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1.
目的:比较应用多层螺旋CT和超声心动图在评价左室功能方面的一致性,探讨多层螺旋CT进行冠状动脉造影所得的数据用于左心室功能评价的准确性。方法:选择2003-12/2004-05北京协和医院心内科病房临床怀疑冠心病患者40例,男21例,女19例,均自愿参加。全部患者均行心脏多层螺旋CT和超声心动图检查。用舒张末期和收缩末期重建图像来计算左心室舒张末期容积、收缩末期容积和射血分数,用Bland-Altman方法比较多层螺旋CT和超声心动图测量左心室收缩末期容积、左心室舒张末期容积和左心室射血分数的一致性。结果:按意向处理分析,可疑冠心病患者40例均进入结果分析。依据Bland-Altman法,多层螺旋CT和超声心动图测定左心室舒张末期容积、收缩末期容积和射血分数的差值分别为(-4.4±11.8)mL,(0.8±6.8)mL和-0.018±0.038,两种检查方法一致性范围分别为-28.0~19.2mL,-12.8~14.4mL和-0.094~0.058。即多层螺旋CT测得的结果比超声心动图结果大0.058或小0.094以上的可能性均小于5%。结论:多层螺旋CT与超声心动图在评价左心室功能某些参数方面虽有一定差异,但两者均非金标准评价体系,因此两者的一致性范围可被临床接受,故本结论可以证实多层螺旋CT在对冠状动脉成像的同时可用于评价左心室功能。  相似文献   

2.
目的:比较应用多层螺旋CT和超声心动图在评价左室功能方面的一致性,探讨多层螺旋CT进行冠状动脉造影所得的数据用于左心室功能评价的准确性。方法:选择2003-12/2004-05北京协和医院心内科病房临床怀疑冠心病患者40例。男21例,女19例,均自愿参加。全部患者均行心脏多层螺旋CT和超声心动图检查。用舒张末期和收缩末期重建图像来计算左心室舒张末期容积、收缩末期容积和射血分数,用Bland-Altman方法比较多层螺旋CT和超声心动图测量左心室收缩末期容积、左心室舒张末期容积和左心室射血分数的一致性。结暴:按意向处理分析,可疑冠心病患者40例均进入结果分析。依据Bland-Altman法,多层螺旋CT和超声心动图测定左心室舒张末期容积、收缩末期容积和射血分数的差值分别为(-4.4&;#177;11.8)mL,(0.8+6.8)mL和-0.018&;#177;0.038,两种检查方法一致性范围分别为-28.019.2mL,-12.8~14.4mL和-0.094~0.058。即多层螺旋CT测得的结果比超声心动图结果大0.058或小0.094以上的可能性均小于5%。结论:多层螺旋CT与超声心动图在评价左心室功能某些参数方面虽有一定差异,但两者均非金标准评价体系,因此两者的一致性范围可被临床接受,故本结论可以证实多层螺旋CT在对冠状动脉成像的同时可用于评价左心室功能。  相似文献   

3.
【目的】探讨256层螺旋 CT(MSCT)与超声心动图评价左心室功能的相关性。【方法】前瞻性收集2012年8月至2013年12月就诊本院并于10日内均行 MSCT 冠状动脉血管造影(CTA)及经胸超声心动图检查者89例。所有患者按心功能(New York Heart Association ,NYHA)分成四个组。比较两种方法检测的左室舒张末期容积(EDV)、左室收缩末期容积(ESV)、左室每搏输出量(SV)和左室射血分数(EF)值,MSCT 评价心功能与临床分级的相关性。【结果】各心功能组 MSCT 与超声心动图所测得的左室功能参数 EDV、ESV、SV 和 EF 值比较差异无统计学意义(P >0.05);经相关性检验两种方法的测量值高度相关(P <0.05);NYHA 不同分级的 EDV、ESV 及 EF 值比较,差异有统计学意义(P <0.05),而 SV 值比较差异无统计学意义。【结论】MSCT 冠状动脉CTA 评价心功能较为准确、可靠;与超声心动图测量结果比较具有很好的相关性。  相似文献   

