彩色多普勒血流显像在胸廓出口综合征中的应用

目的：探讨ＣＤＦＩ在胸廓出口综合征（ＴＯＳ）中的应用价值，方法：对２５例ＴＯＳ患者Ａｄｓｏｎ’ｓ试验前后锁骨下动，静脉进行ＣＤＦＩ检查。ＴＯＳ的超声诊断标准，左上肢过度外展的情况下，锁骨下动脉受压处峰速度≥中立位２倍或血流完全中止，锁骨下静脉血流中止或血流波型不受心跳呼吸的影响。结果：超声Ａｄｓｏｎ’ｓ试验（＋）１７例（６８％）其中动，静脉均显著受压９例，动，静脉显著压迫分别为３例和５例，结论：Ｃ     

彩色多普勒血流显像检测胸廓出口综合症

探讨胸廓出口综合症血流动力学的变化。方法：对２５例患者和２０例正常人Ａｄｓｏｎｓ’ｓ试验前后锁骨下动、静脉进行彩色多普勒血流显像检查。结果：正常锁骨下动脉血流频谱为三相波,静脉为波动性血流Ａｄｓｏｎ’ｓ试验后未见显著性变。结论ＣＤＦＩ可检测ＴＯＳ血流动力学变化,是无创性评价ＴＯＳ的新方法。     

超声Valsalva‘s试验诊断颈部静脉囊样扩症的评价

目的：评价超声Ｖａｌｓａｌｖａｓ试验在诊断颈部静脉囊样扩张症中的临床价值。方法： １１例颈部静脉囊样扩张症的患者进行２ＤＥ、ＣＤＦＩ和ＰＤＥ研究, 超声Ｖａｌｓａｌｖａｓ试验之前和试验期间分别测量静脉的内径并观察其ＣＤＦＩ的血流信号和ＰＤＥ的血流频谱。结果： 在试验期间与试验前相比较, ２ＤＥ图像上所有观察的病变静脉内径均扩张至１．５ 倍以上, ＣＤＦＩ和ＰＤＥ则显示局部出现一过性逆流及随后的血流速度降低。结论： 超声Ｖａｌｓａｌｖａｓ试验是诊断颈部静脉囊样扩张症的一种准确可靠且简便易行的技术方法。     

胸廓出口综合征彩色多普勒的诊断

目的： 探讨胸廓出口综合征彩色多普勒 （ＣＤＦＩ） 的诊断价值。方法： 应用ＣＤＦＩ诊断 ９ 例胸廓出口综合征患者， 并经临床及 Ｘ 线检查证实。结果： 本组病例中， 以动脉型占多数。锁骨下动脉 （ｓｕｂｃｌａｖｉａｎ ａｒｔｅｒｙ，ＳＣＡ） 在近端段受压均出现ＳＣＡ 盗血综合征。ＳＣＡ 第二段受压， 患侧上肢动脉在肩关节过度外展时峰值流速明显减慢。结论： ＣＤＦＩ对本病的诊断及鉴别诊断， 具有较高的准确性、可靠性、无创伤、无禁忌证及可重复性的优点。     

彩色多普勒能量图对闭塞性动脉粥样硬化病的诊断价值

目的：探讨彩色多普勒能量图（ＣＤＥ）对闭塞性动脉粥样硬化病（ＡＳＯ）的诊断价值。方法：对１９例ＡＳＯ４１个闭塞动脉节段进行二维超声（２Ｄ）、彩色多普勒血流显像（ＣＤＦＩ）、ＣＤＥ和脉冲多普勒（ＰＤ）的联合检查，并比较ＣＤＥ和ＣＤＦＩ对ＡＳＯ闭塞血管内血流检出的情况。结果：①ＣＤＥ诊断ＡＳＯ的准确性为９５％，对闭塞部位定位准确性为９８％。②ＣＤＥ和ＣＤＦＩ对ＡＳＯ闭塞血管内血流信号的检出率分别为８５％和６３％，二者差别显著（Ｐ＜０．０５）。③ＰＤ检出ＡＳＯ闭塞血管内及其远端的血流频谱为单相收缩期流速减低、舒张早期反向血流消失、无频窗的“锯齿波”或连续性“带状波”，其检出率为１００％。④２Ｄ对ＡＳＯ血管壁钙化斑块的检出率为１００％。结论：ＣＤＥ结合２Ｄ及ＰＤ检查，可为ＡＳＯ提供可靠的病因、定位和定量诊断，ＣＤＥ比ＣＤＦＩ对ＡＳＯ闭塞血管内血流状态的显示具有更高的灵敏性     

