Stanford B型主动脉夹层旋转血管造影中对比剂注射方案改良研究

目的 探讨两种碘对比剂注射方案对Stanford B型主动脉夹层（aortic dissection,AD）旋转血管造影图像质量的影响.方法 回顾性分析广东省人民医院2012年1月至2013年7月60例Stanford B型AD患者的主动脉旋转血管造影图像资料,对比剂注射方案分别为生产商推荐方案及改良方案.主观评分指标按5分法评分标准（5分-图像极为满意,4分-图像很好,3分-图像可以满足术中诊断需求,2分-部分细节难以显示,1分-不能诊断）进行评估,包括夹层累及范围、破口大小及位置、头臂干、左侧颈总动脉、左侧锁骨下动脉显示情况.对图像主观评分结果采用两独立样本秩和检验进行比较.结果 60例Stanford B型AD患者中,30例患者使用推荐方案,主观评分为（4.4±0.6）分;30例患者使用改良方案,主观评分为（3.9±1.5）分,两种不同碘对比剂注射方案在旋转造影主观图像质量上比较,差异无统计学意义（P＞0.05）.结论 碘对比剂注射改良方案与推荐方案在主动脉旋转血管造影对AD的细节诊断方面没有明显差别,可根据临床需要选择改良方案进行检查,以减少对比剂的用量及相应毒副作用.     

数字减影血管造影技术在胸主动脉夹层动脉瘤诊疗中的应用

目的探讨数字减影血管造影技术(DSA)在胸主动脉夹层动脉瘤治疗中的应用。方法入选2014年1月~2015年1月在哈尔滨医科大学附属第二医院收治的胸主动脉夹层动脉瘤患者62例。采用Philips FD20数字减影血管造影机对所有患者进行数字减影血管造影检查,分析患者临床资料及DSA影像资料,研究DSA检查在胸主动脉夹层动脉瘤治疗中的应用价值。结果根据患者实际病情及个体参数合理的选择体位、仔细计算角度、高压注射参数以及图像后处理,可准确对胸主动脉夹层动脉瘤部位、破口以及真假腔内血流的差别、周围相邻血管进行成像。结论胸主动脉夹层动脉瘤介入治疗中选择正确、合理的DSA成像参数,可对复杂的胸主动脉夹层动脉瘤的破口准确成像,有效提高介入治疗的安全性,对增加超选择性插管成功率及降低手术用时具有重要意义。     

主动脉夹层的早期临床与多层螺旋CT血管造影

目的观察应用多层螺旋CT血管造影（CTA）对复杂危重的主动脉夹层的临床早期诊断的准确性和实用性。方法对于13例临床疑诊为主动脉夹层的病例进行CTA检查（包括血管重建）。观察病变的起始范围和其他重要脏器的情况,进行临床总结和分析。结果13例主动脉夹层的病例经CTA检查均能清晰显示病变,甚至可以了解夹层中的血栓,夹层导致的心包填塞和破入胸腔。结论CTA检查是早期诊断主动脉夹层快捷．准确的方法。结合早期的临床表现使主动脉夹层的早期诊断率接近100％。     

老年StandfordB型主动脉夹层患者冠状动脉造影的临床意义

目的探讨老年StandfordB型主动脉夹层患者中冠状动脉粥样硬化性心脏病（冠心病）的检出率及其相关危险因素。方法回顾性分析134例50岁以上同时进行主动脉造影和冠状动脉造影的StandfordB型主动脉夹层患者的临床资料及影像学资料．对数据进行统计分析。结果134例患者中,冠心病的检出率为26．1％（35例）,其中单支病变22例（16．4％）,2支病变9例（6．7％）,左主干或3支病变4例（3．0％）。多因素Logistic回归分析显示．男性（OR=6．682,95％CI1．01—44．13,P=0．049）及吸烟（OR=3．513,95％CI1．05-11．70,P=0．041）是StandfordB型主动脉夹层合并冠心病的预测因素。结论50岁以上StandfordB型主动脉夹层患者共患冠心病的比例较高,在主动脉造影时有必要常规进行冠状动脉造影检查,以免漏诊。     

64层螺旋CT血管成像技术诊断主动脉夹层56例临床价值

主动脉夹层(aortci dissection,AD)的确切发病率尚不清楚,尸检统计的发病率为2%～3%~([1]),在人群中的发病率为每年2.9/100 000~([2]).多数研究表明AD的发病年龄最常见于60～70岁,且临床症状很不典型,有时类似于心肌缺血,误诊率可高达38%,而且有28%的病人在死亡后尸体解剖中确诊~([3]).     

