多普勒频谱分析胎儿宫内缺氧

目的综合分析子宫动脉、脐动脉及大脑中动脉多普勒指标(PI值)变化关系对评价胎儿缺氧的意义。方法运用多普勒技术检测90例因不良妊娠住院患者子宫动脉、胎儿脐动脉及大脑中动脉搏动指数(PI),回顾分析妊娠结局与各频谱参数变化的关系。结果子宫动脉异常(PI≥95th)伴脐动脉参数升高(PI>50th)和(或)大脑中动脉参数降低(PI<50th)者妊娠结局不良,且脐动脉参数升高至异常时(PI≥95th)围产儿病死率增高;子宫动脉正常时(PI<95th),脐动脉参数异常(PI≥95th)伴大脑中动脉参数降低者(PI<50th)妊娠结局不良;大脑中动脉血流参数异常者(PI≤5th)妊娠结局不良;单一子宫动脉或脐动脉血流参数异常者(PI≥95th)妊娠结局良好。结论综合分析子宫动脉、脐动脉及大脑中动脉频谱指标变化关系,可判定及评估胎儿缺氧情况、提示预后。     

应用MRA评价后交通动脉开放与后循环形态的关系

目的 应用3.0T磁共振血管成像(MRA)技术探讨后交通动脉开放情况与双侧大脑后动脉及基底动脉形态之间的关系.方法 对108名受试者行MRA及常规MRI.观察双侧大脑后动脉P1段粗细及后交通动脉开放情况,测量基底动脉直线长度及内径,并进行统计学分析.结果 大脑后动脉P1段粗细与其同侧后交通动脉粗细相关(Kendall等级相关,右侧:相关系数rk=0.44,P<0.01;左侧:相关系数rk=0.50,P<0.01).双侧后交通动脉均未开放者基底动脉长度比单侧或双侧后交通动脉开放者长(P<0.05).双侧后交通动脉均未开放者基底动脉管腔平均直径比单侧或双侧后交通动脉开放者宽(P<0.01).结论 大脑后动脉P1段粗细及基底动脉长度、直径与后交通动脉是否开放有关.     

椎动脉造影在椎动脉型颈椎病中的诊断价值

通过对30例颈性眩晕患者推动脉造影的X线观察，认为：椎动脉纤细发育不良者及椎动脉于颈椎1～2段走行异常所致血管痉挛引起椎动脉供血不足不属于椎动脉型颈椎病。对以椎动脉供血不全症状为主，血管造影系由于钩椎关节退变、钩突增生肥大压迫致椎动脉狭窄，或因颈椎节段性不稳刺激椎动脉痉挛者，应诊断为椎动脉型颈椎病。目前，椎动脉造影应是诊断椎动脉型颈椎病最可靠的方法之一。     

双源CT诊断先天性冠状动脉瘘

目的 观察双源CT在先天性冠状动脉瘘诊断中的应用价值. 方法 使用双源CT机对9例先天性冠状动脉瘘患者进行增强扫描,将获得的数据进行容积再现、多平面重建、最大密度投影、曲面重建,分析冠状动脉走行及心内外结构. 结果 左冠状动脉主干右心室瘘2例;左冠状动脉主干和(或)前降支主肺动脉瘘7例,其中5例合并右冠状动脉主肺动脉瘘. 结论 双源CT冠状动脉造影方便、快捷、无创,可以作为诊断先天性冠状动脉瘘的首选方法.     

