超声造影评价腹膜后动脉出血的实验研究

目的:探讨超声造影对腹膜后动脉损伤出血的诊断价值。方法:5只实验兔,直接穿刺法建立腹膜后髂外动脉活动性出血模型,创伤后2 min、10 min及40 min分别行超声造影观察,创伤后20 min、30 min两次行DSA检查,作为金标准评价损伤动脉出血情况。结果:动脉损伤2 min时行静脉造影检查,可动态观察造影剂自动脉破口处溢出至腹膜后呈"喷射状",于动脉破口处测得高速血流,动脉损伤后10 min、40 min重复行静脉造影检查,仍可见造影剂自破口处渗出,但流速明显减慢,与DSA检查结果一致。结论:超声造影能准确显示腹膜后动脉活动性出血部位及流速,有较好的临床应用前景。     

超声造影定量观察实验兔肾脏外伤不同程度活动性出血的初步研究

目的探讨超声造影在肾挫裂伤伴发不同流速活动性出血的声像图特征。方法应用超声造影、血管造影和血池显像技术对10只新西兰兔15个肾脏创伤灶进行检查,对比观察不同流速活动性出血灶显示率及声像图特征。结果血管造影显示,10只实验兔15个肾挫裂伤伴活动性出血灶12处;超声造影及血池显像均显示13处活动性出血灶;且超声造影显示5个病灶内造影剂呈快速"涌出样",4处造影剂向被膜破口或肾盂内呈连续"窜动样"表现,4处造影剂逐个"间歇样"向被膜破口或肾盂内溢出。结论超声造影能对不同流速活动性出血进行初步定量分析,可为临床采取合理的治疗方案提供实验依据。     

灰阶超声造影引导止血剂局部注射治疗肝外伤出血的实验研究

目的探讨灰阶超声造影(CEUS)引导止血剂局部注射在肝外伤出血微创治疗中的应用价值。方法对12只健康成年杂种犬开腹直视下暴露肝脏,在肝叶膈面制作表面长为6cm、深为4.5cm的创伤病灶,依据美国创伤外科学会(AAST)的肝外伤分级标准为Ⅳ级。将带伤动物随机分为治疗组与对照组,治疗组采用超声引导蛇毒凝血酶和可吸收性氰基丙烯酸酯粘合胶联合注射,对照组不做处理。外伤病灶形成后对实验动物行常规术中超声及CEUS检查,治疗组在局部注射联合止血剂后行CEUS检测;两组等待30min后再次观察伤口局部是否出血,并记录出血时间及腹腔内总失血量。处死动物,取肝脏损伤灶组织行病理检查。结果观察30min后,两组动物均存活。外伤病灶形成后常规超声显示病灶呈不均匀或欠均匀的略高回声区,部分伴小的无回声区;CEUS表现为边界清晰的低及无增强区,并可见活动性出血所致的高增强区及造影剂外溢。治疗组局部注射联合止血剂后常规超声显示病灶内呈点片状强回声,CEUS显示无造影剂外溢,出血时间为(5.80±0.15)s;对照组观察30min后仍见创口处出血。治疗组与对照组静脉输液量分别约为(55±12)ml和(105±23)ml(P<0.01)。治疗组大体标本显示肝外伤局部被止血胶封闭、止血,局部无血肿;组织切片常规HE染色见血管腔内由氰基丙烯酸酯形成的不定形结构栓塞血管腔,血管周围见少许炎细胞浸润。对照组大体标本显示外伤表面少许血凝块,伤口裂开;组织切片常规HE染色可见局部出血和炎细胞浸润。结论CEUS引导止血剂联合局部注射治疗肝外伤非动脉性出血,止血及时,效果可靠。     

