成年房间隔缺损患者并发肺动脉高压影响因素及介入封堵术后即刻肺动脉压力与肺动脉高压关系研究

目的 分析成年房间隔缺损(ASD)患者并发肺动脉高压(PAH)的影响因素,探讨患者介入封堵术后即刻肺动脉压力的变化情况及其与术后PAH的关系.方法 选取北部战区总医院自2018年1月至2021年1月收治的407例ASD伴不同程度肺动脉压力患者为研究对象.所有患者均接受右心导管检查及封堵治疗.根据术前肺动脉平均压水平不同...     

右室组织多普勒Tei指数评价室间隔缺损右室功能的研究

目的探讨组织多普勒（TDI）Tei指数评价室间隔缺损患者右心室功能的价值。方法根据患者肺动脉收缩压（PASP）水平,将56例室间隔缺损患者分为合并肺动脉高压[PH（＋）]组（33例,PASPI〉40mmHg）和未合并肺动脉高压[PH（-）]组（23例,PASP〈40mmHg）;选取25例健康体检者为正常对照组。利用超声TDI技术获得三尖瓣环组织运动频谱,计算研究对象的右室Tei指数。结果PH（＋）组Tei指数明显高于对照组及PH（-）组（P〈0．05）;PH（＋）组IVRT明显大于PH（-）组（P〈0．05）;与对照组比较,PH（-）组IVRT、IVCT、ET及右室Tei指数均无显著差异（P〉0．05）。TDI测得右室Tei指数与PASP呈正相关（P〈O．01）。结论室间隔缺损合并肺高压患者右室整体功能受损,TDI．Tei指数可较准确反映室间隔缺损患者右室功能。     

Tei指数在评价海员慢性阻塞性肺病患者右心室功能中的应用

目的 探讨Tei指数在评价海员慢性阻塞性肺病患者右心室功能中的作用.方法 在我院2006年至2007年住院的海员患者及健康体检者中选取慢性阻塞性肺病患者38例,正常对照组98例.行超声心动图检查测量右心Tei指数、肺动脉收缩压等.结果 (1)与正常对照组相比,慢性阻塞性肺病患者右心室等容舒张时间(IRT)及等容收缩时间(ICT)明显延长,射血时间(ET)明显缩短,右室Tei指数明显升高(P<0.01);(2)肺动脉高压组间比较显示肺动脉高压的程度对右室Tei指数有一定影响,组间比较差异有统计学意义(P<0.01).(3)右心大小组间比较显示右室扩大的Tei指数增大,但组间比较差异无统计学意义(P>0.05).结论 (1)Tei指数是评价慢阻肺患者右心室收缩舒张功能简便、敏感、综合的多普勒超声新指标;(2)右心室Tei指数受压力负荷增加影响大,受容量负荷增加影响小,其右室功能受损程度与肺动脉收缩压升高有一定相关性.     

肺动脉高压对房间隔缺损封堵术后的影响

目的 探讨房间隔缺损(ASD)封堵术后患者心功能变化及评估肺动脉高压(PAH)对ASD封堵术后心功能变化的影响。方法 选取烟台毓璜顶医院58例ASD患者资料,比较患者术前、术后1天及术后6个月心脏相关参数:左心房收缩末期内径(LA),左心室舒张末期内径(LVEDd)、右心室舒张末期内径(RVEDd)、左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、三尖瓣反流压差(TRPG)。根据术前是否伴有PAH分成两组,并比较两组年龄、ASD大小与PAH的关系,并对两组心脏参数进行对比。结果 两组患者肺动脉压力术后均有下降,而PAH组下降较明显。术前肺动脉压力与ASD的大小及年龄的相关系数分别是r=0.612、r=0.521。心脏各参数对比:其中LA时间因素(P=0.149)、LVEDd主效应(P=0.247)及LVEDV组间效应比较,差异无统计学意义(P> 0.05),余参数比较,差异均有统计学意义(P <0.05)。结论 经超声引导下介入封堵术后无论是否存在PAH,心功能在术后短期内都会有一定程度改善,同时PAH患者会发生一定程度的不可逆转的肺血管变化,早期积极的方法封...     