超声评价不同级别高血压颅内、外段血管血流动力学改变特点

目的 探讨不同级别的原发性高血压患者颈内动脉系和椎-基底动脉系颅内、外段血管血流动力学变化的特点及相关性。方法 将160例原发性高血压患者按照高血压分级分为1~3级高血压组,另选正常对照组50名。采用经颅多普勒超声及彩色多普勒血流显像分别对各组颈内动脉系颅外段的颈内动脉和颅内段的大脑中动脉、大脑前动脉,以及椎-基底动脉系的颅外段椎动脉₂和颅内段的大脑后动脉、椎动脉₁和基底动脉的收缩期峰值流速（PSV）、舒张末期流速（EDV）、血管搏动指数（PI）和阻力指数（RI）进行检测。结果 颈内动脉系和椎-基底动脉系均随着高血压分级的增加,PSV和EDV减低,PI和RI增加。颈内动脉系的PSV和EDV在2级高血压组减低,椎-基底动脉系在1级高血压组EDV减低,RI增加。椎-基底动脉系除3级高血压组的颅内段大脑后动脉和颅外段椎动脉₂的PI及RI呈负相关外,两系的2级和3级高血压组的颅内、外参数相关均呈正相关。结论 2级高血压患者颈内动脉系PSV和EDV降低,1级高血压患者椎-基底动脉系EDV降低和RI增高。颅内、外血管的血流动力学指标仅在2级高血压以上有相关性。     

肠系膜上动脉病变与冠心病相关性研究

目的:提高对冠心病患者并发肠缺血的认识。方法:对可疑冠心病心绞痛患者行冠状动脉和肠系膜上动脉造影,分析冠状动脉和肠系膜上动脉之间以及患者的胃肠症状与肠系膜上动脉影像变化的关系。结果:59例冠心病患者中17例肠系膜上动脉病变(28.8%),24例冠状动脉正常者中2例肠系膜上动脉病变(8.3%)(P<0.05)。冠状动脉多支血管病变27例(45.8%),合并肠系膜上动脉病变14例(23.7%);单支血管病变32例(54.2%),合并肠系膜上动脉病变3例(0.05%)(P<0.05)。34例有胃肠症状患者中13例肠系膜上动脉病变(38.2%);25例无胃肠道症状者中4例肠系膜上动脉有病变(16%)(P<0.05)。结论:冠状动脉与肠系膜上动脉病变之间有相关性。肠系膜上动脉损害一般在冠状动脉损害较严重时发生。冠心病患者的胃肠道症状与肠系膜上动脉血管的改变有相关性,应重视冠心病患者肠缺血的存在。     

肱动脉和股动脉采血法在消化道大出血患者中应用的随机对照研究

目的探讨肱动脉和股动脉采血法在急性消化道大出血患者的临床效果,为其临床应用提供循证医学证据。方法选取2018年6月至2019年10月在陆军军医大学第二附属医院住院治疗且需采血检查的急性消化道大出血患者98例为研究对象,随机分为2组(肱动脉采血组和股动脉采血组),每组49例,按照相应规范进行采血操作,并收集相关信息;比较2组一般情况及临床采血效果。结果肱动脉采血组和股动脉采血组患者的一般情况比较,差异无统计学意义(P>0.05);肱动脉采血组的一次性穿刺成功率和标本合格率分别为95.92%和91.84%,均高于股动脉采血组的79.59%和65.31%,差异有统计学意义(P<0.05);肱动脉采血组的采血时间短于股动脉采血组,不良反应和采血轻度、重度疼痛感发生率均低于股动脉采血组,差异均有统计学意义(P<0.05)。结论肱动脉采血法在急性消化道大出血患者中应用的临床效果优于股动脉采血法,且更易操作和保护患者隐私,有一定临床推广价值。     

桡 尺动脉远侧段的解剖学特性及其临床意义

目的为经冠状动脉造影的临床应用提供解剖学依据。方法用体视显微镜测量37具尸体共64侧桡动脉远侧段的内径、外径;尺动脉远侧段的内径、外径。结果 (1)桡动脉平桡骨茎突上5cm处断面:外径、内径和管壁厚度分别是(2.33±0.49)、(1.31±0.45)、(0.51±0.13)mm;(2)桡动脉平桡骨茎突处断面:外径、内径和管壁厚度分别是(2.71±0.45)、(1.52±0.54)、(0.59±0.16)mm,3者均大于桡动脉平桡骨茎突上5 cm处断面,差异有统计学意义(P0.05);(3)桡动脉的内径、外径及管壁厚度存在性别和年龄的差异,但差异无统计学意义(P0.05);(4)尺动脉平尺骨茎突上5 cm处断面:内径、外径和管壁厚度分别是(4.30±0.27)、(3.30±0.22)、(0.67±0.31)mm;(5)桡动脉和尺动脉在内、外径上比较,差异无统计学意义(P0.05)。也就是说,从解剖学上考虑,尺动脉完全可以用来进行冠状动脉造影。结论本文结果对桡动脉穿刺失败时采用经尺动脉冠状动脉造影术等提供了解剖学依据,具有应用价值。     

