高频重复经颅磁刺激对躯体化障碍的治疗效果

目的 观察高频重复经颅磁刺激（10 Hz,rTMS）对躯体化障碍患者的治疗效果。方法 74 例躯体化障碍患者随机分为研究组（rTMS）38 例和对照组（舍曲林）36 例,治疗8 周。研究组给予10 Hz rTMS 治疗,对照组给予抗抑郁剂舍曲林。两组患者在基线时和治疗后每隔2 周各测评汉密尔顿抑郁量表24 项（HAMD－24）及不良反应量表（TESS）。以HAMD 减分率评价疗效、TESS 评价不良反应。结果 治疗8 周后,两组HAMD－24 评分和疗效比较,差异无统计学意义（P＞0.05）;在各时期不良反应量表评定中,研究组均低于对照组,差异有统计学意义（P＜0.05）。结论 高频重复经颅磁刺激和舍曲林治疗躯体化障碍的疗效相当,前者的不良反应较少。     

超声胃镜联合磁共振对胰腺导管内乳头状黏液瘤的诊断价值

目的 探讨超声胃镜（EUS）联合磁共振（MR）对胰腺导管内乳头状黏液瘤（IPMN）的诊断价值。方法 选取2015 年7 月～2019 年6 月我院收治的疑似胰腺占位性病变患者168 例,行MR 和EUS 检查。根据最终诊断结果,比较两种检查方式单独及联合诊断IPMN 的灵敏度、特异度和准确度。结果 168 例患者中最终诊断IPMN 18 例（10.71%）,其中以患者病理结果作为最终诊断结果确诊15 例,随访6 个月作为最终诊断结果确诊3 例;其他150 例（89.29%）。根据患者最终诊断结果,EUS 灵敏度、特异度和准确度分别为83.33%、92.67%、91.67%,MR 分别为50.00%、85.33%、81.55%,EUS+MR 分别为100.00%、98.67%、98.81%,EUS 和MR 联合诊断IPMN 的灵敏度、特异度和准确度明显高于其单独诊断（P＜0.05）。结论 EUS 联合MR 应用于IPMN 诊断中,能明显提高灵敏度、特异度和准确度,具有较高的临床应用价值。     

彩色多普勒超声帧差伪像的成因与特征探讨

本文目的在于探讨超声帧差伪像的形成原因与声像图特征。通过分析医用超声诊断仪器所采用的设计模型与人体组织声学特性之间存在的矛盾、探头振元数与物理通道数之间的匹配关系、2D图像与彩色多普勒图像在显示屏上的“实时”复合方式,揭示出在图像复合显示过程中,因帧频不同而导致的人体解剖结构与血流信号在时间、空间上“错位”而导致的伪像,阐明它具有的必然性、复合性、隐蔽性、低关注度特点,为仪器设计开发和超声医生在工作中及时识别帧差伪像,减少误诊,提供思路。     

Five-year follow-up of left ventricular diastolic function in systemic sclerosis patients: Determinants of mortality and disease progression

Objectives

In systemic sclerosis (SSc), left ventricular diastolic dysfunction reflects primary myocardial involvement of the disease. We aimed to assess the abnormalities of the diastolic function, analyze the characteristics of the disease progression, and investigate the prognostic value of diastolic dysfunction in SSc patients.

Patients and methods

A total of 34 SSc patients (57 ± 12 years, 31 female) were involved in the study. The following traditional or tissue Doppler parameters of left ventricular diastolic function were obtained: E/A, lateral E?, E/E?, left ventricular mass index (LVM index), and maximal left atrial (LA) volume index. Measurements were repeated after 5.5 years.

Results

At baseline, diastolic dysfunction was found in 62% of the SSc patients. Follow-up time was 5.4 ± 1.2 years. A total of 6 patients died of heart failure. In univariate Cox regression analysis, age (HR = 1.08, p < 0.05), LVM index (HR = 1.07, p < 0.01), lateral E? (HR = 1.57, p = 0.05), and LA volume index (HR = 1.11, p < 0.01) were predictors of survival. During the follow-up, significant increase in LA volume index (27.5 ± 9.7 vs. 35.4 ± 10.6 cm³/m², p < 0.001) and E/E? was found (7.6 ± 2.5 vs. 8.7 ± 3.8, p < 0.05) while E? did not change (9.6 ± 2.6 vs. 9.2 ± 1.9 cm/s, NS). The increase in LA volume index showed positive correlation (r = 0.46, p < 0.05) while the decrease in E? values showed negative correlation (r = −0.54, p < 0.01) with the duration of the SSc.

Conclusion

In SSc patients, left ventricular diastolic dysfunction is highly prevalent and is associated with increased risk of mortality. Our data suggest that in the advanced phase of the disease, the myocardial fibrotic processes burns out while the increase of the filling pressure progresses continuously.     

A New Tissue Doppler Index to Predict Cardiac Death in Patients with Heart Failure

Background

It has been shown that a new tissue Doppler index, E/(E''×S''), including the ratio between early diastolic transmitral and mitral annular velocity (E/E''), and the systolic mitral annular velocity (S''), has a good accuracy to predict left ventricular filling pressure.

