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101.
64层螺旋CT三联检查在急性胸痛诊断中的应用 总被引:13,自引:0,他引:13
目的探讨64层螺旋CT(MSCT)三联检查显示急性胸痛患者肺动脉、胸主动脉和冠状动脉病变的能力及其临床应用价值。方法70例患者进行64层MSCT回顾性心电门控肺动脉、胸主动脉和冠状动脉联合检查。采用多平面重组(MPR)、最大密度投影(MIP)、曲面重组(CPR)及容积再现(VR)多种重组技术显示肺动脉、胸主动脉和冠状动脉,评价成像质量能否满足临床诊断需要。结果平均扫描时间(8.5±1.0)s,总对比剂用量100ml。肺动脉和主动脉增强后CT值均≥200HU者占95.7%(67/70);冠状动脉显影图像质量优的节段占85.8%(720/839),图像质量良的节段占8.6%(72/839),图像质量差的节段占5.6%(47/839)。共检出冠状动脉狭窄≥50%者20例,肺动脉栓塞2例,主动脉夹层2例。结论64层MSCT三联检查能够在8s左右1次扫描完成肺动脉、胸主动脉和冠状动脉检查,图像质量可以满足临床诊断需要,在急性胸痛病因诊断中具有很高的临床应用价值。 相似文献
102.
1198例非体外循环冠状动脉旁路移植术的早期临床分析 总被引:40,自引:0,他引:40
目的 总结分析非体外循环冠状动脉旁路移植术 (OPCAB)的早期临床结果和经验体会。方法 1996年 10月至 2 0 0 2年 5月在国内 15个冠心病微创外科中心完成非体外循环冠状动脉旁路移植术 1198例 ,占同期冠心病手术的 79 5 % ,OPCAB实施率 (即OPCAB占单纯冠状动脉旁路移植术的百分比 )为 85 2 %。年龄平均 (6 1 6± 9 0 )岁 ,男性占 77 3%。 18 7%为左主干病变 ,76 9%为 3支病变。左心室射血分数平均 0 5 6± 0 17。其中二次手术者占 1 5 % ,急诊手术占 9 9%。结果 2 2例为小切口单支病变旁路移植手术 ,其余均为正中切口、多支病变的OPCAB手术。远端吻合口为 (3 1± 0 9)个 ,乳内动脉桥占 6 5 6 % ,桡动脉桥占 18 0 % ;5 2 %病人使用主动脉内球囊反搏。住院死亡 14例 ,病死率 1 2 %。其中术后心跳骤停或室颤 7例 ,大出血 2例 ,昏迷伴肾功能衰竭 2例 ,大面积脑梗塞 2例 ,呼吸衰竭 1例。并发症中 ,围术期心肌梗死占 0 4% ,急性左心功能衰竭占 0 3% ,严重心律失常占 1 2 % ,呼吸系统并发症占 2 0 % ,器质性神经系统并发症占 1 2 % ,新发或加重的肾功能不全占 0 7% ,出血二次开胸占1 0 % ,胸骨愈合不良占 0 6 %。结论 OPCAB手术安全可行 ,早期效果满意 ,远期效果有待进一步观察。OPCAB具备一 相似文献
103.
血管紧张素转换酶基因与中国人群冠心病、高血压病及糖尿病的关系 总被引:1,自引:0,他引:1
目的:研究血管紧张素转换酶(ACE)基因与中国人群冠心病(CHD)、高血压病(EH)及2型糖尿病(T2DM)的关系。方法:250例呈不同组合的EH、T2DM以及CHD患者及90例正常对照用改良的聚合酶链反应(PCR)方法检测ACE基因型,比较基因型及等位基因频率分布。结果:①无合并CHD的T2DM及EH组ACE基因型及等位基因频率与正常对照无显著差异;②CHD组无论是否合并EH及/或T2DM,Ⅲ基因型及Ⅰ等位基因频率均显著低于正常对照,而DD基因型及D等位基因频率均显著高于正常对照;③T2DM合并CHD组及EH合并CHD组中Ⅱ基因型及Ⅰ等位基因频率均显著低于正常对照,而DD基因型及D等位基因频率均显著高于正常对照。结论:ACE基因多态性与中国人群CHD相关。这种关联亦见于EH或T2DM合并CHD中,但ACE基因仅是CHD发病的遗传学基础,而与是否合并EH及/或T2DM无关。 相似文献
104.
105.