组织多普勒成像在房间隔缺损封堵术中的应用

 目的 应用组织多普勒成像技术(DTI)对房间隔缺损(ASD)封堵术前后的左、右室壁运动状态进行观察,评价左、右室功能变化.方法 ASD封堵术患者30例,均于术前、术后48 h及术后3个月行DTI检查,观察左、右室壁收缩波、舒张早期波和舒张晚期波峰值速度S'、E'、A'.结果 与术前相比,三尖瓣环及右室侧壁中段术后48 h和3个月各峰均显著减低;室间隔中段术后48 h S'、E'峰及术后3个月各峰均显著降低;左室侧壁处二尖瓣环术后3个月各峰显著升高;左室侧壁中段术后3个月S'及A'峰显著升高.结论 应用组织多普勒技术能够准确评价ASD封堵术后各室壁和房室瓣环的运动变化,反映左、右室壁功能改变,可为临床评价ASD封堵术疗效提供有用信息.     

高原地区老年房间隔缺损介入封堵治疗疗效和安全性研究

目的：探讨高原地区经导管介入封堵治疗老年房间隔缺损（ASD）的有效性和安全性。方法：分析经导管封堵治疗的37例老年ASD患者的临床和介入治疗资料。结果：全组治疗成功率为90.1%,TTE测量ASD平均大小（24.7±6.1）mm,封堵器平均大小（28.2±8.6）mm,均采用国产封堵器。术后3个月平均肺动脉收缩压较术前下降明显（38.5±15.4）mmHg vs（57.2±14.8）mmHg,P〈0.05,右心房、右心室内径较术前减小。微少量残余分流3例,3个月后复查分流消失。并发症发生率10.8%,无死亡病例。随访（6-42）个月,封堵器无移位,心功能改善。结论：高原地区老年ASD患者有缺损大、肺动脉高压程度严重、合并症多的特点,严格掌握适应证,规范操作,积极治疗合并症,是成功封堵的关键。     

组织多普勒右室Tei指数评价肺动脉高压模型兔右室功能的实验研究

目的探讨超声心动图组织多普勒Tei指数在评价肺动脉高压模型兔右心功能方面的应用价值,并分析尼可地尔对肺动脉高压所致的右心功能减退是否有缓解作用。方法研究对象为33只雄性新西兰白兔随机分为三组：I组,肺动脉高压模型组（肺动脉收缩压〉30mmHg）;II组,尼可地尔组;III组,空白对照组（肺动脉收缩压≤30mmHg）。对所有模型测定右心功能超声指标,比较各组间指标的差别,分析右室Tei指数对右心功能的影响。取标准心尖四腔观,测量右室收缩期右房室环最大运动速率（Sm）、舒张早期最大运动速率（Em）、舒张晚期最大运动速率（Am）和Em/Am值,以及ET,计算右室Tei指数。结果肺高压组（I组）右室Em下降,Am增高,Em/Am比值降低。与正常对照组（III组）相比,肺高压组（I组）右室Tei指数明显升高（P〈0.01）,与正常对照组（III组）相比,尼可地尔组（II组）右室Tei指数明显升高（P〈0.01）。肺高压组（I组）与尼可地尔组（II组）相比,肺高压组（I组）Tei指数较高,差异有统计学意义（P〈0.05）。结论利用TDI技术测量右心Tei指数对右心功能不全患者可无创、迅速地评价其右心室功能,对指导临床治疗具有较高的应用价值。尼可地尔对改善由肺动脉高压导致的右心功能减退亦有一定的疗效。     