经桡动脉与股动脉 2 种途径行冠状动脉介入术的效果比较及护理

目的探讨经桡动脉与股动脉2种途径行冠状动脉介入术诊治冠心病的利弊,以及针对不同的途径采取相应的护理措施。方法将645例冠心病患者按介入途径不同分为桡动脉组510例和股动脉组135例,比较2组患者手术并发症和主观不适等发生率。结果桡动脉组患者术后卧床时间、住院时间短于股动脉组,迷走神经反射、患者主观不适、皮下血肿、假性动脉瘤、排便困难、术后低血压的发生率均低于股动脉组。结论2种穿刺途径行冠状动脉介入诊疗均安全、可行。经桡动脉穿刺不良反应发生率低,术后护理相对简单,可提高护理人员工作效率,患者更易接受。     

Screening angiography of supraaortic vessels performed by invasive cardiologists at the time of cardiac catheterization: indications and results

An aging population makes multiple vascular distributions more likely in patients arriving at the cath lab for coronary artery angiography or complete cardiac catheterization. Whether or not screening angiography of supraaortic vessels can be performed at the time of cardiac catheterization by the invasive cardiologist is still debatable. We sought to determine safety and utility of performing angiography of supraaortic vessels during cardiac catheterization. Medical records of all patients undergoing combined coronary and noncoronary angiography between May 1998 and December 2002 was retrospectively reviewed. One hundred and forty patients (80 males, mean age 67.8 ± 5.4 years) underwent combined cardiac catheterization and angiography of supraaortic vessels. Carotid artery angiography was performed at the same time of cardiac catheterization in 62 patients and subclavian artery angiography in the other 78 patients. Significant findings were reported in 32 (22.8%) patients. Complications included 1 transient ischemic attack and 2 carotid spasm resolved with nitrates infusion. In most cases the same standard catheters used during coronary angiography were used also for noncoronary angiography (119 patients, 85%). The incidence of significant angiographic findings and the relatively frequent association of CAD with supraaortic vessel atherosclerosis supports combined cardiac catheterization and angiography of supraaortic arteries but only in patients with multivessel coronary artery disease.     

红外热成像技术在冠心病诊疗中的应用

目的我们应用自主研发的医用热成像诊断系统,采集冠心病病例术前热成像资料及冠状动脉旁路术中心肌热成像数据加以分析,以期为冠心病诊疗提供新的方法。方法同期临床确诊冠心病,多支病变患者12例常规行冠状动脉旁路移植术并于术前及术中行红外热成像数据采集。结果经红外热成像技术,所有研究对象顺利采集到相应心肌温度数据及相应热区分布变化,对比其他临床辅助检查手段证实了其有效性。结论红外热成像技术作为一种新型医学诊断技术手段,可安全、有效地应用于冠心病诊疗过程并具指导意义。     

A solitary precaval right renal artery: A case report

Knowledge of aberrant renal vasculature is critical for preoperative planning of either open or minimally invasive renal surgery. A precaval right renal artery is a rare anatomical variant in which the artery passes anterior to the inferior vena cava(IVC), as opposed to coursing posteriorly. When encountered, this artery is mostly accessory and thus accompanied by renal vessels in orthotopic position. Here, we describe an unusual instance of a solitary, main precaval right renal artery. It can be diagnosed preoperatively by a cross‐sectional imaging study. Awareness of this anomaly is very important to prevent iatrogenic injury during surgical intervention.     

肱动脉流量介导的舒张功能与冠心病的关系

目的探讨肱动脉流量介导的舒张功能(FMD)与冠心病的关系.方法受试者98人,分为冠心病组(52人)和有冠心病倾向的对照组(46人).用高分辨率超声心动图仪检测所有受检者的肱动脉FMD.结果冠心病组患者FMD 0.05±0.01,对照组为0.09±0.04,二组间差异有显著性意义(P=0.01).FMD与冠状动脉病变程度不相关(P>0.05).当把FMD临界点定为10%时,诊断冠心病的敏感性为88%,特异性为71%.结论超声检测FMD是监测冠心病的一项重要指标.     