Pleural effusion following coronary perforation during balloon angioplasty: an unusual presentation of the postpericardiotomy syndrome. 总被引:4,自引:0,他引:4
We report on the development of features of the postpericardiotomy syndrome following coronary perforation during balloon angioplasty, in a patient that was managed conservatively. The case illustrates that while cardiac tamponade does not invariably follow coronary perforation, late consequences derived from this complication may occur. It also widens the spectrum of conditions where the postpericardiotomy syndrome has been observed. 相似文献
106.
Gianmauro Sacchetti Eugenio Inglese Angelo S Bongo Franco Aina Marco Brambilla Alberto Baroli Carmelo Cernigliaro Pierfranco Dellavesa Edgardo Pittaluga Marco Rudoni 《European journal of nuclear medicine and molecular imaging》1997,24(10):1230-1236
The aim of this study was to determine the diagnostic accuracy of technetium-99m tetrofosmin myocardial imaging for the localization
of coronary artery stenoses of different degrees of severity. Stress-rest single-photon emission tomography (SPET) was performed
on separate days in 80 patients (64 males, 16 females; mean age 61 years; 43 patients with previous myocardial infarction;
18 patients with pharmacological stress), within 6 months of coronary angiography. Scintigraphic images were blindly and independently
evaluated by three observers. Coronary stenosis was defined as a >50% narrowing in luminal diameter; severe stenosis was defined
as a proximal stenosis of >75% or a peripheral stenosis of >90%. Coronary angiography revealed normal coronary arteries or
insignificant coronary stenosis in 13 patients and significant coronary stenoses in 67 patients. The sensitivity and specificity
of 99mTc-tetrofosmin SPET in respect of severely stenosed vessels were, respectively, 80% and 65% for the left anterior descending
artery (LAD), 100% and 46% for the right coronary artery (RCA) and 58 and 78% for the left circumflex artery (LCx) territories.
Considering all the significantly stenosed vessels, a significant decrease in sensitivity was observed for LAD territories
(to 59%, P=0.05), and a nonsignificant decrease for RCA (88%) and LCx (47%) territories while specificity values remained essentially
unchanged. No significant changes in sensitivity or specificity were observed when regions with previous myocardial infarction
were excluded. In conclusion, the sensitivity of 99mTc-tetrofosmin SPET for the localization of individual stenosed vessels is only moderate when all significant stenoses are
considered, but the ability of this technique to predict the location of severe coronary artery stenoses seems satisfactory,
with the exception of the low specificity in respect of RCA territories.
Received 26 April and in revised form 7 June 1997 相似文献
107.
Abdou Elhendy Marcel L. Geleijnse Ron T. van Domburg Jeroen J. Bax Peter R. Nierop Suzan A. M. Beerens Roelf Valkema Eric P. Krenning M. Mohsen Ibrahim Jos R. T. C. Roelandt 《European journal of nuclear medicine and molecular imaging》1997,25(1):69-78
Stress echocardiography has been considered an accurate method for the diagnosis of coronary artery disease in hypertensive
patients and in patients with left ventricular hypertrophy. In contrast, the specificity of myocardial perfusion scintigraphy
in these patients has been questioned. The aim of this study was to compare the accuracy of these two imaging modalities in
conjunction with dobutamine stress test for the diagnosis of coronary artery disease in hypertensive patients with and without
left ventricular hypertrophy. Dobutamine (up to 40 μg kg–1min–1) stress echocardiography in conjunction with sestamibi (MIBI) single-photon emission tomography (SPET) was performed in 84
patients with the diagnosis of systemic hypertension who had been referred for evaluation of myocardial ischaemia. Ischaemia
was defined as new or worsened wall motion abnormalities at echocardiography and reversible perfusion defects at SPET. Significant
coronary artery disease (≥50% luminal diameter stenosis) was detected in 66 patients (79%). The sensitivity, specificity and
accuracy of the ischaemic pattern at echocardiography for the diagnosis of coronary artery disease were 73% (CI 63%–82%),
83% (CI 75%–91%) and 75% (CI 66%–84%), those for MIBI were 67% (CI 57%–77%), 83% (CI 75%–91%) and 70% (CI 60%–80%) respectively
(P = NS vs echocardiography). Significant stenosis was detected in 123 (49%) of the 252 analysed coronary arteries. The sensitivity,
specificity and accuracy of echocardiography for the regional diagnosis of coronary artery disease were 63% (CI 56%–69%),
90% (CI 86%–94%) and 77% (CI 72%–82%). Those for MIBI were 58% (CI 51%–64%), 91% (CI 87%–94%) and 75% (CI 69%–80) respectively
(P = NS vs echocardiography). Left ventricular hypertrophy was detected in 59 patients (70%) by echocardiography and did not
influence the overall or regional specificity of echocardiography or MIBI SPET. It is concluded that in hypertensive patients,
dobutamine stress echocardiography and MIBI SPET have a comparable accuracy for the overall and regional diagnosis of coronary
artery disease. Hypertensive patients with or without left ventricular hypertrophy should not be considered unsuitable candidates
for stress myocardial perfusion scintigraphy.
