超声模拟人在超声专业住院医师规范化培训中的应用

应用超声模拟人技能操作训练系统对超声专业住院医师进行规范化培训,内容包括检查前准备训练、仪器操作训练、标准切面训练、典型病例训练及人文关怀训练,超声模拟人技能操作训练系统作为一种新的教学工具,能改进并丰富住院医师规范化培训超声教学的方法,提高培训质量。     

常规诊断用B超对早孕绒毛组织影响的研究

本文将６－１０周的３０例欲行人工流产术的健康妇女分成７个对照组，再分别用常规诊断用Ｂ超辐照１、２、３、４、５、７、１０分钟。我们用电镜对每例的绒毛超微结构进行了Ｂ超辐照前、后的自身对比研究，结果表明均无任何变化。     

Influence of Microbubble Size and Pulse Amplitude on Hepatocyte Injury Induced by Contrast-Enhanced Diagnostic Ultrasound

Recent research has found that contrast-enhanced diagnostic ultrasound (CEDUS) has the potential to induce localized injury in the liver, with clearly observable effects for contrast agent doses higher than the recommended dose and maximal mechanical index values. This study was undertaken to assess effects with intermittent exposure at lower contrast doses of infusion and at reduced output to determine thresholds. In addition, microbubble (MB) suspensions with enhanced content of larger MBs were tested. Exposure from a phased array probe (GE Vivid 7 Dimension, GE Vingmed Ultrasound, Horten, Norway) was applied at 1.6 MHz and 1-s intermittent frame trigger for 10 min with infusion of MB suspension with normal (1.8 µm), medium (3.1 µm) and large (5.3 µm) mean MB diameters. The bio-effect endpoint was the count of hepatocytes stained with Evans blue dye in frozen sections. For the normal MBs, the count increased for clinically relevant infusion dosages, but leveled off above 20 µL/kg/min. The evidence of injury declined with time from 30 min to 4 h and was lacking at 24 h. The exposure thresholds in terms of peak rarefactional pressure amplitude, divided by the square root of frequency (in situ mechanical index) were 1.7, 1.3 and 1.2 for the normal-, medium- and large-sized MB suspensions. The enhanced efficacy for larger MBs lends support to the two-criterion model for cavitational microvascular injury during CEDUS. Overall, CEDUS in liver appears to have markedly less potential for induction of tissue injury than has been reported in other tissues, which indicates a satisfactory safety profile for CEDUS using recommended parameters in normal liver.     

经阴道超声检查对妇科疾病的诊断价值

目的评价经阴道超声检查法（TVS）对妇科疾病的诊断价值。方法对146例妇科疾病患者做经阴道超声检查，并与经腹超声（TAS）检查做对比分析，总结两者检查方法的阳性率及优缺点。结果子宫肌瘤67例，绝经后子宫内膜出血28例，子宫内膜厚度11例，附件包块36例，官腔内团状稍强回声15例。结论经阴道超声检查法对盆腔脏器中小病变能获得更多细微结构的诊断信息，其阳性检出率大于经腹超声检查法阳性检出率。     

不同肺超声阳性诊断标准评价心源性肺水肿的价值比较

分析比较3种肺超声阳性标准在评估心源性肺水肿的诊断效能,以获得最优诊断标准为临床快速诊断心源性肺水肿提供有效的辅助手段。方法 纳入2022年6月至2022年11月上海交通大学医学院附属胸科医院行肺超声患者98例,根据最终临床诊断,将患者分为非心衰组（n＝55）和心衰组（n＝43）。收集患者临床资料及肺超声相关信息。采用6点法进行肺超声检查,根据阳性点的个数及分布范围定义了3种阳性标准（阳性1：至少有两个阳性点;阳性2：至少有3个阳性点;阳性3：每侧至少有一个阳性点）,评估3种肺超声阳性标准诊断心源性肺水肿的效能,并探讨3种肺超声阳性标准诊断心源性肺水肿与临床最终诊断的一致性。结果 阳性1、阳性2、阳性3诊断方法的诊断敏感性分别为88%、72%、79%,特异性分别为89%、100%、93%,准确率分别为87%、88%、87%。3种肺超声阳性标准均对心源性肺水肿的诊断与临床最终诊断具有明显的一致性（P＜0.05）。阳性2对心源性肺水肿的诊断具有较高的一致性(Kappa值=0.877)。阳性1及阳性3对心源性肺水肿的诊断一致性一般(Kappa值分别为0.783和0.727)。结论 3种肺超声阳性标准诊断心源性肺水肿的效能均较高,但阳性2诊断标准对心源性肺水肿的诊断与临床最终诊断更为一致,能够更好的为临床诊断提供帮助。     