4.
经胸三维超声心动图测定左室容量及收缩功能的临床应用   总被引:1,自引:0,他引:1  
目的:探讨经胸三维超声心动图测量复杂型先心病患者的左室容量及收缩功能的可行性。方法:复杂型先心病患儿19例,应用HP5500型彩色多普勒超声心动图仪,通过手动控制探头采集三维数据,采用圆盘总和法(Disk summation)测量了左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、每搏量(SV)和射知分数(LVEF)。同时在二维引导下以M型超声心动图(Teichholtz)测量了上述指标,并应用心导管检查(Fick)测量了患儿左室的每搏量。结果:经胸M型超声心动图及心导管检查所测SV呈中度相关,r为0.88,而经胸三维超声心动图测量SV与心导管检查所测结果呈高度相关,r为0.90。经胸M型超声心动图与三维超声心动图所测LVEDV、LVESV、SV及LVEF显著相关,r分别为0.86、0.87、0.88和0.89,两者间有显著性差异。结论:经胸三维超声心动图测定复杂型先心病患者的左室容量和收缩功能是准确可行的。  相似文献   

5.
目的应用定量组织速度成像结合二维超声心动图观察冠脉微血栓栓塞对大鼠左室形态及收缩功能的影响。方法24只SD大鼠随机分为两组:冠脉微血栓组12只,自主动脉根部注入月桂酸钠诱发冠脉微血栓形成;对照组12例,自主动脉根部注入生理盐水。术前及手术4周后行超声心动图检查,测量左室舒张末期内径(LVEDD)、收缩末期内径(LVESD)、左室舒张末期容积(EDV)、左室射血分数(LVEF),计算左室短轴缩短率(FS),术后加用QTVI测量收缩期峰值。结果与对照组相比,微血栓组LVESD、LVEDD、EDV显著增加(P<0.01);FS、LVEF显著降低(P<0.01);微血栓组心尖四腔左室侧壁及后间隔二尖瓣环、左室长轴观前间隔及后壁中间段收缩期峰值速度显著下降(P<0.01)。结论大鼠慢性冠脉微血栓栓塞后,心室发生重塑,收缩功能下降。定量组织速度成像结合二维超声心动图能较准确评价大鼠冠脉微血栓栓塞后的左室收缩功能的改变。  相似文献   

6.
将我院收治的36例患者作为研究对象,运用心脏超声心动图(心动图组)和多层螺旋CT(CT组)对患者左心室功能进行检查,比较两种方法测量的左心室参数结果,并进行对比分析。结果运用心脏超声心动图和多层螺旋CT检查患者左心室功能评价结果显示,左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)左心室每搏输出量(LVSV)、左心室心肌质量(LVMM)参数等比较差异无统计学意义(P0.05);其中LVEDV、LVESV、LVSV具有较高的相关性,LVEF、LVMM相关性中等。运用多层螺旋CT检查和心脏超声心动图对左心室功能检查具有准确、可靠的效果,但多层螺旋CT能够行冠状动脉造影检查,有效显示心脏冠状动脉、静脉的病变状况。  相似文献   

7.
【目的】对比法洛四联症(TOF)患者根治术前后左室容积和左室收缩功能的变化,旨在评估二维超声心动图(2DE)在TOF术前病例选择、术后疗效和预后判断中的价值。【方法】52例TOF患者均经手术治疗,在手术前后分别用2DE测量左室舒张末期内径(LVEDD)、左室舒张末期容积(LVEDV)、左室收缩末期内径(LVESD)、左室收缩末期容积(LVESV)、左室每搏输出量(LVSV)及左室射血分数(LVEF)和左室短轴缩短率(LVFS)。将手术前后测量数据采用t检验进行分析。【结果】LVEDD、LVEDV、LVESD、LVESV、LVSV比手术前明显增大,两者差异显著(P<0.01);LVEF和LVFS手术前后改变不明显,两者差异无显著性(P>0.05)。【结论】超声心动图可作为诊断TOF的主要手段,可为选择手术方式及时机,判定术后疗效提供可靠依据。  相似文献   

