应变-血压指数评价2型糖尿病患者中型动脉弹性的初步研究

目的 探讨应用应变-血压指数评价2型糖尿病患者肱动脉和胫前动脉弹性的临床价值及可行性.方法 随机选取2型糖尿病患者46例作为病例组,健康志愿者50例作为对照组.应用应变和应变率成像对肱动脉和胫前动脉进行检查.通过应变和应变率成像获得肱动脉和胫前动脉的最大圆周应变,同时测量被检者肱动脉和胫前动脉血压,肱动脉和胫前动脉的应变-血压指数=最大圆周应变/[(局部收缩压-局部舒张压)/局部舒张压]×100%,胫-肱指数=胫前动脉的应变-血压指数/肱动脉应变-血压指数,踝肱指数=胫前动脉收缩压/肱动脉收缩压.将病例组和对照组的参数进行对比分析.结果 2型糖尿病患者的胫前动脉应变-血压指数和胫-肱指数明显低于对照组,差异有统计学意义(P<0.05),而2型糖尿病患者的肱动脉应变-血压指数略低对照组,但差异无统计学意义(P>0.05).两组间的踝肱指数差异无统计学意义(P>0.05).结论 应变-血压指数可以作为评价2型糖尿病患者中型动脉弹性改变的新指标,胫-肱指数可以反映2型糖尿病患者胫前动脉和肱动脉弹性变化的相对差异.     

急性骨筋膜室综合征小腿前室压力与胫前动脉管径的相关性研究

目的 研究小腿前室压力与胫前动脉管径的相关性,探讨超声在小腿骨筋膜室综合征（OCS）中的诊断价值。方法 对35例高度怀疑OCS的小腿进行超声检查和小腿前室测压,将小腿前室压力与胫前动脉管径进行相关性分析。结果 小腿胫前动脉管径随着压力的升高而缩小,胫前动脉中段及下段管径缩小率与前室压力呈直线相关（中段：r=0．559,P〈0．001;下段：r=0．487,P=0．003）,以胫前动脉中段管径缩小率为自变量,前室压力为因变量的直线回归公式为Y=0．521;X＋42．92（R^2=0．312,P〈0．001）。结论小腿胫前动脉中段管径缩小率与前室压力存在良好的相关性,是判定小腿OCS临床分期的一项值得重视的指标。     

降糖药物对新发2型糖尿病患者胫前动脉弹性影响的初步探讨

目的 探讨降糖药物对新发2型糖尿病患者胫前动脉弹性的影响.方法 随机选取新发2型糖尿病患者100例,分为对照组50例和病例组50例.计算胫前动脉的应变-血压指数(SBPI),所有患者服用降糖药物6个月后再次计算胫前动脉的SBPI,并进行组间和组内对比分析.结果 对照组胫前动脉SBPI治疗后高于治疗前(P<0.05).病例组胫前动脉SBPI治疗前后比较差异无统计学意义(P>0.05).病例组胫前动脉SBPI在治疗前和治疗后均低于对照组(P<0.05).结论 降糖药物对不合并血管并发症的新发2型糖尿病患者胫前动脉弹性有较好的保护作用.

Abstract：

Objective To investigate the effects in elasticity of anterior tibial artery in new patients with type 2 diabetes caused by medicines of reducing blood sugar. Methods One hundred patients with type 2 diabetes were involved. The patients were divided into control group(50 cases) and case group(50 cases) according the vascular complications (including macroangiopathy and microangiopathy). Maxmum of circumferential strain(CSmax) of anterior tibial artery was acquired through strain and strain rate imaging. Local blood pressure which included local systolic blood pressure(LSBP) and local diastolic blood pressure (LDBP) of anterior tibial artery was measured at the same time. Strain-blood pressure index(SBPI) of anterior tibial artery was calculated, SBPI = CSmax/[(LSBP - LDBP)/LDBP] × 100%. It took six months for each patient to take medicines of reducing blood sugar. Then SBPI of anterior tibial artery was calculated again. Parameters were compared inter- and intra-groups. Results SBPI of anterior tibial artery after therapy was higher than that before therapy in control group( P<0. 05). There was no significant difference between SBPI of anterior tibial artery before therapy and that after therapy in case group( P >0. 05). SBPI of anterior tibial artery in case group was lower than that in control whatever before and after therapy( P < 0. 05). Conclusions The protection of medicines of reducing blood sugar on elasticity of anterior tibial artery in new diabetic patients without vascular complications was better.     

