in 64-row multi-slice spiral CT pulmonary angiography.Methods Ninety patients with high risk of pulmonary artery embolism were sequentially enrolled in the study and divided into 3 groups employing completely randomized design: (1) Regular group included 30 patients using 120 kV and fixed dose of 70 ml contrast agent, (2)Another 30 patients were in 120 kV group, using 120 kV and the contrast amount was determined according to the patient weight (1.0 ml/kg), (3) The remaining 30 patients were included in 100 kV group, using 100 kV and the contrast amount was also determined according to the patient weight(1.0 ml/kg).Administration of contrast agent was completed within 20 seconds for all the patients, followed by 20 ml of saline.The objective and subjective indexes for assessing CT image quality, CT dose index volume (CTDIvol) and effective received dose (ERD) were compared between 120 kV group and 100 kV group; then the contrast media volume, injection rate, objective CT image indexes and subjective indexes for image quality was compared between the 100 kV group and regular group.The variance analysis and post hoc test were employed for the statistical analysis.Results Compared with 120 kV group(3.4± 0.7), the image quality of 100 kV group(5.2±1.8)had higher noise(52.9%), but subjective index for the image quality demonstrated no differences(q=0.272 ,P=0.063)in mediastinum window while CTDIvol and ERD decreased for 34.9%[(9.5±0.0) vs (14.6±0.0) mGy]and 36.8%[(3.8±0.6) vs (2.4± 0.4) mSv].The mean CT values on pulmonary artery of 100 kV group[(269.2±54.7) HU]were 13.4% (31.8/237.4) higher than the 120 kV group[(237.4±62.9) HU], but there was no statistical differences eornpared to normal group(q=0.172,P=0.260).Conclusion Using low kV setting (100 kV) to reduce radiation dose is proved to be effective and feasible in 64-MSCT pulmonary angiography.Personalized contrast agent injection has clinical application value for specific patient group.     

64层螺旋CT肺动脉成像低管电压设置结合个体化对比剂应用的对照研究

Objective To investigate the feasibility of the low tube voltage setting and personalized contrast agent application in 64-row multi-slice spiral CT pulmonary angiography.Methods Ninety patients with high risk of pulmonary artery embolism were sequentially enrolled in the study and divided into 3 groups employing completely randomized design: (1) Regular group included 30 patients using 120 kV and fixed dose of 70 ml contrast agent, (2)Another 30 patients were in 120 kV group, using 120 kV and the contrast amount was determined according to the patient weight (1.0 ml/kg), (3) The remaining 30 patients were included in 100 kV group, using 100 kV and the contrast amount was also determined according to the patient weight(1.0 ml/kg).Administration of contrast agent was completed within 20 seconds for all the patients, followed by 20 ml of saline.The objective and subjective indexes for assessing CT image quality, CT dose index volume (CTDIvol) and effective received dose (ERD) were compared between 120 kV group and 100 kV group; then the contrast media volume, injection rate, objective CT image indexes and subjective indexes for image quality was compared between the 100 kV group and regular group.The variance analysis and post hoc test were employed for the statistical analysis.Results Compared with 120 kV group(3.4± 0.7), the image quality of 100 kV group(5.2±1.8)had higher noise(52.9%), but subjective index for the image quality demonstrated no differences(q=0.272 ,P=0.063)in mediastinum window while CTDIvol and ERD decreased for 34.9%[(9.5±0.0) vs (14.6±0.0) mGy]and 36.8%[(3.8±0.6) vs (2.4± 0.4) mSv].The mean CT values on pulmonary artery of 100 kV group[(269.2±54.7) HU]were 13.4% (31.8/237.4) higher than the 120 kV group[(237.4±62.9) HU], but there was no statistical differences eornpared to normal group(q=0.172,P=0.260).Conclusion Using low kV setting (100 kV) to reduce radiation dose is proved to be effective and feasible in 64-MSCT pulmonary angiography.Personalized contrast agent injection has clinical application value for specific patient group.     