星状神经节阻滞治疗重症头痛的临床效果及其与双颈总,双 …

目的：探讨重症头痛双颈总动脉、双椎动脉血流动力学特征及其与星状神经节阻滞（ＳＧＢ）效果的相关性。方法：选择本院门诊重症头痛病人３０例为治疗（Ｔ）组,和非头痛病人３０例做对照（Ｃ）组,以ＤＩＡＳＯＮＩＣＳ,ＳＰＥＣ－ＴＲＡ彩色多普勒超声诊断仪,测量两组ＳＧＢ前,及Ｔ组阻滞后５分钟（Ｔ５）的双侧颈总动脉和双侧椎动脉血流动力学参数：血流量（ＦＬＯＷ）,阻力指数（ＲＩ）,峰值流速（ＰＫＶ）,时间平均流速（     

超声心动图评价房间隔缺损患者左心室收缩功能

用超声心动图检测２８例继发孔型房间隔缺损（ＡＳＤ）患者及４０例正常人左心室收缩功能（ＬＶＳＦ）。结果表明：ＡＳＤ患者左室射血分值（ＬＶＥＦ）、短轴缩短分数（ＬＶＦＳ）、每搏量（ＳＶ）、心输出量（ＣＯ）、主动脉瓣口血流速度（ＡＶ）、速度时间积分（ＡＶＩ）均较正常人明显降低（Ｐ＜０．００１～０．０５），左室射血前期（ＬＰＥＰ）延长（Ｐ＜０．０１）、射血时间（ＬＶＥＴ）缩短（Ｐ＜０．０５）、ＬＰＥＰ／ＬＶＥＴ增大（Ｐ＜０．０１），且ＬＶＥＦ、ＬＶＦＳ、ＳＶ、ＣＯ、ＡＶ、ＡＶＩ与肺／体循环量比值（Ｑｐ／Ｑｓ）呈中度负相关（ｒ＝－０．３９～－０．７８，Ｐ＜０．０５）。结论认为：ＡＳＤ患者ＬＶＳＦ存在一定程度的减退，并推测其机理可能与ＡＳＤ患者因右室容量超荷所致的左室扩张性降低、舒张末容积减小、室间隔运动异常及左室几何形态改变等有关     

彩色多普勒超声对经颈静脉肝内门体分流术前后血流动力学的…

本文应用彩色多普勒超声对１９例肝硬化门脉高压症的门脉系统血流动力学在经颈静脉肝内门体分流术（ＴＩＰＳＳ）前后进行研究，结果表明Ｂ型超声可以清晰显示支架回声，ＣＤＦＩ可以清楚显示支架内血流通畅情况，术后门静脉，脾静脉血流速度，血流量显著增加，肝内门静脉分支血管速度显著减慢，血流量显著减少，门静脉左矢状支８／１２（６７％）例次，右前支７／１２（５４％）例次出现反应血流，我们认为ＣＤＦＩ对于估价ＴＩＰＳ     

彩色超声多普勒及OXLDL检查联合诊断颈动脉粥样硬化病变的价值

目的研究彩色超声多普勒（ＣＤＦＩ）及血浆ＯＸＬＤＬ水平在诊断颈动脉粥样硬化（ＣＡＳ）病变中的价值。方法应用ＣＤＦＩ检查１６８例颈动脉（ＣＡ）,以ＣＡ内膜厚度、斑块情况、狭窄程度的超声分级和病理学分型作为评价ＣＡＳ硬化程度的指标。从中筛选出６６例,分为ＣＡＳ组和正常对照组,进行血脂、低密度脂蛋白（ＬＤＬ）及氧化修饰型ＬＤＬ（ＯＸＬＤＬ）水平测定。ＣＡＳ组再分为糖尿病ＤＭ（＋）和ＤＭ（－）组。将所有结果逐一对比分析。结果ＣＤＦＩ检出阳性患者１２５例。ＣＡＳ组ＯＸＬＤＬ水平明显高于对照组（Ｐ＜０００１）,具有显著性差异;ＤＭ（＋）组显著高于ＤＭ（一）组（Ｐ＜００５）。分析表明血浆ＯＸＬＤＬ水平增高是致ＡＳ的危险因素之一。超声检查能发现早期临床无症状的ＣＡＳ,并能够提示ＣＡＳ斑块造成ＣＡ狭窄程度。结论ＣＤＦＩ与ＯＸＬＤＬ检查联合应用可为预防ＣＡＳ的形成,早期发现及治疗提供可靠的依据。     