经颅多普勒超声评估Willis环动脉变异

目的探讨经颅多普勒超声评估Willis环动脉变异的价值。方法152例无脑血管病患者,在行颈总动脉压迫试验时采用经颅多普勒超声(TCD)检测大脑前动脉交通前段和大脑后动脉交通前段的血流速度。结果30%患者的前交通动脉和两侧后交通动脉均开放,构成一个血流动力学完整的Willis环;95%患者的Willis环前部动脉开放,另3%前交通动脉及2%大脑前动脉交通前段缺如导致Willis环前部动脉不开放;44%Willis环后部动脉发育异常,阻碍了侧支血流从基底动脉到颈内动脉.其中36%后交通动脉缺如.8%大脑后动脉起源于颈内动脉。结论经颅多普勒超声结合颈总动脉压迫试验检测Willis环动脉变异既安全又方便,其检出率与解剖学研究一致。     

Case study: analysis of an acute anterior-lateral myocardial infarction in a 16-year-old patient with familial hypercholesterolemia

This article presents a case study of a 16-year-old male patient with a significant family history for hypercholesterolemia and coronary artery disease, who suffered an anterior lateral myocardial infarction. On admission, his electrocardiograms revealed the classic pattern of an anterior lateral acute myocardial infarction plus a left anterior hemiblock. His cholesterol level was 750 mg/dL, and his low-density lipoprotein was 650 mg/dL. He underwent a cardiac catheterization that revealed an occluded left anterior descending artery requiring a percutaneous transluminal angioplasty and three coronary stents. The 12-lead electrocardiograms on admission and before discharge are analyzed. This article discusses the electrocardiogram characteristics of anterior lateral wall myocardial infarction coupled with a left anterior hemiblock.     

Reversal of Cluster Headache Side Following Treatment of Arteriovenous Malformation

We describe the case of a forty-four year old man who had typical right sided cluster headaches and an arteriovenous malformation supplied mainly by the right anterior cerebral artery. Following endovascular embolisation of this artery the AVM was supplied mainly by the left anterior cerebral artery. Subsequent headaches have always been on the left. Transcranial Doppler studies now suggested an increase of middle cerebral artery flow velocity. We suggest that the change in haemodynamics was responsible for the change in headache side.     

Deep femoral to anterior tibial bypass after failed femoropopliteal reconstructions

Deep femoral to anterior tibial artery bypass is a reconstructive technique occasionally applicable when more conventional attempts at revascularization of the distal portion of the leg have failed. Three such patients, in whom the anterior tibial was the only distal patent branch of the popliteal artery, had severe symptoms of arterial insufficiency. Deep femoral to anterior tibial bypass was done using autogenous The distal portion of the deep femoral artery was exposed through an anteromedial distal thigh approach. The three patients have been followed up for a mean of 20.3 months, and each maintains graft patency and marked symptomatic improvement.     

Effects of Defibrillation Shocks Delivered Directly Over a Major Coronary Artery

This study investigated the influence of defibrillator shocks delivered directly over a coronary artery, independent of ventricular fibrillation, on cardiac hemodynamics. Thirty-six open chest, halothane anesthetized pigs were randomized to receive six shocks at one of 5,0, 7.5, or 10.0 joules (J). Shocks were delivered between two mesh electrodes (Medtronic TX-7) sutured onto the epicardium, one over the left anterior descending coronary artery and the second directly opposite on the posterobasal ventricular surface. Shock delivery was synchronized to the R wave of the cardiac cycle, to reduce the risk of inducing fibrillation, with a 5-minute stabilization period between successive shocks. Pressure from the left ventricle, the left anterior descending coronary artery, distal to the mesh electrode and the left circumflex (control) artery and contractility in the regions perfused by both arteries were measured. The shocks invariably produced an immediate (2-second postshock), but transient, depression in systolic pressure of the same magnitude for the left anterior descending coronary artery, circumflex artery and the left ventricle that recovered by 5-minute postshock. There was no dose dependent relationship to energy. Also there was no clear difference in myocardial wall motion between the area perfused by the left anterior descending coronary artery and that perfused by the circumflex artery. These results suggest that shocks up to 10 J delivered over an epicardial artery do not cause arterial spasm and do not compromise coronary artery blood flow.     

