压力导丝在冠状动脉内支架置入中的意义

目的　通过与血管内超声 ( IVUS)相比较 ,探讨压力导丝在评价冠脉内支架置入即刻效果 ,指导优化支架置入中的作用。方法　 5 1例患者置入冠脉内支架后先后予血管内超声和压力导丝检测判断是否达到相应的理想支架置入标准。若未达标准 ,则进一步采用更高压力同样球囊或更大球囊再扩张。结果　支架置入后 IVUS判断 3 1例达到标准 ,不需再扩张 ,15例不满意者再扩张支架 ,支架内截面积增加 2 4 .3 % ( P<0 .0 5 ) ,最终 4 1例 ( 89% )得到满意 IVUS,5例因超声导管未跨过支架无超声资料 ;压力导丝检测 3 5例达到标准 ,不需再扩张 ,16例不满意者再扩张支架最终 4 5例 ( 88% )得到满意结果 (心肌部分血流储备 ,FFRmyo>0 .90 )。血管内超声和压力导丝两者在判定理想支架置入方面有很好的相关性 ,符合率达 90 %。以血管内超声检测作金标准 ,应用受试者工作特性曲线 ( ROC)计算心肌部分血流储备 FFRmyo预测理想支架置入的最佳临界点为 0 .90。结论　压力导丝是指导冠脉支架置入更方便、安全的有效手段 ,有广泛推广应用的价值     

Die dopplersonographische Bestimmung der maximalen Blutströmungsgeschwindigkeit in der Diagnostik peripherer arterieller Verschlußkrankheiten bei Diabetes mellitus

Summary Seventy-five diabetic and 40 nondiabetic subjects who where suffering from peripheral vascular disease were studied in order to determine whether the degree of the severity of their disease can be better calculated by Doppler ultrasound examinations of the peak velocity than by the systolic pressure of the peripheral bloodstream. In 46 examinations of normal controls the mean value of the peak velocity was 13.3±3.3 cm/s with a standard deviation of 15.4%±13.2% on one day and 16.1%±15.9% on different days. Considering patients with or without diabetes mellitus the velocity was significantly decreased in correlation to an increasing degree of severity of the vascular disease (P<0.001); however, the decrease was lower in diabetic than in nondiabetic subjects (6.9±2.8 vs 4.6±6.2,P<0.05). The systolic pressure hardly decreased, but remained higher in all stages of peripheral vascular disease of diabetics than in the nondiabetic subject (P<0.05 toP<0.005). There was a significant decrease of the systolic pressure only in diabetic subjects with the most advanced degree of the disease, i.e. stage IV (P<0.05).It is concluded from this study that Doppler ultrasound measurements of the peak velocity of the peripheral bloodstream are a useful parameter to calculate the degree of severity of the peripheral vascular disease. In addition, it is concluded than peak velocity is an even better prognostic indicator of peripheral vascular disease than is measurement of the systolic blood pressure at the feet.

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Abkürzungen AVK periphere arterielle Verschlußkrankheit - USDI Ultraschall-Doppler-Index - MSBG maximale Blutströmungsgeschwindigkeit - HFV Herzfrequenzvariation     

Homocysteine-Lowering Therapy and Early Progression of Transplant Vasculopathy: A Prospective, Randomized, IVUS-Based Study

Although observational studies suggest that hyperhomocysteinemia may be a risk factor for coronary allograft vasculopathy (CAV), prospective data on homocysteine-lowering interventions and CAV development are lacking. We, therefore, randomized 44 de novo heart transplant (HT) recipients to 15 mg/day of 5-methyl-tetrahydrofolate (n=22), or standard therapy (control group, n=22) to investigate the effect of homocysteine lowering on the change in coronary intimal hyperplasia during the first 12 months after transplant, as detected by intra-vascular ultrasound (IVUS). Although 12 months after HT, homocysteinemia was lower in folate-treated patients (p<0.001), coronary intimal area increased similarly in the two groups (p>0.4). Conversely, hypercholesterolemia and cytomegalovirus infection were both associated with increased intimal hyperplasia (p<0.04), independently from folate intake. Sub-group analysis revealed that folate therapy reduced intimal hyperplasia in patients with hyperhomocysteinemia before randomization (n=19; p=0.02), but increased intimal hyperplasia in patients with normal homocysteine plasma concentrations (p=0.02). This bimodal effect of folate therapy persisted significantly after adjusting for cytomegalovirus infection and hypercholesterolemia. Despite effective in prevent hyperhomocysteinemia after heart transplantation, folate therapy does not seem to affect early CAV onset. However, sub-group analysis suggests that folate therapy may delay CAV development only in patients with baseline hyperhomocysteinemia, while may favor CAV progression in recipients with normal baseline homocysteinemia.     

常规应用螺内酯联合依那普利治疗老年扩张型心肌病心力衰竭

目的评价螺内酯联合依那普利治疗老年人扩张型心肌病（DCM）心力衰竭的有效性和安全性。方法以148例老年DCM心力衰竭患者作研究对象,按随机化原则分为观察组（74例）和对照组（74例）。对照组为依那普利,加上基础用药（地高辛、双氢克尿噻）;观察组为对照组用药加上螺内酯。治疗6周后复查两组的动态心电图、超声心动图。结果治疗后两组的左室射血分数（LVEF）均有增加,左室收缩末期容积（LVESV）和左室舒张末期容积（LVEDV）均有减少,24 h室性早搏（VA）数也均有减少;观察组与对照组比较,LVEF显著增加。两组均未发现高血钾及肝肾功能损害。结论在老年DCM心力衰竭常规用药的基础上,常规加用螺内酯联合依那普利的治疗有效、安全,可显著改善左室重构和防治猝死。     

Fetal cardiac screening by three- and four-dimensional ultrasound

Objective. The objective of our paper is to show that the spatio-temporal image correlation (STIC) and tomographic ultrasound imaging (TUI) is very convenient and helpful for the fetal screening of complex congenital heart defects (CHD).