Objectives

We investigated the value of E/(E''×S'') to predict cardiac death in patients with heart failure.

Methods

Echocardiography was performed in 339 consecutive hospitalized patients with heart failure, in sinus rhythm, after appropriate medical treatment, at discharge and after one month. Worsening of E/(E''×S'') was defined as any increase of baseline value. The end point was cardiac death.

Results

During the follow-up period (35.2 ± 8.8 months), cardiac death occurred in 51 patients (15%). The optimal cut-off value for the initial E/(E''×S'') to predict cardiac death was 2.83 (76% sensitivity, 85% specificity). At discharge, 252 patients (74.3%) presented E/(E''×S'') ≤ 2.83 (group I) and 87 (25.7%) presented E/(E''×S'') > 2.83 (group II), respectively. Cardiac death was significantly higher in group II than in group I (38 deaths, 43.7% vs 13 deaths, 5.15%, p < 0.001). By multivariate Cox regression analysis, including variables that affected outcome in univariate analysis, E/(E''×S'') at discharge was the best independent predictor of cardiac death (hazard ratio = 3.09, 95% confidence interval = 1.81-5.31, p = 0.001). Patients with E/(E''×S'') > 2.83 at discharge and its worsening after one month presented the worst prognosis (all p < 0.05).

Conclusions

In patients with heart failure, the E/(E''×S'') ratio is a powerful predictor of cardiac death, particularly if it is associated with its worsening.     

血液透析患者脑血流动力学变化与认知功能损伤相关性临床研究

目的探讨维持性血液透析(MHD)患者脑血流动力学变化与认知功能损伤的关系。方法对2017年5月至6月在北京世纪坛医院94例MHD患者,根据蒙特利尔认知评估量表(MoCA)评估分为认知功能损伤(CI)组与认知功能正常(NC)组。采用经颅多普勒超声(TCD)进行脑血流动力学检查。比较两组患者之间相关指标,采用二分类Logistic回归方法分析CI与TCD指标的关系。结果 94例患者中,CI组59例,NC组35例,CI患病率为62.8%。CI组年龄、女性患者比例、透析龄及心脏病患病比例均高于NC组,受教育程度低于NC组(P<0.05)。CI组大脑中动脉(MCA)及大脑前动脉(ACA)的平均血流速(Vm)均低于NC组,MCA及ACA的搏动指数(PI)均高于NC组(P<0.05)。Logistic回归结果显示,年龄、心脏病史、MCA-Vm及MCA-PI是MHD患者CI发生的相关危险因素(P<0.05)。结论MHD患者颅内动脉平均血流速度降低,其中MCA-Vm越低,MCA-PI越高,患者发生认知功能损伤的风险越大。     

高血容量血液稀释对老年患者围术期血流动力学的影响

目的:观察高血容量血液稀释(hypervolemic hemodilution,HHD)对老年患者围术期血流动力学的影响。方法:选取20名无心脏病史的麻醉手术患者;10名患者65周岁,10名55周岁。所有入试患者在术前接受相同的HHD处理(60 g/L羟乙基淀粉静脉输注,15 ml/kg)。在血液稀释后不同时间使用经食管多普勒超声监测(transesophageal Doppler monitoring,TDM)患者的血流动力学变化,同时监测患者血细胞比容(Hct)、血红蛋白、血气及心电变化。结果:所有患者手术期间均未发生任何并发症。两组患者间的一般资料、生化检查数据、Hct、血气等均无统计学差异。HHD后对照组(55周岁)的心排出量(cardiac output,CO)升高,老年组(65周岁)降低。对照组的心率(heart rate,HR)下降和心搏指数(stroke index,SI)升高(P0.05),而老年组HR无明显改变,SI轻微下降。血液稀释后对照组患者的外周血管阻力值有明显下降(P0.05),而老年患者出现了升高的趋势。结论:无心脏病史的老年患者并不能很好耐受术前急性高容量血液稀释。HHD可以导致由SI下降所致的CO下降。     

三维能量超声诊断子宫内膜癌的临床价值

目的比较三维能量多普勒超声测量子宫内膜良、恶性病变患者的血流参数值;研究子宫内膜癌患者病理分期与血流参数的相关性。方法选择绝经后阴道流血患者55例,测定收缩期峰值流速(PSV)、搏动指数(PI)、阻力指数(RI)及血管形成指数(VI)。结果 1子宫内膜癌组的超声血管参数PSV、PI、RI值均显著低于子宫内膜良性病变组,VI值显著高于子宫内膜良性病变组(P<0.05);2子宫内膜癌组的VI值在Ⅰ期与Ⅱ期、Ⅱ期与Ⅲ期分别比较有显著差异(P<0.05);子宫内膜癌有、无淋巴结转移组间RI和VI值差异显著(P<0.05)。结论三维能量多普勒超声技术对子宫内膜良、恶性病变的诊断与鉴别诊断有重要临床价值,为临床术前评估子宫内膜癌的分期提供了一种相对准确的新手段。