碘对比剂血管造影应用相关不良反应中国专家共识

<正>几乎所有的药物在发挥其功效的同时都会引发一定程度的不良反应。即便在正常用法、用量情况下,也有可能出现有害的或与用药目的无关的反应,严重者甚至可危及生命。按照WHO国际药物监测合作中心的规定,将正常剂量的药物用于预防、诊断、治疗疾病或调节生理功能时出现的有害和与用药目的无关的反应称为药物不良反应(adverse drug reaction,ADR)。随着碘对比剂在心血管病诊疗中应用的不断增多,碘对比剂引起的不良反应及其危险性已备受关注。专家组参考国内外文献和经多次讨论,制定了这一版《碘对比剂血管造影应用     

64排螺旋CT低剂量扫描方案在老年人主动脉夹层诊断中的应用价值

<正>主动脉夹层(AD)是一种严重威胁人类生命的血管疾病,在老年人中的发病率较高,不及时进行诊治死亡率极高。随着多排螺旋CT在临床的应用,特别是64排螺旋CT对血管内成像显示的更加清晰,对于AD能清晰显示其破口的位置、病变形态、范围、重要分支血管情况以及其与周围解剖结构的关系。但是常规扫描的主动脉CT血管造影(CTA)扫描辐射量大,并且应用的对比剂量大,一方面增加老年人罹患癌症的概率,另     

多层螺旋CT血管造影在主动脉夹层诊断中的价值

目的探讨多层螺旋CT血管造影在主动脉夹层中的应用价值。方法对21例主动脉夹层患者进行CT血管造影,层厚2.5mm,重建间隔1.6mm,螺距1.25,对比剂用量100mL,注射速度3mL/s,延迟时间18~20s;将数据传输到工作站进行最大密度投影、多平面重建、表面遮盖显示、容积再现等处理。结果21例中,DebakeyⅠ型5例,Ⅱ型3例,Ⅲ型13例。所有病例均很好地显示了主动脉全程及其分支,真腔、假腔、内膜片及夹层动脉瘤的部位、范围得到满意显示。结论多层螺旋CT血管造影在主动脉夹层的诊断和治疗中有积极的临床应用价值。     

血尿酸浓度与主动脉夹层的关系

目的 应用病例对照研究方法探讨血尿酸浓度与主动脉夹层的相关性,进一步从临床生化角度探讨主动脉夹层发病的相关危险因素.方法 病例组为新疆医科大学临床医学院自2012年8月至2014年6月收治的主动脉夹层患者160例;对照组选择同期住院的体检健康者157名,排除合并主动脉夹层、痛风、严重肾功能不全等相关疾病.收集患者的一般资料、既往病史,入院时常规实验室检查包括:血脂分析、D-二聚体、血尿酸、C反应蛋白、血小板、白细胞、血糖等结果.分析主动脉夹层发病的相关危险因素.结果 病例组血尿酸浓度较对照组显著增高,差异有统计学意义[(343.08±136.10) mmol/L vs.(312.5±85.61) mmol/L,P=0.030].多因素非条件Logistic回归分析显示,高尿酸血症是主动脉夹层发病的危险因素(OR=1.231,95％CI:0.919～0.981,P=0.002).结论 新疆地区人群中高尿酸血症可能为主动脉夹层的危险因素.     