64层螺旋CT肺动脉成像低管电压设置结合个体化对比剂应用的对照研究

Objective To investigate the feasibility of the low tube voltage setting and personalized contrast agent application in 64-row multi-slice spiral CT pulmonary angiography.Methods Ninety patients with high risk of pulmonary artery embolism were sequentially enrolled in the study and divided into 3 groups employing completely randomized design: (1) Regular group included 30 patients using 120 kV and fixed dose of 70 ml contrast agent, (2)Another 30 patients were in 120 kV group, using 120 kV and the contrast amount was determined according to the patient weight (1.0 ml/kg), (3) The remaining 30 patients were included in 100 kV group, using 100 kV and the contrast amount was also determined according to the patient weight(1.0 ml/kg).Administration of contrast agent was completed within 20 seconds for all the patients, followed by 20 ml of saline.The objective and subjective indexes for assessing CT image quality, CT dose index volume (CTDIvol) and effective received dose (ERD) were compared between 120 kV group and 100 kV group; then the contrast media volume, injection rate, objective CT image indexes and subjective indexes for image quality was compared between the 100 kV group and regular group.The variance analysis and post hoc test were employed for the statistical analysis.Results Compared with 120 kV group(3.4± 0.7), the image quality of 100 kV group(5.2±1.8)had higher noise(52.9%), but subjective index for the image quality demonstrated no differences(q=0.272 ,P=0.063)in mediastinum window while CTDIvol and ERD decreased for 34.9%[(9.5±0.0) vs (14.6±0.0) mGy]and 36.8%[(3.8±0.6) vs (2.4± 0.4) mSv].The mean CT values on pulmonary artery of 100 kV group[(269.2±54.7) HU]were 13.4% (31.8/237.4) higher than the 120 kV group[(237.4±62.9) HU], but there was no statistical differences eornpared to normal group(q=0.172,P=0.260).Conclusion Using low kV setting (100 kV) to reduce radiation dose is proved to be effective and feasible in 64-MSCT pulmonary angiography.Personalized contrast agent injection has clinical application value for specific patient group.     

胰岛素泵在糖尿病患者治疗中的临床应用及护理

目的:探讨胰岛素泵在糖尿病患者治疗中的临床应用特点及护理方法。方法:回顾性分析我院70例糖尿病患者使用胰岛素泵的临床资料,总结护理经验。结果:使用胰岛素泵治疗时间4-11天,平均8.10天,70例患者使用胰岛素泵后,经过3~11天的治疗,空腹血糖控制于7.21±1.65mmol/L,早餐后2小时血糖控制于10.63±4.50mmol/L,午餐后2小时血糖控制于9.76±3.79mmol/L,晚餐后2小时血糖控制于11.85±3.29mmol/L,睡前血糖控制于10.48±2.24mmol/L。有4例患者发生低血糖反应,予进食及静推葡萄糖后症状均可迅速缓解。血糖控制效果满意。结论:心理护理、健康教育、安置胰岛素泵前中后期的护理对保证胰岛素泵在糖尿病患者治疗中效果具有重要作用。     

同型半胱氨酸检测在老年急性心肌梗死早期诊断中的临床意义

目的探讨检测同型半胱氨酸对老年急性心肌梗死早期诊断的意义,为临床诊治提供依据。方法选择2013年1月—2014年6月确诊为急性心肌梗死的老年患者(>60岁)80例为实验组,按疾病发作时间分为早期组(<6 h)46例和中晚期组(>6 h)44例,选择同期体检结果正常的健康者40例为对照组,均进行同型半胱氨酸、缺血修饰白蛋白浓度水平检测,并对结果进行比较分析。结果与对照组比较,早期组和中晚期组患者的同型半胱氨酸、缺血修饰白蛋白浓度水平均有明显升高(P<0.05);实验各组患者的同型半胱氨酸阳性检出率在80.00%以上,各组组内患者的同型半胱氨酸、缺血修饰白蛋白阳性检出率无明显差异(P>0.05),联合两项指标检测阳性率均超过90.00%,与单独检测两两比较,差异均有统计意义(P<0.05)。结论同型半胱氨酸对于老年急性心肌梗死的早期辅助诊断具有积极的临床价值,联合检测同型半胱氨酸和缺血修饰白蛋白能够有效地提高阳性检出率,降低漏诊率。     