经导管髂内动脉栓塞术治疗盆腔出血

目的：探讨经导管髂内动脉栓塞术治疗急性盆腔出血的治疗价值。方法：30例急性盆腔出血患者，均经B超、CT检查或妇检病理证实。所有病例均先行DSA造影，找到出血靶动脉，然后行栓塞治疗，栓塞材料为明胶海绵颗粒或条。结果：22例可见明显造影剂外溢征，8例未见明显造影剂外溢，但可见异常增多杂乱的新生血管，肿瘤性病变可见肿瘤血管和染色征。即时止血率83．3％，术后1例因子宫切口感染切除子宫，未出现其它并发症。结论：经导管髂内动脉栓塞术是治疗急性盆腔出血安全有效的方法，无明显不良反应。     

髂内动脉栓塞术治疗难治性产后出血临床效果

目的观察髂内动脉栓塞术治疗难治性产后出血的临床效果。方法对8例难治性产后出血患者采用髂内动脉栓塞术治疗,通过数字减影血管造影(DSA)明确盆腔血管走向及造影剂外溢情况后,双侧分别注入明胶海绵栓塞。结果8例患者栓塞治疗均一次成功,手术时间短、止血速度快,并且保留子宫及其生理功能,临床随访无严重并发症。结论髂内动脉栓塞术是治疗难治性产后出血的一种快速、安全、有效方法。     

动脉损伤腔内气囊止血对血管壁的影响

管腔内气囊压迫止血对动脉创伤 ,尤其是深部动脉损伤控制出血很有意义。现就其不同压力和压迫时间条件下对血管壁的影响进行研究 ,报告如下。1　材料与方法1.1　动物 :2 4只新西兰兔 ,取单侧髂外动脉共 2 4条 ,根据气囊压力和压迫时间不同随机分为 A、B、C、D 4组。1.2　方法 :2 %硫喷妥钠 30 mg/kg静脉麻醉。髂动脉手术入路 ,游离实验侧髂外动脉 ,对侧股动脉穿刺 ,插入气囊接压力表。手术损伤髂外动脉后立即于损伤近端腔内气囊压迫止血 ,A组 :30 4k Pa(3atm ) 90分钟 ;B组 :30 4k Pa(3atm )4 5分钟 ;C组 :15 2 k Pa(1.5 atm ) 90分钟 ,…     

Fecl_3诱导兔颈动脉血栓形成建立缺血性脑卒中模型的实验研究

目的通过超声评估Fecl_3诱导兔颈动脉血栓,探讨Fecl_3不同浸润时间建立缺血脑卒中模型的成功率。方法将30只新西兰大白兔随机分为三组(A、B、C组),每组10只。采用70%浓度Fecl_3浸润左侧颈总动脉,分别对A组浸润10min,B组浸润20min,C组浸润30min。浸润前超声检测颈总动脉管径、峰值流速及血D-二聚体指标,浸润结束后超声评估血栓占据管腔比例,每组随机选取2只行颈动脉病理检测;24h后对剩余大白兔(每组8只)行神经功能缺损Purdy评分及脑组织病理学检测,评估每组兔子脑缺血模型的成功率。结果 Fecl_3浸润前,3组兔颈总动脉管径、峰值流速、血D-二聚体指标均无明显差异(P0.05)。浸润后,A组实验段颈总动脉内未见明显血栓形成;B组及C组可见血栓形成,血栓占据管腔比例分别为(58.10±9.83)%、100%,病理结果显示为混合血栓。A、B、C组成功建模0、8、5例,死亡的例数分别为0、0、3例;A组神经功能缺损未见异常,B、C组的Purdy评分分别为(6.000±1.155)、(8.400±2.171)分,C组兔Purdy评分高于B组(P0.05)。结论 Fecl_3诱导的兔急性颈动脉血栓可用于制备局灶性脑缺血模型,浸润颈动脉20min,建模成功率更高。     