小肠CT造影对比剂的优选

目的:评价何种对比剂在小肠CT造影时能充分充盈扩张肠管、不易形成伪影,在显示小肠肠腔、肠壁方面最佳.方法:8条健康成年毕格犬麻醉后,插管至十二指肠屈氏韧带以下,静脉注射654-2,经导管注入不同的对比剂:纯水、纯牛奶、10mL/L泛影葡胺后行MSCT扫描,平扫结束后行增强扫描.通过横断面及多平面重建,测量肠腔宽度、肠壁厚度,对各组测量及评价结果进行统计学分析.同时测量平扫、增强后20 s、30 s、40 s、50 s时肠壁的CT值,测量计算肠腔与肠壁对比程度最好时,肠腔与肠壁密度的CT值差值范围.结果:在肠腔宽度的比较上,纯牛奶组与纯水组、泛影葡胺组的差异有统计学意义(F=28.115,P＜0.01),纯水组与泛影葡胺组无明显统计学差异;在肠壁厚度的比较上,纯牛奶组、纯水组、泛影葡胺组的差异均无明显统计学差异.纯水与纯牛奶组肠腔、肠壁显示最好,此时肠壁与肠腔密度的差值为69.25±6.28HU.结论:纯牛奶是较理想的小肠CT造影对比剂.能够充分充盈扩张肠腔,同时能够较好的显示肠腔、肠壁的情况.     

Cardiac catheterization and selective coronary angiography in ascending aortic aneurysm or dissection

Cardiac catheterization and coronary angiography can be technically demanding and is potentially risky in patients with ascending aortic aneurysm or dissection. We describe our approach to and results in catheterizing 63 patients with ascending aortic pathology. © 1994 Wiley-Liss,Inc..     

Intravenous digital subtraction angiography in the diagnosis and management of acute aortic dissection

Eleven patients presenting with the clinical diagnosis of suspectedaortic dissection underwent intravenous digital subtractionaortography. In nine patients digital subtraction angiography(DSA) was performed as the investigation of first choice. Infive of these the diagnosis was confirmed with this techniquealone and surgical repair was undertaken without further investigation.Direct cine aortography was also undertaken in the other fourpatients and confirmed the DSA findings, demonstrating aorticdissection in one case and no dissection in three others. In two of the eleven patients, direct cine aortography was performedas the initial investigation. The results of subsequent digitalaortography concurred in both cases, aortic dissection beingdemonstrated in one patient. In two cases, despite normal cineand digital aortography, aortic dissection was confirmed bycomputed tomography. We have found DSA to be a valuable technique for diagnosingaortic dissection, with no false positive or false negativefindings when compared to direct cine aortography. Since itis a less traumatic procedure than direct aortography it shouldbe the investigation of choice if computed tomography is notimmediately available.     

非离子造影剂对老年冠状动脉造影患者肾功能的影响

目的观察非离子造影剂对老年冠状动脉(冠脉)造影患者肾功能的影响。方法选择具有冠脉造影适应证并行冠状动脉介入诊断、经皮冠脉介入治疗(PCI)的老年患者41例,年龄60~84(66±6)岁。于冠脉造影前、后第2天、第5天分别检查各项肾功能指标。以造影后2天内血清肌酐(Cr)比造影前增加44μmol/L或增加25%,或内生肌酐清除率(CCr)比造影前下降25%为诊断造影剂肾病的标准。结果PCI术后第2天血清尿素氮(BUN)、Cr、尿微量白蛋白浓度(UMALB)及24 h微量白蛋白总量(24 h UMALB)升高,24 h尿肌酐(UCr)、CCr较术前下降(P<0.05)。术后第5天上述指标与术前比较差异无显著性(P>0.05)。自由水清除率(free water clearance,CH2O)冠脉造影后第2天较术前升高(P<0.05),术后第5天未能恢复到术前水平(P<0.05)。按照造影剂肾病的诊断标准,共有8例患者可诊断造影剂肾病。结论非离子造影剂对行冠脉造影术的老年患者肾功能有一定损害,但多数属可逆性。     

Successful transfemoral aortic Edwards® SAPIEN® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent

Severe anaphylactoid reaction after the use of iodinated contrast media are rare but can contraindicate the use of contrast agent. It was the case of a 53‐year‐old woman suffering from symptomatic severe aortic stenosis, recused for cardiac surgery because of deleterious effects of chest‐wall irradiation, with porcelain aorta. We decided to implant a 23‐mm Edwards^® SAPIEN^® transcatheter aortic valve via a femoral route without using any contrast media. The implantation was successful after surgical approach of the femoral artery, transesophageal echocardiography guiding, and localization of native leaflets and coronary trunk with catheters. Immediate and one month post‐interventional follow‐up was favorable and echocardiography showed a good functioning of the aortic bioprosthesis. Although conventional angiography is the best way to visualize the good positioning of the valve before deployment, our case suggests that, in special situations, transfemoral implantation of an Edwards^® SAPIEN^® aortic bioprosthesis is feasible without any contrast injection. © 2012 Wiley Periodicals, Inc.     

A comparison of heparinized low osmolality ionic and nonionic contrast media in 500 patients undergoing cardiac angiography

Low osmolar contrast media (CM) cause less hemodynamic and electrical changes than conventional CM, and many cardiologist have switched to the newer agents. Recently, concerns about a possible increased frequency of thromboembolic complications with low osmolar CM have been raised. This study compared two low osmolar heparinized CM, one ionic (Hexabrix) and the other nonionic (Isovue), in 500 consecutive patients undergoing either diagnostic catheterization (417) or coronary angioplasty (83). Adverse effects were uncommon (37 patients), but were more frequent with Hexabrix (12%) than Isovue (3%); p less than 0.05. The most common adverse effects were nausea or vomiting. Death, related to abrupt occlusion of a severe left main stenosis occurred in one patient who received Hexabrix, and acute pulmonary edema occurred in one patient who received Isovue. No apparent thromboembolic complication occurred. In conclusion, both low osmolar CM were well tolerated, but Hexabrix caused more transient nausea or vomiting. Both CM were safe and the incidence of thromboembolic complications when prospectively looked for was very low.     

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文章论述主动脉夹层(AD)、主动脉壁间血肿(出血)、主动脉穿透性溃疡的影像学诊断的进展,并讨论三者的关系,提出影像学检查在诊断和鉴别诊断中具有重要的作用。     

旋转冠状动脉造影的临床应用和安全性研究

目的:评估旋转冠状动脉造影在冠心病诊断中的临床应用和安全性.方法:入选准备行诊断性冠状动脉造影的患者60例,随机分为标准冠状动脉造影(SA)组与旋转冠状动脉造影(RA)组.比较2组间应用造影剂和射线辐射量.结果:RA组所有患者成功行旋转冠状动脉造影.与标准SA组相比,RA组造影剂应用减少18%[(62.16±15.03):(76.91±20.00)ml,P=0.042],总的射线辐射量,左冠RA与SA相比,射线量减少了23%[(24.4034±8.1150):(31.8861±12.9449)Gycm2,P=0.0188],右冠RA与SA相比,射线量减少了27%[(3.9936±2.089):(5.4869±2.5002)Gycm2,P=0.0263].RA与SA相比,总的手术时间呈缩短趋势[(374.8±136.2):(417.2±183.5)sec;P＝0.2].结论:旋转冠状动脉能够快速完成,安全有效,造影射线量和造影剂明显减少,可以成为评估冠心病的一种补充和/或替代方法.     

Biomarkers in acute aortic dissection and other aortic syndromes

Acute aortic syndromes have an incidence of >30 per million per annum and a high mortality without definitive treatment. Survival may relate to the speed of diagnosis. Although pain is the most common symptom, there is a large fraction of patients in whom the diagnosis may be mistaken or overlooked. Currently, a high index of clinical suspicion is the chief prompt that diverts a patient into a definitive algorithm of imaging investigations. Although there is no point-of-care biochemical test that can be reliably used to positively identify dissection, biomarkers are available that could accelerate the diagnostic pathway and thereby expedite treatment.