微小表面线圈和3D-PSIF-DWI在面神经腮腺段成像中的初步应用

目的探讨使用微小表面线圈及三维翻转稳态自由进动扩散加权成像(3D-PSIF-DWI)在面神经腮腺段成像中的临床应用价值。资料与方法分别使用头线圈及微小表面线圈结合3 T MR 3D-PSIF-DWI对21名健康志愿者行面神经腮腺段扫描,然后对原始图像行多平面重组(MPR)及薄层最大强度投影(MIP),对原始图像及后处理图像进行分析,比较两者显示腮腺段面神经情况,并分别计算面神经/腮腺的信号强度比(SIR),对结果进行统计学分析。结果头线圈及微小表面线圈结合3D-PSIF-DWI对于腮腺段面神经主干、一级分支(颞面干、颈面干)、二级分支(颞支、颧支、颊支、下颌缘支、颈支)的显示率分别为100%、97.6%、51.4%和100%、100%、83.8%,经统计学分析,对于二级分支的显示率差异有统计学意义(P<0.05)。两者的面神经/腮腺信号强度比分别为1.37±1.06和1.89±0.87,经统计学分析,差异有统计学意义(P<0.05)。结论使用微小表面线圈结合3D-PSIF-DWI可以清楚显示腮腺段面神经主干及其分支,增加了面神经/腮腺信号强度比,并且在显示二级分支方面较头线圈更有优势。     

三叉神经痛MRI序列研究及诊断价值

目的 探讨MR序列对导致三叉神经痛病变的显示能力及诊断价值.方法 回顾性分析60例三叉神经痛患者临床及MRI资料,与临床手术对照,比较不同序列MRI显示病变能力.所有患者均行常规头部MR平扫,其中9例行增强扫描,49例行桥小脑角区高分辨3D-TOF和3D-快速SE(TSE)序列扫描.利用x2检验分析3D-TOF和3D-TSE两序列的敏感度、特异度和准确度.结果 MR常规平扫及增强扫描显示6例桥小脑区肿瘤、3例三叉神经根及其周围脑膜炎,以及脑干多发硬化斑块及梗死各1例.49例为神经血管压迫所致,与手术对照3D-TOF和3D-TSE序列显示血管压迫的敏感度、特异度、准确度分别为95.3％ (41/43)、66.7％ (4/6)、91.8％ (45/49)和95.6％ (43/45)、50.0％ (2/4)、91.8％ (45/49),两者差异无统计学意义(x2值分别为0.13、0.19、0.17,P值均＞0.5).结论MRI对显示和诊断三叉神经痛病因具有重要意义.MR全脑常规扫描可以显示或排除肿瘤、炎症等病变.桥小脑角区3D-TOF和3D-TSE扫描可以敏感和准确地显示和明确神经、血管的关系.     

钙化斑块:薄层平板CT和64层螺旋CT的面积测量及与组织病理学的对比

目的本研究的目的是使用多层螺旋CT和平板容积CT对离体冠状动脉标本进行检查,以病理结果为标准,比较其钙化斑块的面积,评估两者的溢出伪影。方法本研究     

带血管蒂空肠段人工乳头成形胆肠吻合术：附280例分析

我院自行设计一种新的手术方式——带血管蒂空肠段人工乳头成形胆肠吻合术。1982年以来临床应用280例,经“T”型管胆道造影及口服钡餐检查以及追踪观察效果满意。 材料与方法 本组收集1982年以来经PTC和B超诊断     

有奖阅片测试

病史:男,60岁,打鼾10年并咽部异物感8年余。