三种TOF法MRA诊断实验性动脉瘤的对比分析

目的：比较分析三种ＴＯＦ法ＭＲＡ的图像质量，以及不同成像技术对动脉瘤的诊断价值。材料与方法：用静脉囊镶嵌法将１８只犬制成三种类型（单侧型、分叉型、末梢型）颈总动脉囊状动脉瘤模型，术后２周分别进行ＩＡＤＳＡ、２ＤＴＯＦ、单层块３ＤＴＯＦ、薄块多层重叠技术（ＭＯＴＳＡ）ＭＲＡ检查。结果：以ＩＡＤＳＡ图像为标准，２ＤＴＯＦ、单层块３ＤＴＯＦ、ＭＯＴＳＡＭＲＡ都能显示动脉瘤的位置、形态、类型、大小、瘤颈、瘤体伸展方向。其中以ＭＯＴＳＡＭＲＡ图像最具评价能力，显示动脉瘤的形态、类型、瘤颈优于２ＤＴＯＦ、单层块３ＤＴＯＦ，不足之处图像有层块梯阶样伪影。三种ＴＯＦ成像技术对动脉瘤内缓慢血流、湍流、血栓、大动脉瘤有不同程度的信号丢失。结论：三种ＴＯＦ法成像技术中，ＭＯＴＳＡ技术最有利于作为临床３ＤＴＯＦ法ＭＲＡ检查颅内动脉瘤的常规成像技术。     

Non-invasive investigation of vascular compression in patients with thoracic outlet syndrome

Summary. Three hundred and seventy-seven patients with brachial pain and 63 controls have been examined regarding presence of symptomatic compression of the brachial plexus and subclavian vessels (Thoracic Outlet Syndrome=TOS). Each patient was examined clinically and by Doppler flowmetry. Two hundred and thirty (61%) had moderate to pronounced compression of the brachial plexus and 11 (2·9%) isolated compression of the subclavian artery or vein. One hundred and twenty-nine patients had symptoms not related to TOS. The prevalence of TOS was almost twice as common in women as in men, 1·76:1. The TOS patients were younger than the non-TOS patients, P<0·05. There was a significant correlation between arterial compression measured by Doppler flowmetry and the presence of compression of the plexus, P < 0·001. But the validity of this method was not satisfactory, giving both false positive and negative results. Furthermore, there was a very good correlation between arterial compression assessed clinically and by Doppler flowmetry, P< 0·001. Thus, the diagnosis of TOS is still a clinical judgement, the Doppler technique adding very little and any significant vascular compression being easily detected by clinical assessment.     

锁骨下动脉盗血综合征的彩色多普勒血流显像分析

目的分析比较27例锁骨下动脉盗血综合征(SSS)患者锁骨下动脉、椎动脉和桡动脉的血流动力学、频谱特点,以及狭窄程度与盗血的关系等.方法 27例患者均经临床检查、超声诊断以及相关检查确诊.彩色多普勒超声常规显示颈动脉、椎动脉、桡动脉、锁骨下动脉及无名动脉的内径、内膜和血流方向及速度.结果 27例患者中,锁骨下动脉狭窄18例,内径1.0～4.4 mm,血流速度100～420 cm/s;9例锁骨下动脉闭塞,均引起完全性盗血.椎动脉及桡动脉峰值血流速度患侧明显低于健侧,患侧椎动脉出现反向血流,桡动脉血流与锁骨下动脉狭窄程度和反向椎动脉血流有一定关系.结论彩色多普勒血流显像(CDFI)可对完全性SSS做出诊断,部分性SSS可辅助于脉冲多普勒和束臂试验明确诊断.完全性和部分性盗血与血管狭窄程度有关.患侧椎动脉反向血流和桡动脉峰值血流速度取决于侧支循环建立的完善与否.     

VASCULAR THORACIC OUTLET IN A COMPETITIVE SWIMMER: A CASE REPORT

Thoracic outlet syndrome (TOS) is a well‐described condition resulting from compression of the brachial plexus, subclavian artery and/or vein. Though symptoms of pain, numbness, tingling and signs of muscular weakness associated with this condition usually begin insidiously, on rare occasions the presentation is of acute onset and may represent an acute vascular compression. An unusual form of “effort” thrombosis of the subclavian vein may require emergency care in order to ensure controlled clot lysis and thrombus dissolution. Confirmation of subclavian thrombus is obtained by venography and makes use of real time videography to assess for venous flow impairment. Definitive treatment for the underlying cause of this form of TOS is first rib resection and scalenectomy. This case report presents a competitive swimmer who developed an acute onset of limb cyanosis and turgidity during swim training. Awareness of the possibility of acute thrombosis obstructing venous return and producing such signs and symptoms should lead the astute clinician to consider recommending contrast venography to assess the lesion and lead to appropriate medical intervention.     