携带凝血酶原复合物的阴离子脂膜微泡造影剂联合超声治疗对兔肾创伤性出血模型的止血效果

目的 探讨携带凝血酶原复合物的阴离子脂膜微泡（PCCMB）造影剂联合超声治疗对兔肾创伤性出血模型的止血效果。方法 对24只健康新西兰大白兔建立兔肾创伤性出血模型,并随机分为3组,即单纯超声治疗组（US组）、单纯PCCMB注射组（SHAM组）及PCCMB注射联合超声治疗组（PCCMB+US组）,每组各8只。对各组均通过10 min出血量及视觉评分评价止血效果。并对SHAM组及PCCMB+US组于超声治疗前和治疗后即刻、治疗后60 min行CEUS检查,对US组于超声治疗后即刻及治疗后60 min行CEUS检查,测量兔肾造影峰值强度（PI）。结果 所有实验兔均顺利完成实验。治疗后PCCMB+US组10 min出血量低于SHAM组及US组（P均<0.05）;PCCMB+US组视觉评分明显低于SHAM组及US组（P均<0.05）。PCCMB+US组超声治疗后即刻及治疗后60 min的PI均高于超声治疗前（P均<0.05）。SHAM组及US组超声治疗前与治疗后即刻及治疗后60 min PI差异均无统计学意义（P均>0.05）。结论 PCCMB造影剂联合超声治疗对兔肾脏创伤性出血可起到快速、有效止血的效果。     

经胆道途径超声造影对肝内胆管灌注的实验研究

目的探讨经胆道途径超声造影研究胆管灌注的可行性。方法采用雄性日本大耳兔16只,游离肝外胆管,使用22G导管插入胆总管并固定,经此路径给药。按造影剂浓度分为4组,每组4只,分别为A组:超声造影剂为1/100标准浓度;B组:超声造影剂为1/200标准浓度;C组:超声造影剂为1/400标准浓度;D组:超声造影剂为1/800标准浓度。给药后在超声造影模式下观察微泡在肝内胆管的灌注是否完全充盈、造影信号有无外溢及造影显像满意持续时间。结果 16只大耳兔均成功制作模型,注入超声造影剂5 m L。A组肝内胆管均完全充盈,且都出现了造影信号的外溢;B组肝内胆管均完全充盈,有1例出现了造影信号的外溢。A组和B组的造影满意持续时间分别为(340±29)、(284±37)s,差异无统计学意义(P=0.06)。C组中有1例肝内胆管不完全充盈,D组均为造影剂不完全充盈。C组和D组均无造影信号的外溢。C组造影满意持续时间(82±8)s,和A组、B组的造影满意持续时间之间差异均有统计学意义(P<0.01)。在造影剂完全充盈和造影信号外溢方面A组和D组间差异有统计学意义(P=0.03),A组和B组、C组之间差异均无统计学意义(P>0.05)。结论经胆道途径给药超声造影研究胆管灌注是可行的,造影剂浓度不宜过低,1/200稀释浓度的成像效果最佳。     

米诺环素经腹主动脉灌注对兔脊髓缺血再灌注损伤的保护作用

目的建立兔脊髓缺血再灌注损伤模型,研究经腹主动脉灌注米诺环素对脊髓缺血再灌注损伤的作用。方法新西兰大耳白兔16只,随机分为A、B两组,各8只,A组为对照组,B组为米诺环素组。静脉麻醉后气管插管,持续监测平均动脉压、心率、脉搏血氧饱和度及直肠温度。手术暴露腹主动脉和双侧髂总动脉,经股动脉置一细导管至腹主动脉内距左肾动脉1．0cm处,于左肾动脉开口远端0．5cm阻断腹主动脉,同时阻断左、右髂总动脉,阻断即刻开始经导管向阻断的腹主动脉远端以12ml·kg^-1·h^-1的速度灌注实验药物0．5h,A组灌注常温生理盐水,B组为等容量米诺环素溶液（10mg／kg）,30min后开放血管。于动物完全清醒即刻、再灌注后6、24、48h对双后肢神经功能进行评估;再灌注48h,取脊髓L3-5 3个节段制作石蜡切片,光镜观察并计数正常前角运动神经元。结果清醒即刻、再灌注后6、24、48h,B组神经行为学评分明显高于A组（P〈0．05）;再灌注48h,A、B两组脊髓前角正常神经元中位数（P25-P75）分别为1（0～2）、8（4～11）。B组明显高于A组（P〈0．05）。结论腹主动脉阻断期间动脉内灌注米诺环素可减轻脊髓缺血再灌注损伤。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.