显微外科手术治疗前交通动脉瘤的临床分析

目的探讨经翼点入路显微外科手术治疗前交通动脉瘤的方法。方法回顾性分析2006年1月-2007年1月间38例前交通动脉瘤患者的临床表现,影像资料、手术治疗及预后情况。所有患者均施行经翼点入路手术,夹闭38例。结果治愈37例,死亡1例。37例随访12个月均无前交通动脉瘤再出血发生。结论经翼点入路手术治疗前交通动脉瘤可收到满意的手术治疗效果。     

二维超声心动图“双环征”图像特征及规律性研究

目的：探讨二维超声心动图（２ＤＥ）“双环征”图像特征及规律性。方法：５２８例２ＤＥ“双环征”,男３１８例,女２１０例,年龄６个月～４７（平均９．８４）岁。４７４例做了心血管造影检查,３１２例经手术证实。结果：５２例２ＤＥ“双环征”并存８种均有大动脉转位先心病。其中３００例大动脉右转位双环回声呈右前左后排列或正前后排列,２２８例大动脉左转位双环回声呈左前右后排列。４７０例肺动脉狭窄（ＰＳ）位于后方环状回声明显小于前方环状回声内径,５８例肺动脉高压（ＰＨ）位于后方环状回声大于或等于前方环状回声内径。结论：２ＤＥ“双环征”患者均有大动脉转位;２ＤＥ“双环征”常并存８种先心病,是哪一种先心病需进一步检查才能确定;根据双环相互位置关系可确定大动脉转位的类型;根据双环内径比较可判定是ＰＳ还是ＰＨ。     

Three-dimensional coronary imaging for the ostium of the left anterior descending artery

Conventional coronary angiography is subject to a significant foreshortening of the proximal left anterior descending artery and overlapping of the left anterior descending artery and the circumflex artery that limits the accurate identification of the ostium of the left anterior descending artery. The aim of this study was to determine whether the three-dimensional (3D) reconstruction of traditional coronary angiography could optimize the projection angle to clearly show the ostium of the left anterior descending artery. The left main bifurcations of 18 consecutive patients were analyzed. A 3D image of the bifurcation was reconstructed from two conventional images and the optimal projection angle was chosen to clearly identify the ostium of the left anterior descending artery. The optimal angle was the right anterior oblique 18.8 ± 20.9°-caudal 26.9 ± 32.3°. The length from the left main trunk to the proximal left anterior descending artery on the optimal views was significantly longer than that on the routine views (25.0 ± 6.1 vs. 22.4 ± 5.3 mm, P = 0.011). The angles of the left main bifurcations were not substantially different between the optimal and the routine views. The optimal views selected using the 3D system provided clearer images of the ostium of the left anterior descending artery with less overlapping and foreshortening. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

经内踝动脉采集血标本在危重新生儿中的应用及护理

目的观察危重新生儿经内踝动脉采集血标本的效果及总结护理要点。方法2006年6月-2007年12月对320例危重新生儿在常规无菌技术操作下，在内踝前动脉采集动脉血标本。结果320例危重新生儿行内踝前动脉采血一次成功276例，成功率为86．3％，采集后无发生并发症。结论对行桡动脉、头皮动脉等多处部位采血穿刺困难的危重新生儿，可采取经内踝前动脉采血，其采集动脉血标本成功率高，方便，快捷，能为临床动脉采血提供一个选择部位，值得推广应用。     

Doppler echocardiographic approach to the blood flow of the left anterior descending coronary artery