Use of Sonography in Thoracic Outlet Syndrome Due to a Dystonic Pectoralis Minor

Objective. For patients with thoracic outlet syndrome (TOS), it is important to determine the location of the neurovascular compression to achieve effective intervention. Methods. The diagnostic workup for a 39‐year‐old man with TOS included a selective anesthetic block of the pectoralis minor muscle and duplex sonography before and after the block. Results. The subclavian artery peak systolic flow velocity decreased after the block from 208 to 63 cm/s when the arm was in the abduction and external rotation position, indicating a reduction in the severity of focal arterial compression. Also, the arterial diameter increased by 10% after the block (from 0.80 to 0.88 cm). His level of discomfort was reduced from 6 to 2 on a scale of 1 to 10 (66%). Conclusions. The pectoralis minor block resulted in an improvement in subclavian artery blood flow and symptoms and confirmed the diagnosis of pectoralis minor TOS. This suggests that selective anesthetic muscle blocks and duplex sonographic studies may be useful before chemodenervation and surgery.     

Thoracic outlet syndrome: a rare case with bilateral cervical ribs and bilateral anterior scalene hypertrophy

Thoracic outlet syndrome (TOS) is a rare neurovascular disorder generally caused by the presence of a cervical rib or hypertrophic scalene anterior muscle that can compress the brachial plexus and/or subclavian vessels. In the vascular form, the symptoms are caused by the compression of the artery and/or the subclavian vein. In the first case, the compression is caused by the cervical rib and leads to hypo-perfusion with cooling and cyanosis of the upper limb, while in the second case, the compression is caused by the anterior scalene muscle and leads to congestion, cyanosis, swelling and pain in the higher limb. In this paper, we describe a case with the simultaneous presence of a bilateral cervical rib and bilateral hypertrophy of the anterior scalene muscle. TOS diagnosis is based on neurological, clinical and instrumental tests, such as chest radiography and color Doppler ultrasonography. The treatment of these patients can be surgical or conservative.     

彩色多普勒超声在肝移植血管并发症中的应用价值

目的 确定彩色多普勒超声成像(CDFI)技术在肝移植血管并发症中应用价值。方法 应用彩色多普勒及频谱多普勒技术对26例肝移植病例(7例小儿部分肝移植及19例成人肝移植)进行术前评价，术中指导及术后监测，重点观察受体术后至少180d内肝血流动力学各项参数及肝脏动、静脉及门静脉血流频谱形态变化，及时发现血管狭窄及血栓等严重并发症。结果 26例肝移植病例，术后CDFI及时发现肝动脉狭窄(HAS)1例及肝动脉血栓(HAT)1例，经过血管造影证实。发现门静脉血栓1例，肝静脉狭窄2例，经过再次手术取栓及狭窄处球囊扩张后，血流灌注恢复正常。结论 应用CDFI监测各项血流指标，对于术后早期发现肝脏血管狭窄及血栓等严重并发症具有较高的敏感性和特异性，提高了手术的成功率和患者的生存率。     

彩色多普勒超声在小儿部分肝移植血管并发症中的应用

目的：正确评价彩色多普勒超声成像(CDFI)技术在围手术期小儿部分肝移植血流动力学监测中价值，寻找可靠的方法及早发现肝移植血管并发症。方法：应用彩色多普勒及频谱多普勒技术对5例小儿部分肝移植病例的受体及供体进行术前评价，术中指导及术后监测，参照国外文献标准，重点观察受体术后肝血流动力学各参数包括肝脏动、静脉及门静脉血流频谱形态变化，及时发现血管狭窄及血栓等严重并发症。结果：5例小儿部分肝移植病例，手术顺利，术后CDFI即时发现门静脉血栓1例，肝静脉狭窄1例，经过再次手术取栓及狭窄处球囊扩张后，两例血流灌注恢复正常，未发现肝动脉狭窄及血栓。结论：应用CDFI监测各项血流指标，可以确定活体肝移植手术适应症，术中指导手术方式并实时观察血管吻合情况和血流灌注情况，术后及早发现多种并发症，尤其是肝脏血管狭窄及血栓形成等严重并发症，具有较高的敏感性和特意性，提高了手术的成功率和生存率，成为肝移植手术非常关键的检查方法之一。     

宫外孕氨甲喋呤静脉途径保守治疗的超声监测价值

本文对１２例主要用氨甲喋呤（静脉点滴或推注,每日２０ｍｇ,连用５天）治疗的输卵管妊娠时行超声监测。使用东芝ＳＳＡ－２４０型超声诊断仪,探头频率是３．７５ＭＨｚ。按常规进行探查。１２例输卵管妊娠均经超声发现附件区的异位妊娠包块,最大径线２．１～４．７ｃ...