8.
目的探讨实时三维超声心动图(RT-3DE)评价心肌梗死患者左室收缩功能的准确性。方法选择临床已确诊的心肌梗死患者25例,分别利用二维超声心动图Simpson’s法、RT-3DE全容积法及心脏磁共振成像(CMRI)测量患者左室舒张末容积(LVEDV)、每搏输出量(SV)、左室射血分数(LVEF),并将三种方法所测参数进行对比分析。结果二维超声心动图Simpson’s法与CMRI所测LVEDV、SV比较差异均有统计学意义(均P0.05),而LVEF差异不明显。RT-3DE与CMRI所测LVEDV、SV、LVEF比较,差异均无统计学意义。Simpson’s法所测LVEDV、SV、LVEF与CMRI所测结果相关(r=0.75、0.75、0.80,P0.05);RT-3DE全容积法所测LVEDV、SV、LVEF与CMRI所测结果高度相关(r=0.89、0.88、0.91,P0.05)。结论 RT-3DE可以准确评价心肌梗死患者的左室收缩功能。  相似文献   

9.
三维超声评价急性心肌梗死再灌注后左室重构   总被引:3,自引:0,他引:3  
目的:探讨实时三维超声心动图对急性心肌梗死患者接受再灌注治疗后左室重构的诊断价值。方法:首次急性心肌梗死接受直接经皮冠状动脉介入治疗(P-PCI)或溶栓治疗患者共53例,比较治疗前及P-PCI治疗后1h、溶栓治疗后2h的心电图上ST抬高段的总和。按ST段下降幅度分为两组:ST段下降≥50%(A组n=32);ST段下降<50%(B组n=21)。于治疗后2d、10d、90d时行M型超声心动图和实时三维超声心动图(RT3DE)检查,分别测定左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、治疗后90d时LVEDV增大率作为反映左室结构和功能变化的指标,并比较M型超声心动图和RT3DE结果。结果:无论是M型超声心动图还是RT3DE,A组治疗后90d时与治疗后2d相比,LV-EDV、LVESV明显减小,LVEF明显增大(P<0.05);10d时变化不明显(P>0.05)。B组治疗后10d、90d与治疗后2d相比,LVEDV、LVESV均明显增大,LVEF均明显减小。M型超声心动图所测数值均大于RT3DE测值(P<0.05);对于B组,治疗后90d时M型超声心动图所测LVEDV增大...  相似文献   

10.
多层螺旋CT与超声对比定量评估左心功能   总被引:9,自引:0,他引:9       下载免费PDF全文
目的通过16层螺旋CT(MSCT)与超声左心容积数据的对比,初步探讨MSCT定量评估左心功能在心容积数据方面的准确性及可行性。方法选择22例8h内同时进行了MSCT冠状动脉造影及超声心动图检查的患者,对比MSCT自动测量与手工测量值的相关性,MSCT自动测量与超声测量值的相关性。结果MSCT左心容积各组数据自动与手动测量结果相关性高(r>0.98,P>0.05);MSCT自动测量与超声测量结果相关性良好(r>0.90,P>0.05)。结论MSCT冠状动脉造影检查所获得的自动与手动左心容积数据准确性高,可用于临床诊断。  相似文献   

11.
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.  相似文献   

12.
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.  相似文献   

13.
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.  相似文献   

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15.
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.  相似文献   

16.
Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.  相似文献   

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Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.  相似文献   

19.
ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.  相似文献   

20.
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.  相似文献   

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