Tei指数评价高海拔地区肺动脉高压患者右心功能的临床研究

目的：探讨Tei指数评价高海拔地区肺动脉高压患者右心功能的临床价值。方法：对西宁地区48例肺动脉高压患者和33例正常人,行超声检查,测量右房横径、右室横径、右室前壁厚度、肺动脉主干内径根据三尖瓣返流和肺动脉瓣返流估测肺动脉收缩压、肺动脉舒张压、肺动脉平均压,并计算右心Tei指数。结果：肺动脉高压患者与对照组右心Tei指数有显著统计学差异,不同肺动脉压力组之间右心Tei也有统计学差异。结论：右心Tei指数是反映右心整体功能较敏感的指标。     

彩色多普勒超声心动图在小儿房间隔缺损诊治中的作用分析

目的探讨彩色多普勒超声心动图(TTE)在小儿继发孔房间隔缺损(ASD)诊治中的作用。方法筛选98例小儿继发孔ASD患者,封堵术前应用二维超声心动图(2DE)观察ASD位置、大小和残余边缘长度。应用彩色多普勒血流显像(CDFI)观察过房间隔分流束和各瓣膜反流情况。应用连续波多普勒(CW)估测肺动脉压力。封堵术中应用2DE监视封堵器位置是否正常,应用CDFI观察是否有残余分流及是否引起或加重瓣膜反流。封堵术后应用2DE测量心腔内径的变化,观察封堵器是否有移位、脱落。应用CDFI观察是否有残余分流及瓣膜反流情况。应用CW估测肺动脉压力变化。结果本组98例小儿继发孔ASD患者经TEE术前筛选适应证、术中监测和术后疗效判断,实施ASD封堵术全部获得成功,包括合并畸形全部实施介入治疗,治疗效果满意。结论彩色多普勒超声心动图在小儿继发孔房间隔缺损的术前诊断、术中监测及术后疗效判断中具有重要的临床作用。     

高海拔地区动脉导管未闭藏族患者介入治疗的疗效分析

 目的 探讨高海拔缺氧地区动脉导管未闭(patent ductus arteriosus,PDA)藏族患者介入手术治疗效果.方法 9例来自西藏、生长环境均在海拔3500 m以上的藏区PDA患者.年龄3～21岁,平均(10 4±5 5)岁,入我院行超声心动图检查确诊后行介入治疗.其中合并轻度肺动脉高压( pulmonary hypertension,PH)1例,中度肺动脉高压1例,重度肺动脉高压2例.手术皆采用国产封堵器在降主动脉造影下行介入封堵.结果 除1例试封堵失败转外科外,余8例手术均取得成功.2例重度PH患者术前测肺动脉收缩压分别为78、83 mmHg,术后即刻测肺动脉收缩压降至16、48 mmHg,中度及轻度PH患者术后即刻肺动脉压均降至正常.术后2例出现一过性血小板减少症,2例存在少量残余分流,无严重肺部感染及封堵器脱落等严重并发症.结论 长期生活在高海拔低氧地区可逆性PH的PDA患者经导管介入封堵治疗安全有效.     

Mistakes in the diagnosis and treatment of the complete dislocation and fractures of the acromial end of the clavicle

The analysis of the mistakes in the operative treatment of the sick with such a trauma was conducted. Two typical examples were given. The mistakes were stipulated non-diagnosis of the simultaneous break of the coracoclavicular ligament and not taking measures for its recovery. The radiodiagnosis based on N. Z. Shmidt's method is considered to be inevitable for this category of the sick. After the confirmation of the diagnosis the operation of choice can be the operation of Yotkins-Leochuk for the sick with the complete dislocation of the acromial end of the clavicle, and the operation of Yotkins for the sick with fractures of the acromial end of the clavicle with the break of the coracoclavicular ligament. By means of these methods 43 sick men with the dislocation and 7 sick men with fractures of the acromial end of the clavicle have been operated since 1973. No cases had complications, relapses or unsatisfactory results.     

Quantitative evaluation of the echo intensity of the median nerve and flexor muscles of the forearm in the young and the elderly

Objectives

Musculoskeletal structures often appear brighter on imaging in the elderly, which makes it difficult to accurately delineate a peripheral nerve during ultrasound-guided regional anaesthetic procedures. The echo intensity of skeletal muscles is significantly increased in the elderly. However, there are no data comparing the echo intensity of peripheral nerves in the young and the elderly, which this study was designed to evaluate.