Methods. Ultrasound examinations were performed using a Voluson 730 EXPERT or PRO system (GE Medical system, Kretztechnik, Zipf, Austria), and the transabdominal probe (RAB 4-8 MHz or 1-5 MHz) was used to acquire the STIC volumes. Various complex CHD including heterotaxia, ventricular septal defect (VSD), atrio-ventricular septal defect (AVSD), tetralogy of fallot (TOF), transposition of great artery (TGA), hypoplastic left heart syndrome (HLHS) were examined between 20 weeks and 35 weeks. After routine cardiac screening and examination by two-dimensional ultrasound, three- and four-dimensional ultrasound were performed by gray-scaled and color flow mapping. After the examination detailed analysis of CHD were performed by STIC and TUI.

Results. In the case of heterotaxia, STIC and TUI was useful for the detection of stomach and cardiac apex in the different slices. In the case of VSD and AVSD, they were useful for the exact determination of septal defect location. In the cases of TOF, TGA and HLHS, they were helpful for observation of outflow tract and exact diagnosis.

Conclusion. In the screening of complex CHD including heterotaxia, VSD, AVSD, TOF, TGA and HLHS, STIC is very useful and powerful tool.     

高频超声引导定位前臂浅静脉穿刺

目的探讨高频超声引导定位穿刺前臂浅静脉的应用价值。方法对40例常规浅静脉穿刺失败，采用高频探头在同一体表区域寻找并标记浅静脉走行及深度，确认进针方向后再次静脉穿刺，必要时采用实时引导。结果11例经高频超声标记、29例经高频超声实时引导静脉穿刺均一次成功。结论高频超声引导下静脉穿刺的成功率高，无并发症，是一种简便有效的方法，值得在临床推广应用。     

彩超引导介入治疗腘窝囊肿23例

目的探讨彩超引导下腘窝囊肿介入治疗的价值。方法在彩超引导下穿刺囊肿并抽尽囊液，生理盐水反复冲洗囊腔后注入无水乙醇，5min后抽出，反复2～3次。结果23例中22例穿刺一次治愈，1例穿刺2次治愈。23例随访6个月，无复发。结论彩超引导下介入治疗腘窝囊肿操作简便，创伤轻微，安全可靠，效果显著，可重复操作。     

彩超、增强磁共振动脉造影对颅外颈动脉狭窄的术前评估

目的 评价彩超、增强磁共振动脉造影(CEMRA)对颅外颈动脉狭窄的术前评估价值。方法 回顾分析了93例因颅外颈动脉狭窄而接受介入治疗患者的术前彩超、CEMRA检查结果。结果 超声检查可判断狭窄性质和狭窄程度，CEMRA能显示颈动脉全程，显示多发狭窄。但两者对狭窄程度都有过高评估的倾向，对斑块溃疡难以显示。结论 就目前彩超和磁共振机器的性能，尚无法替代DSA检查。必须有机地结合彩超、CEMRA和DSA检查，以多侧面、全方位地了解狭窄的颈动脉，制定合理的治疗方案。     

Outcome in Children With Significantly Abnormal Cerebral Blood Flow Detected by Doppler Ultrasonography: Focus on the Survivors

BACKGROUND AND PURPOSE: The Doppler waveform patterns of loss of diastolic flow, appearance of retrograde diastolic flow, or no detectable flow in the cerebral arteries suggest significantly abnormal cerebral blood flow (CBF). A retrospective study was performed to show that significantly abnormal CBF alone, without clinical criteria, is not necessarily specific to brain death in the young pediatric population. PATIENTS AND METHODS: Forty-seven pediatric patients, from newborn to 4 years of age, were found to have significantly abnormal CBF, including 7 patients with loss of diastolic flow, 28 with retrograde diastolic flow, and 23 with no detectable cerebral flow on serial Doppler sonographic examinations. Their clinical data and sonographic results were collected and analyzed. RESULTS: Forty-two patients died, a few of whom had only transient improvement of cerebral flow. All of the patients with no detectable cerebral flow expired. Five patients survived with or without sequelae. Their underlying conditions that caused increased intracranial pressure were treated by medical and/or surgical intervention, and diastolic reversal of CBF corrected within 1 day in all 5. CONCLUSIONS: Although no detectable flow is a lethal sign, pediatric patients with loss or reversal of diastolic flow may survive with prompt and effective treatment. Using Doppler ultrasound to diagnose cerebral circulatory arrest should be done with caution in pediatric patients.     

脾脏肿块的超声诊断

目的 :探讨脾脏肿块的超声表现及鉴别要点。材料和方法 :回顾性分析 76例脾脏肿块患者的超声检查资料 ,分析脾脏肿块的大小、数目、边界、内部回声等多种超声表现。结果 :76例脾脏肿块中有 3例错构瘤 ,10例血管瘤 ,16例淋巴瘤 ,2例淋巴管瘤 ,4例血管肉瘤 ,11例脾转移瘤 ,16例脾囊肿 ,4例脾梗死 ,3例脾血肿 ,5例脾脓肿 ,2例付脾 ,其超声表现各具特征。结论 :超声检查可早期发现并区别脾脏肿块的囊、实性 ,借助彩色血流显像可进一步鉴别良、恶性病灶。