Received 10 July and in revised form 19 September 1997 相似文献
108.
Koichiroh Nandate Kenji Muranaka Koichi Shinohara Kazuyoshi Ishida Hiroko Ishida Katsuhiro Seo Hiroshi Takeshita 《Journal of anesthesia》1997,11(2):117-120
We retrospectively reviewed the records of 250 consecutive patients undergoing coronary artery bypass graft surgery (CABG)
from January 1994 through January 1996 to determine the incidence of persistent postoperative neurological dysfunction after
CABG and to compare normothermic and moderate hypothermic cardiopulmonary bypass (CPB). Normothermic CPB was used in 128 patients
(36°–37°C) and hypothermic CPB (27°–28°C) in 122 patients. Postoperative neurological dysfunction included focal motor deficits,
delayed recovery of consciousness (>24h) after surgery, and seizures within 1 week postoperatively. Persistent neurological
dysfunction was diagnosed if complete resolution had not occurred within 10 days of surgery. The incidence of persistent postoperative
neurological dysfunction was 4.1% in the hypothermic CPB group and 2.3% in the normothermic CPB group. There were no statistically
significant differences between the two groups (P=NS). These results suggest that normothermic CPB did not increase the incidence of persistent postoperative neurological
dysfunction compared to hypothermic CPB. 相似文献
109.
Junichi Taki Akihiro Ichikawa Kenichi Nakajima Michio Kawasuji Norihisa Tonami 《European journal of nuclear medicine and molecular imaging》1997,24(12):1487-1493
Stress thallium-201 tomography was performed to compare the flow capacities of arterial and saphenous vein grafts in patients
with coronary artery bypass grafting (CABG). One hundred and seven consecutive patients (95 male and 12 female; mean age 58±9.1
years) underwent exercise-redistribution 201Tl myocardial single-photon emission tomography 4–5 weeks after CABG. When a reversible perfusion defect was present in the
area covered by a patent bypass graft, the flow capacity of the graft was defined as insufficient. Of all 285 grafts, 211
were considered as complete bypass. Reversible perfusion defects were present in 29 (27%) of 108 myocardial areas supplied
by patent arterial grafts but in only 5 (5%) of 103 myocardial areas supplied by patent saphenous vein grafts (P<0.0001). In the LAD area reversible defects were observed in 22 of 82 areas covered by arterial grafts, in contrast to only
1 of 29 areas covered by venous grafts (P<0.01); in the RCA area reversible defects were observed in 7 of 17 and 4 of 41 areas respectively (P<0.01). There was no difference between the native coronary artery stenosis bypassed by patent arterial and venous grafts
(88%±12% vs 86%±14% respectively, P=0.27). In conclusion, flow capacities during peak myocardial demand were more frequently insufficient in arterial bypass
grafts than in saphenous vein grafts.
Received 23 May and in revised form 7 August 1997 相似文献
110.
Daniel F. Worsley Anthony Y. Fung David B. Coupland Cori G. Rexworthy George P. Sexsmith Brian C. Lentle 《European journal of nuclear medicine and molecular imaging》1992,19(6):441-444
Unlike conventional thallium-201 myocardial imaging, technetium-99m methoxyisobutylisonitrile (MIBI) requires separate stress and rest injections. We prospectively studied 148 consecutive patients referred for myocardial perfusion studies to determine the diagnostic value of rest images once normal exercise or dipyridamole tomographic images had been obtained. In patients referred with no history of previous myocardial infarction in whom the diagnosis of coronary artery disease was suspected, 45 of 109 (41%) patients had normal stress tomographic images. Obtaining rest images did not alter the final interpretation in any of these cases. From this we infer that in patients with normal images after exercise or dipyridamole administration and no past history of myocardial infarction, 99mTc-MIBI rest images are not required. This provides several advantages including increased speed of diagnosis, decreased patient radiation exposure, improved cost efficiency and decreased demand on tomographic camera time.
Offprint requests to: A.Y. Fung 相似文献