Ultrasound Phantom Using Sodium Alginate as a Gelling Agent

For medical workers, ultrasound phantoms for human soft tissue are used not only for accuracy management of ultrasound diagnosis but also to aid ultrasound‐guided needle and blind catheter insertion training without risk to real patients. For the phantoms, ultrasound characteristics and a texture are required to mimic the human soft tissue. The proposed phantom was composed of sodium alginate, calcium sulfate dihydrate, trisodium phosphate 12‐hydrate, glycerol, and water. The propagation speed, attenuation coefficient, acoustic impedance, and texture of the proposed phantom were almost the same as those of human soft tissue. Expensive chemicals and special equipment are not required.     

Pulmonary Capillary Hemorrhage Induced by Diagnostic Ultrasound in Ventilated Rats

Pulmonary capillary hemorrhage (PCH) can be induced by diagnostic ultrasound—a potential safety issue. Anesthetized rats were intubated for intermittent positive-pressure ventilation (IPPV) with 0 end-expiratory pressure, +4?cm H₂O end-expiratory pressure (PEEP) and ?4?cm H₂O end-expiratory pressure (NEEP). Rats were imaged at 7.6?MHz with a Philips HDI 5000 ultrasound machine. The output was low (mechanical index [MI] = 0.22) for aiming and then was raised for 5?min in 20 different exposure groups with n = 8. Peak rarefactional pressure amplitudes were measured in water and de-rated for chest attenuation. The PCH areas were measured on the lung surface. At 2.2?MPa, PCH was 9.3 ± 6.6?mm² for IPPV, 1.6 ± 3.2?mm² for PEEP (p?<0.001) and 26.8 ± 6.4?mm² for NEEP (p?<0.001). Thresholds were 1.3?MPa for IPPV, 2.1?MPa for PEEP and 1.0?MPa for NEEP. The small ventilator pressures subtracted or added to trans-capillary stress generated by diagnostic ultrasound pulses, virtually eliminating PCH for PEEP but enhancing PCH for NEEP.     

Emergency Department Ultrasound Credentialing: a sample policy and procedure

Emergency physician use of bedside ultrasound has increased dramatically over the last two decades. However, many emergency departments find it difficult to gain formal hospital credentialing for bedside sonography. We present the Emergency Department (ED) Ultrasound Credentialing Policy from the University of California, San Francisco. Although the American College of Emergency Physicians has published formal guidelines on this subject, they are not written in such a way that they are readily transcribed into a document suitable for review by credentialing committees and executive medical boards. Our policy details the background of emergency bedside ultrasound, the goals of its use, the scope of emergency physician sonography, credentialing criteria, and an example of a quality assurance program. We have not changed the components of the previously published guidelines. Rather, this document has withstood the rigor of our own credentialing process and is presented as an example in the hopes that it may help other EDs who seek credentialing in their institutions. This document is intended as a guideline for credentialing committees and will require alteration to meet the needs of each different hospital; however, the overall framework should allow for a less time-consuming process.     