Assessment of flow in the left anterior descending coronary artery by Doppler echocardiography appeared to be possible in some patients in which the coronary artery system might be wide and/or the displacement of the coronary artery might be reduced because of cardiac enlargement or of impaired cardiac function. A study of this possibility was carried out in 78 patients, 20 cases with hypertrophic cardiomyopathy, 10 with dilated cardiomyopathy, 20 with aortic valve disease, and 28 following valve replacement for aortic valve disease. The anterior interventricular sulcus was a helpful landmark to search for the left anterior descending artery. The characteristic feature of the coronary flow pattern, that the flow ran mainly during diastole, was also helpful in finding the coronary artery. Complementary roles of ultrasonic imaging and Doppler ultrasound evaluation should be emphasized for identifying a thin echo-free space in the sulcus as the coronary artery. The left anterior descending coronary artery was imaged in 26 of the 78 patients. The peak velocity ranged 24 cm/s to 75 cm/s in different patients. Because the present study was carried out in patients with some particular diseases, these results do not indicate that current techniques can be routinely used for assessing the coronary flow. The detection rate will be increased with improvements in image resolution and the Doppler sensitivity. Although the detection rate of the coronary artery was not satisfactory in the present stage, the effect of sublingual administration of nitroglycerin on coronary circulation was noninvasively assessed in some patients, where reduction of the flow velocity by about 27% was observed in real time.     

Transesophageal examination of the left coronary artery with a 7.5 MHz annular array two-dimensional color flow Doppler transducer

To determine the value of a recently developed 7.5 MHz annular array two-dimensional and color flow Doppler transducer for examination of the proximal parts of the left coronary artery, 25 patients were studied immediately after coronary artery bypass surgery, and the findings were compared with preoperative coronary angiograms. With two-dimensional imaging, the left main coronary artery was visualized in 22 patients (88%), left anterior descending in 13 patients (52%), and circumflex in 22 patients (88%). Stenoses were correctly identified in four of four left main coronary arteries, in five of seven left anterior descending arteries, and in none of four left circumflex arteries. Adding color flow to two-dimensional imaging in 20 patients, we found a disturbed flow signal, as a sign of stenosis, in five of five left anterior descending artery and two of four left circumflex artery stenoses. We concluded that these initial findings with this new 7.5 MHz annular array two-dimensional and color flow Doppler transducer, are promising in imaging and detection of stenoses in the proximal parts of the left coronary artery.     

Left anterior descending artery occlusion secondary to blunt chest trauma diagnosed by comprehensive echocardiography and coronary angiography

Blunt chest trauma can cause serious complications, but coronary artery occlusion is rare. In a 19-year-old man, 40 days after a motorcycle accident, comprehensive echocardiography detected left anterior descending artery occlusion and left ventricular dysfunction, which was confirmed by coronary angiography and ventriculography. Echocardiography was also able to confirm restored left anterior descending artery flow and improved left ventricular function after coronary artery bypass grafting.     

小腿内侧远端动脉穿支显微解剖与隐神经营养血管皮瓣设计

背景:隐神经营养血管远端蒂皮瓣,为踝足部组织缺损的修复提供了一种成功率高的修复方法,但其旋转轴点高,对远端蒂血管分布特点缺少具体可操作性的描述,临床实际应用起来还较为困难。目的:研究小腿内侧远端的动脉穿支,为合理设计隐神经-大隐静脉营养血管远端蒂皮瓣、复合瓣提出解剖学理论。设计:单一样本实验。单位:解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心材料:实验于2004-05/10在解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心实验室完成。研究材料为34侧经动脉内灌注红色乳胶成人下肢标本(由南京军区福州总医院军区骨科研究所临床解剖学研究中心提供)。方法:将34侧经成人下肢标本,以内踝最凸出点为标志点,在小腿内侧远段进行显微解剖。主要观察指标:重点观察:①小腿内侧远端的动脉穿支。②隐神经-大隐静脉远端的营养血管。③营养血管与邻近肌、骨、皮的血供关系。结果:①小腿内侧远端的动脉穿支有9个来源:胫后动脉肌间隙支、胫前动脉踝上支、腓动脉或胫后动脉骨皮穿支、内踝前动脉内踝支、胫后动脉踝管支、足底内侧动脉内踝支、足底外侧动脉内踝支、足底内侧动脉浅支内踝支和跗内侧动脉内踝支。②上述动脉穿支发出皮支、筋膜支、骨膜支、隐神经和大隐静脉营养血管,形成深筋膜上下血管网、浅筋膜、皮神经浅静脉血管链和骨膜血管网。动脉穿支构成了小腿内侧远端前、中、后3条纵向的吻合筋膜血管丛:内踝前动脉和胫前动脉踝上支的前纵向血管丛,骨皮穿支的中纵向血管丛,踝管动脉穿支和胫后动脉肌间隙支的后纵向血管丛。结论:小腿内侧远端的血供具有多源性、明显纵向性和营养血管同源性的解剖学特点,是构成远端蒂复合瓣的解剖学基础,可以设计以胫后动脉肌间隙支、内踝前动脉穿支和以踝管区动脉穿支血管蒂的3种隐神经-大隐静脉营养血管远端蒂皮瓣或复合瓣,旋转轴点在内踝平面,适宜小腿远段、踝足部及其远侧的组织缺损修复。     