Methods

13 healthy, young volunteers (aged <30 years) and 11 elderly patients (aged >60 years) who were scheduled to undergo orthopaedic lower limb surgery were recruited. The settings of the ultrasound system were standardised and a high-frequency linear array transducer was used for the scan. A transverse scan of the median nerve (MN) and the flexor muscles (FMs) at the left mid-forearm was performed and three video loops of the ultrasound scan were recorded for each subject. Still images were captured from the video loops and normalised. Computer-assisted greyscale analysis was then performed on these images to determine the echo intensity of the MN and the FMs of the forearm.

Results

The echo intensity of the MN and FMs of the mid-forearm was significantly increased in the elderly (p<0.005). There was also a reduction in contrast between the MN and the adjoining FM in the elderly (p=0.04).

Conclusion

Under the conditions of this study, the MN and the FMs in the forearm appeared significantly brighter than those in the young, and there was a loss of contrast between these structures in sonograms of the elderly.Recently, there has been an increase in interest in the use of ultrasound to guide peripheral nerve blocks [1-3]. We have observed during such procedures that musculoskeletal structures often appear significantly brighter and that there is loss of contrast between the nerve and its adjoining muscles in the elderly, which often makes it difficult to accurately delineate a peripheral nerve using ultrasound in this age group. There are published data showing that the echo intensity (EI) of skeletal muscles is significantly increased in the elderly [4]. However, there are no data comparing the EI of a peripheral nerve in the young and the elderly, which this study was designed to evaluate.     

Sonography of the wrist and the hand

Sonographic examination of the hand requires high-frequency linear transducers. As the relevant structures are located very close to the surface, water stand-off pads are mandatory. Owing to the high sensitivity of sonography in the detection of fluid, exudative synovitis, tenosynovitis and ganglia can be easily diagnosed. Sonographic information on muscle atrophy and alterations of the shape and echogenicity of the median nerve in patients with carpal tunnel syndrome may be useful in evaluating the extent of disease. Further indications for the sonographic examination of the hand include suspected tumors, foreign bodies and synovial proliferation. Osseous destruction can be visualized in patients with rheumatoid disease, but the precise extent is hard to determine.     

Aspects of the venous drainage of the pons and the mesencephalon

Summary After a brief resumé of the morphology of the pontomesencephalic veins, the authors demonstrate the drainage dynamics of these veins in normal and pathlogical vertebral angio-seriograms. The repercussions of drainage impairment are illustrated.

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Untersuchungen über die Venen-Drainage von Pons und Mesencephalon

Zusammenfassung Nach kurzer Beschreibung der Morphologie der pontomesencephalen Venen wird die Drainagedynamik dieser Venen anhand normaler und pathologischer Vertebralisangiogramme demonstriert. Die unterschiedlichen Mechanismen einer Drainagebehinderung werden erläutert.

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A propos du drainage veineux du pont et du mésencéphale

Résumé Après un bref résumé de la morphologie des veines ponto-mésencéphalques, les auteurs décrivent les modalités de drainage de ces veines en sérioangiographie vertébrale normale et pathologique. Ils illustrent les répercussions de drainage défectueux.

     

高原彝汉成年人血红蛋白、红细胞值调查分析

目的了解高原地区彝汉成年人血红蛋白、红细胞及相关指标的基础水平，探讨其与国家参考值指标是否存在差异。方法选择健康成人规范采集静脉血，用美国COULTERAC·Tdiff2血球分析仪检测，对数据进行统计学处理。结果川西南高原彝汉成人的血红蛋白、红细胞水平及相关指标与国家参考值比较差异有非常显著的意义，P〈0．001；当地彝汉民族比较差异无显著意义，P〉0．05。结论有必要制定高原地区成人血红蛋白、红细胞及相关指标的正常参考值，为临床提供更科学实际的参考依据。     

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulner nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.