Supraorbital artery as an alternative site for oscillometric blood pressure measurement

Objective. Noninvasive blood pressure measured from the superficial temporal artery bas been shown to correlate well with pressure in the brachial artery. The supraorbital artery may be an even better site for monitoring blood pressure on the forehead because it originates from the internal carotid artery, and it is easier to locate anatomically. This study compares mean pressure measured oscillometrically over the supraorbital artery and at the upper arm.Methods. Oscillometric signals from the supraorbital artery were recorded in 20 surgical patients under general anesthesia using a 2.5- × 1-cm bladder attached to the forehead with a self-adhesive pad. Blood pressure was measured simultaneously from the arm using a Dinamap 1846 blood pressure monitor, and the resulting data compared with the supraorbital artery measurements.Results. The mean difference between 219 pairs of blood pressure measurements, from the forehead and the arm, was 3.8 mm Hg. The standard deviation of the differences was 7.4 mm Hg. The linear regression equation for the data wasy = 0.98x + 3.25, with a standard error of estimate of 7.31 mm Hg. The correlation coefficient between the two measurements was 0.82.Conclusions. The results show that mean blood pressures measured oscillometrically from the supraorbital and brachial arteries agree and correlate well with each other. The supraorbital artery should be a good alternative site for blood pressure measurement. This article has been used by Tai-Kwong Lee as part of a dissertation, titled “Noninvasive blood pressure monitoring from the supraorbital artery of the forehead by oscillometry”, submitted to the Department of Bioengineering, University of Utah, in partial fulfillment of the requirements for a doctoral degree, June, 1996.     

超声评价颈、股动脉内-中膜厚度与冠心病相关性研究

目的 探讨颈动脉（CA）、股动脉（FA）的内一中膜厚度（IMT）对冠心病（CAD）的诊断价值。 方法 对189例连续冠脉造影（CAG）受检者术前利用高频超声进行CA、FA的IMT检查，并与CAG结果进行相关性研究。 结果 CAD单支病变组、多支病变组CA、FA的IMT增厚以及斑块发生率均明显高于对照组（P〈0．01）；多支病变组CA、FA的IMT显著高于单支病变组，斑块发生率与单支病变组之间无显著性差异（P〉0．05），CA粥样硬化斑块对CAD诊断的敏感度、特异度及对CAD阳性预告值分别为72．3％、79．2％及89．5％；FA粥样硬化斑块对CAD诊断的敏感度、特异度及对CAD阳性预告值分别为83．2％、77．8％及90％；CA、FA两处均有粥样硬化斑块对诊断的敏感度、特异度及对CAD阳性预告值分别为84．1％、87．6％及93．1％。 结论 CAD患者及具有其危险因素人群中，进行CA、FA超声检查，可成为研究CAD的间接指标和窗口。     

Mid‐term outcome after carotid artery stenting depends on presence of coronary artery disease

BACKGROUND. Longer‐term outcome of patients following carotid artery revascularization depends predominantly on cardiac events rather than neurological events.

AIM. To assess the longer‐term outcomes of patients with known coronary artery morphology undergoing carotid artery stenting.

METHOD. In a prospective observational study including 549 consecutive patients undergoing carotid artery stenting, a coronary angiography was performed in a single session unless a recent angiogram was available. Following the intervention, patients were followed prospectively to determine neurological events as well as major adverse coronary events (MACE) during long‐term follow‐up.

RESULTS. Coronary artery disease was present in 378 patients including 92 patients without current significant stenosis. The MACE rate was 6.4% in patients without coronary artery disease compared to 28.3% in patients with coronary artery disease (P<0.00001). Cardiac and all‐cause mortality were statistically significantly higher in patients with a significant coronary stenosis than in patients without coronary artery disease (P<0.001 and P<0.01). Cardiac mortality and all‐cause mortality were 2.3% and 7.6% in patients without coronary artery disease (patient group I), 7.6% and 13.0% in patients with coronary artery disease but no current significant stenosis (patient group II), and 10.5% and 16.1% in patients with significant coronary stenosis (patient group III). Neurological events, however, were distributed equally among the three patient groups.