冠状动脉慢血流现象的冠状动脉血流成像分析

目的 应用冠状动脉血流成像(CFI)无创性评估冠状动脉慢血流现象患者的冠状动脉血流速度变化.方法 冠状动脉无明显狭窄且心肌梗死溶栓试验(TIMI)提示慢血流现象患者21例,冠状动脉造影无明显狭窄且TIMI血流正常者9例作为对照组.采用校正的TIMI血流计帧法(CTFC)评价冠状动脉血流速度.常规超声心动图测量左室舒张末期内径、收缩末期内径、左室射血分数、E峰、A峰、E/A值.CFI测量冠状动脉前降支远端舒张期峰值血流速度(Vmax)、舒张期平均流速(Vmean)和血流速度时间积分(VTI).结果 慢血流组前降支CTFC为(45.37±8.62)帧,对照组为(15.94±4.66)帧,二者差异有统计学意义(t=-9.596,P=0.000).慢血流组与对照组常规超声心动图测值差异均无统计学意义.慢血流组前降支Vmax为(22.86±3.04)cm/s,Vmean为(17.62±2.89)cm/s,VTI为(8.49±2.01)cm;对照组前降支Vmax为(31.78±9.28)cm/s,Vmean为(23.67±7.60)cm/s,VTI为(10.91±4.47)cm,两组差异均有统计学意义(P＜0.05).对照组及慢血流组前降支CTFC与Vmax和Vmean呈负相关,对照组前降支CTFC与VTI呈负相关,慢血流组前降支CTFC与VTI无相关性.结论 冠状动脉慢血流现象患者冠状动脉前降支远端血流速度减慢,CFI能够反映冠状动脉造影TIMI血流的变化,但诊断冠状动脉慢血流现象有局限.

Abstract：

Objective To non-invasive assess coronary blood flow velocity changes of patients with slow coronary flow phenomenon (SCFP) by coronary blood flow imaging (CFI).Methods Twenty-one patients who had no significant coronary artery stenosis but had thrombolysis in myocardial infarction (TIMI) slow-flow phenomenon were the experimental group,nine patients who has no significant coronary stenosis and TIMI flow normal were the control group.Using corrected TIMI frame count(CTFC) assess velocity of coronary artery.The left ventricular end diastolic diameter,end systolic diameter,ejection fraction,E peak velocity,A peak velocity,E/A ratio were measured by conventional echocardiography.The distal anterior descending coronary artery diastolic peak flow velocity(Vmax),mean velocity(Vmean) and blood flow velocity time integral(VTI) were measured by CFI.Results The corrected TIMI frame count (CTFC) of left anterior descending artery blood flow in slow blood group was (45.37 ± 8.62)frame,that in control group was (15.94± 4.66)frame,the difference was statistically significant (t = -9.596,P =0.000).The conventional echocardiographic measurements of two groups were not significantly different.The left anterior descending artery Vmax was (22.86 ± 3.04)cm/s,Vmean was (17.62 ± 2.89)cm/s,VTIwas (8.49± 2.01)cm in the slow blood flow group,the left anterior descending artery Vmax was (31.78 ± 9.28) cm/s,Vmean was (23.67 ± 7.60) cm/s,VTI was (10.91 ± 4.47) cm in the control group.The difference was statistically significant.The left anterior descending artery CTFC with Vmax and Vmean was negative correlation in the control group and the slow blood flow group.The left anterior descending artery CTFC was negatively correlated with VTI in the control group,there was no correlation between left anterior descending artery CTFC and VTI in the slow blood flow group.Conclusions Coronary artery flow velocity in the left anterior descending artery was declined.CFI can reflect changes in coronary TIMI flow,but in the diagnosis of coronary slow flow phenomenon CFI has limitations.     