手术治疗盆腔脓肿25例治疗临床分析

目的：探讨盆腔脓肿的临床表现,超声诊断结果及手术探查情况以提高诊疗水平。方法：对2000年1月～2006年12月我科收治的25例手术治疗的盆腔脓肿病例进行回顾性分析。结果：其临床表现主要为腹痛、发热、腹部或盆腔包块等。超声声像显示：盆腔内不规则囊性或多房性输卵管卵巢肿块,囊内不均质光点,伴有或不伴有盆腔积液。手术探查表现为：盆腔粘连,一侧或双侧输卵管脓肿或输卵管卵巢脓肿。结论：盆腔脓肿的临床表现不典型,术前易出现误诊和漏诊;随着病情的变化,结合临床表现、阳性体征的发现及超声诊断可以提高其检测率。     

Common Iliac Artery Tortuosity Simulating Aortic Dissection on Focused Abdominal Ultrasound in the Emergency Department

Background

Bedside ultrasonography performed by the Emergency Physician is a safe procedure for evaluating patients with trauma, hypotension, chest or abdominal pain, and dyspnea of unknown origin.

Objectives

To present a case with apparent concordance between the patient's history, symptoms, signs, and ultrasound imaging, that lead to diagnostic error.

Case Report

A 74-year-old man was admitted to the hospital due to epigastric pain, radiating to the back. He reported previous detection of a small dilatation in the ascending aorta. On physical examination, the heart rate was 120 beats/min and the blood pressure was 90/60 mm Hg. These facts suggested the possibility of an aortic dissection; therefore, a bedside emergency ultrasound examination was performed. The first part of the examination focused on the ascending aorta, but the results were not significant. Then, an abdominal evaluation was performed that revealed an ovular and pulsatile anechoic mass in the infrarenal tract, with an echoic wall and an endoluminal flap. A computed tomography scan of the aorta was ordered, and it showed a regular aorta in the entire tract, with an abnormal tortuosity of iliac arteries as the basis of the false-positive ultrasound.

Conclusions

The use of ultrasound in emergency settings has improved the clinical evaluation of critical patients by Emergency Physicians, but the possibility of a false-positive diagnostic error always should be considered.     

胃肠超声造影对儿童胃十二指肠溃疡的诊断价值

目的探讨胃肠超声造影对儿童胃十二指肠溃疡的临床意义。方法该院462例上消化道疾病的患儿口服超声造影剂,观察其贲门、胃底、胃体、胃窦及十二指肠球部等各部位形态及层次结构,分析异常回声区。超声造影诊断消化性溃疡的93例患儿,比较其胃镜检查结果。结果以胃镜检查结果作对照,胃肠超声造影对儿童胃十二指肠溃疡诊断的符合率为93.54%,2种检测方法比较,差异无统计学意义(P0.05)。结论胃肠超声造影检查在儿童胃十二指肠溃疡疾病诊断中具有较高的临床价值,是对胃镜检查的良好补充,可作为儿童上消化道疾病的一种筛查方法而应用于临床。     

高频三维超声对三角韧带断裂的诊断价值

目的探讨高频三维超声对三角韧带断裂的诊断价值。方法对68例拟诊为三角韧带断裂患者分别采用高频三维超声和MRI检查,以手术中探查结果作为三角韧带是否断裂的最终结果,比较2种检查方法的符合率。结果高频三维超声诊断三角韧带断裂40例,在超声下主要表现为踝关节内侧韧带连续性完全中断,部分区域出现无回声区,内翻试验无回声区间距明显增大;外/内翻韧带试验下探查见低-无回声区间距增大;MRI检查诊断三角韧带断裂41例,表现为韧带的连续性中断,韧带松弛以及波浪状改变,韧带内出现异常高信号;其中有一种检查结果提示三角韧带断裂,即行三角韧带探查,42例行手术探查证实三角韧带断裂,并行三角韧带探查修补术,26例行保守治疗;高频三维超声检查真阳性39例,假阳性1例;MRI检查真阳性40例,假阳性1例;高频三维超声诊断符合率为92.85%（39/42）,MRI检查诊断符合率为95.23%（40/42）。结论高频三维超声对三角韧带断裂诊断符合率接近MRI检查,具有便捷、可重复检查等优点。