CONCLUSIONS<1/emph>. In the longer term, outcomes in patients undergoing carotid artery stenting depend on concomitant coronary artery disease rather than neurological events, cardiac mortality and even all‐cause mortality depending on a significant coronary artery stenosis.     

Bilateral internal mammary artery grafting

The superiority of the left internal mammary artery over the saphenous vein graft led many surgeons to adopt bilateral internal mammary artery (BIMA) as a good surgical option for further improving late outcome of patients undergoing myocardial revascularization. However, routine use of BIMA was limited by some potential drawbacks: the increase of deep sternal wound problems, especially in diabetic patients; the shortness of right internal mammary artery (RIMA), which limited its utilization as an in situ graft; the low patency rate if grafted to the right coronary artery; and the longer operative time. The skeletonization of the internal mammary artery along with a better glucose control in diabetic patients significantly reduced the incidence of deep sternal problems. Another problem to solve was finding the optimal target of the RIMA. The general consensus is that RIMA appears to be more efficient if grafted to the lateral wall. The Y or T configuration of double mammary arteries could be more helpful to reach the lateral target vessels. Finally, recent reports clearly demonstrate the superiority of BIMA over single internal mammary artery in terms of survival or quality of life. The latter finding has also been reported in diabetic patients.     

不同部位测量儿童血压结果的比较

目的探讨儿童肱动脉血压值和桡动脉血压值的相关关系以及能否用测量桡动脉血压来取代测量肱动脉血压。方法用电子血压仪监测了105例儿童的肱动脉血压值和桡动脉血压值,采用自身对照方法进行比较。结果105例儿童的肱动脉和桡动脉血压的平均值之间差异无统计学意义(P>0.05),直线回归和相关分析表明,105例儿童的肱动脉与桡动脉血压值之间呈直线正相关(P<0.0001)。结论采用儿童的桡动脉血压测量可以取代肱动脉血压测量。     

A risk–benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review

Cervical artery dissection refers to a tear in the internal carotid or the vertebral artery that results in an intramural haematoma and/or an aneurysmal dilatation. Although cervical artery dissection is thought to occur spontaneously, physical trauma to the neck, especially hyperextension and rotation, has been reported as a trigger. Headache and/or neck pain is the most common initial symptom of cervical artery dissection. Other symptoms include Horner’s syndrome and lower cranial nerve palsy. Both headache and/or neck pain are common symptoms and leading causes of disability, while cervical artery dissection is rare. Patients often consult their general practitioner for headache and/or neck pain, and because manual-therapy interventions can alleviate headache and/or neck pain, many patients seek manual therapists, such as chiropractors and physiotherapists. Cervical mobilization and manipulation are two interventions that manual therapists use. Both interventions have been suspected of being able to trigger cervical artery dissection as an adverse event. The aim of this review is to provide an updated step-by-step risk–benefit assessment strategy regarding manual therapy and to provide tools for clinicians to exclude cervical artery dissection.

• Key messages

• Cervical mobilization and/or manipulation have been suspected to be able to trigger cervical artery dissection (CAD). However, these assumptions are based on case studies which are unable to established direct causality.

• The concern relates to the chicken and the egg discussion, i.e. whether the CAD symptoms lead the patient to seek cervical manual-therapy or whether the cervical manual-therapy provoked CAD along with the non-CAD presenting complaint.

• Thus, instead of proving a nearly impossible causality hypothesis, this study provide clinicians with an updated step-by-step risk–benefit assessment strategy tool to (a) facilitate clinicians understanding of CAD, (b) appraise the risk and applicability of cervical manual-therapy, and (c) provide clinicians with adequate tools to better detect and exclude CAD in clinical settings.

     

小儿肱动脉桡动脉处血压值比较

本文对２２０例小儿肱动脉,桡动脉处的血压进行了测量比较,结果不同年龄组,不同体位时,该二处的收缩压及舒张压均无统计学差异（Ｐ〉０．５）。桡动脉处可作为小儿血压测定的另一选择,桡动脉处测甚为方便,临床实用性更大,左右上肢血压值也无显著差异（Ｐ〉０．５）,临床上测定时可任选其一。