彩色多普勒超声多指标评价小腿急性骨筋膜室综合征的临床研究

目的 研究彩色多普勒超声(color Doppler ultrasound,CDU)在小腿急性骨筋膜室综合征(osteofascial compartment syndrome,OCS)诊断中运用的可行性及评估手术指征的价值.方法 前瞻性选取36例高度怀疑或确诊小腿急性OCS的患者,针刺法测量小腿前室压力.CDU重点观察小腿肌肉纹理回声、间室横切面积、胫前胫后动脉管腔内径及多普勒频谱变化,计算小腿前室横切面积扩大率、胫前动脉管径缩小率,与临床诊断及治疗措施作相关性研究.结果 (1)21例OCS患者小腿肌肉大范围(>1/2～2/3)肿胀,回声不均匀增强,肌纹理不清或消失,室内积液、血肿;(2)小腿中段水平前室横切面积扩大率及胫前动脉中段管腔内径缩小率增高;(3)胫前动脉频谱出现双期双向舒张期全反向波、双期单向单相波、单期单向单相波及类静脉频谱波.结论 CDU可运用于小腿急性OCS的诊断,以4项指标中符合任意3项作为诊断标准的敏感性、特异性、准确性分别为86.4%、71.4%及80.6%;作为手术指征的敏感性、特异性、准确性分别为94.7%、70.6%及83.3%.     

Blood redistribution in the fetal brain during chronic hypoxia.

BACKGROUND: Studies on blood flow velocity in the fetal middle cerebral artery have revealed signs of brain sparing in chronic hypoxia. These signs of brain sparing can disappear in the terminal case, but whether this applies to the whole brain or only parts of it is unknown. METHODS: Velocity waveforms of the middle cerebral, anterior cerebral and posterior cerebral arteries were recorded in 221 pregnancies complicated by pregnancy-induced hypertension. The presence of brain sparing (pulsatility index < 2 standard deviations) was noted and correlated to outcome of pregnancy, including emergency operative intervention and/or neonatal distress. RESULTS: Signs of brain sparing in the anterior cerebral artery were found in 90 fetuses, and in the middle cerebral and posterior cerebral arteries in 52 and 65, respectively. Signs of brain sparing in the anterior cerebral artery showed the strongest relationship to adverse perinatal outcome. The anterior cerebral artery was the only vessel in which signs of brain sparing were predictive of perinatal mortality. CONCLUSIONS: Velocimetry of the anterior cerebral artery appears to be superior to that of the middle cerebral and posterior cerebral arteries as a means to predict adverse perinatal outcome. Anterior cerebral artery brain sparing may therefore be less transitory than sparing in the middle cerebral and posterior cerebral arteries, possibly suggesting that the frontal lobes are spared longer than the lateral and occipital regions of the fetal brain.     

Effects of prophylactic ibuprofen on cerebral and renal hemodynamics in very preterm neonates

OBJECTIVE: To evaluate the effects on cerebral and renal blood flow velocities of ibuprofen when used as prophylaxis for patent ductus arteriosus in preterm neonates (gestational age <30 weeks). METHODS: Blood flow velocities in the anterior cerebral artery and the renal artery were measured with Doppler ultrasonography in 17 neonates before, during, and 10, 30, and 60 minutes after administration of 10 mg/kg ibuprofen lysine. RESULTS: In four (23.6%) neonates without echocardiographic patency of the ductus, no significant modifications in blood flow velocities and Doppler indexes were found either in the anterior cerebral artery or in the renal artery. In 13 (76.4%) neonates, cardiac echocardiographic Doppler showed patency of the ductus and left-to-right shunt. In these neonates diastolic and mean blood velocities rapidly increased both in the anterior cerebral artery and the renal artery (P < .0001). Resistance and pulsatility index decreased during the study period (P < .0001 and P < .001, respectively, in the anterior cerebral artery; P < .0001 in the renal artery). CONCLUSIONS: Data suggest that ibuprofen does not determine any direct effect on cerebral and renal blood flow velocities; hemodynamic modifications observed in neonates with patency of ductus can be related to closure of the ductus induced by the drug.