冠状动脉搭桥术与冠状动脉介入术患者左心室收缩功能的评估

目的 比较冠状动脉搭桥术(CABG)或经皮冠状动脉介入术(PCI)对心脏收缩功能的影响。方法 采用回顾性分析方法,CABG组28人,PCI组33人,应用Acuson公司的Aspen彩色多谱勒超声诊断仪,于术前、术后3个月和术后6个月进行多谱勒组织成像(DTI)及常规超声心动图检查患者心脏收缩功能。结果 CABG及PCI术后,左室射血分数(EF值)及应用DTI技术检测的二尖瓣环四点(室间隔、侧壁、前壁、下壁)收缩期主峰速度的平均值(S值)均较术前提高,但两种手术对左室EF值及S值改善情况差异无统计学意义。结论 GABG及PCI重建冠心病患者心肌血运后,存活心肌功能逐步恢复,左室收缩功能逐步改善;这两种手术方法在改善冠心病患者左室收缩功能方面无显著差异。     

超声心动图定量评价冠脉支架置入术后左室收缩功能变化

目的:应用组织多普勒成像(DTI)及主动脉瓣上流速定量评价冠状动脉置入术后左室局部及整体收缩功能的变化,旨在探讨超声心动图评价冠状动脉支架置入术后左室收缩功能改善情况的简便方法.方法:采用PW-DTI技术对59例急性心肌梗死并行冠状动脉支架置入术患者分别干术前24h、5d、15d检测左室梗死区对应心肌节段的基底段、中段心肌的收缩期峰值速度PSV,比较支架置入前后梗死区局部心肌收缩速度变化;同时检测支架置入术前后主动脉瓣上血流速度变化,记录并测量支架置入前后左室射血分数LVEF的变化.结果:术后5d左室受累节段心肌收缩期峰值速度较术前明显增加,P＜0.05;术后15d受累节段心肌收缩期峰值速度较术前及术后5d均明显增加,P＜0.01;术后5d主动脉瓣上流速较术前增加,P＜0.05,术后15d主动脉瓣上流速较术前及术后5d均显著增加,P＜0.01;术后5d LVEF较术前有增加趋势,但差异无统计学意义,术后15dLVEF较术前明显增加,差异有统计学意义,P＜0.01.结论:冠状动脉支架置入术后早期左室局部心肌收缩功能有明显改善,随时间延长心肌收缩功能显著提高,组织多普勒成像可直观、定量估测受累心肌恢复情况;主动脉瓣上流速亦可直观评估左室整体收缩功能改善情况,流速变化较组织多普勒及左心功能测定更加直观简便.     

组织追踪显像对冠状动脉介入术后左室室壁运动及收缩功能的研究

目的 :探讨组织追踪显像 (TTI)技术评价经皮冠状动脉介入术后左室室壁运动和左室功能变化。方法 :冠心病组 35例 ,正常对照组 30例。在组织位移曲线图状态下测定左室各节段及二尖瓣收缩期最大位移。左室射血分数 (LVEF)采用心尖四腔观单平面改良Simpon方法。冠心病组每位受检者上述测量均于术前、术后 1周、术后 3个月分别进行一次。结果 :与正常人相比 ,冠心病患者缺血心肌运动异常节段心肌位移值明显减小 (P <0 .0 1) ,冠心病组左室射血分数有不同程度的减少 (P <0 .0 5 ) ,收缩期 6个位置二尖瓣环运动位移平均值呈有意义的减少 (P <0 .0 5 )。与术前相比 ,术后 1周运动异常节段位移值以及LVEF的变化无显著性意义 (P <0 .0 5 ) ;术后 3个月各项指标较术前均有显著性差异 (P <0 .0 5 )。线性相关分析表明二尖瓣环位移值与LVEF的相关性较好 (r =0 .83,P <0 .0 1)。结论 :TTI技术对冠心病心肌缺血治疗后局部血运改善的评价具有较高的应用价值。     

斑点追踪技术研究冠状动脉介入术对左室心功能的影响

目的探讨二维斑点追踪成像(STI)技术的心肌扭转与旋转指标对评价急性前壁心肌梗死(AMI)的意义。方法 49例患者PCI术前和术后72 h内行超声心动图检查,进行常规超声参数及STI参数测定。结果常规超声指标仅LVEF值有统计学意义(P<0.05);前壁心尖段术后局部扭转速度与解旋速度较术前提高,扭转时间与解旋减半时间较术前减少,左室基底段和心尖段的整体解旋角度术后均增加(P﹤0.05)。结论 STI技术的左室扭转解旋指标可定量评价心肌梗死患者术后左心整体与节段舒缩功能。     

STI评价原发性高血压与尿毒症左室壁增厚患者的左室纵行心肌应变

目的:应用斑点追踪技术成像(speckle tracking imaging,STI)评价原发性高血压与尿毒症左室壁增厚患者的左室纵行心肌应变。方法:正常对照组20例,原发性高血压组40例,尿毒症组30例。常规心脏数据测量后,连接胸导联心电图,分别采集心尖位3个长轴切面的二维灰阶动态图,取3个连续稳定心动周期,脱机分析18个节段收缩期峰值应变、二腔切面总应变、三腔切面总应变、四腔切面总应变及3个切面的平均总应变,记录并比较各参数测值。结果:正常对照组左室各壁收缩期峰值应变自基底段至心尖段逐渐增加;同一室壁各节段心肌收缩期峰值应变达峰时间基本一致。原发性高血压组左室前间隔中间段、心尖段与后壁中间段、心尖段,后间隔基底段收缩期峰值应变降低,与正常对照组差异有统计学意义,余室壁收缩期峰值应变、二腔切面总应变、三腔切面总应变、四腔切面总应变及3个切面的平均总应变与正常对照组差异无统计学意义;同一室壁各节段心肌应变曲线紊乱,收缩期峰值应变达峰时间一致性差。尿毒症组左室各壁收缩期峰值应变、二腔切面总应变、三腔切面总应变、四腔切面总应变及3个切面的平均总应变明显降低,与另外2组相比差异均有统计学意义;同一室壁各节段心肌应变曲线紊乱,收缩期峰值应变达峰时间一致性差。结论:STI能准确、快速地测定原发性高血压和尿毒症左室壁增厚患者左室局部心肌收缩期峰值应变的减低,提示患者左室整体收缩功能正常情况下存在节段性收缩功能降低。     

~(99m)Tc-MIBI潘生丁负荷心肌灌注断层显像评价冠状动脉支架术后血管再狭窄的价值

目的: 通过对冠状动脉(简称冠脉)支架植入前后进行静息和潘生丁负荷99mTc-MIBI断层显像(R-MPTI、P-MPTI),以了解SPECT在支架置入术前筛选、术后再狭窄评价中的价值.材料和方法: 95例冠心病患者在冠状动脉介入治疗前、术后3～6个月行R-MPTI和P-MPTI.潘生丁最大剂量时注射740MBq99mTc-MIBI,1h后行心肌断层显象;24h后重复静态心肌显象.与术后复查冠脉造影(CAG)对比,分析心肌灌注显像对支架术后再狭窄的诊断效果.结果: 95例冠心病患者共有855个心肌血流灌注节段,术前R-MPTI发现196个心肌血流灌注缺损,P-MPTI发现351个.支架置入后R-MPTI检查发现62个心肌血流灌注缺损病变节段,P-MPTI检查发现145个心肌血流灌注缺损病变节段.术后CAG随访92例,18例(18/92,19.6%)共29支血管发生再狭窄.按再狭窄冠脉支数计算,R-MPTI、P-MPTI对再狭窄的诊断准确性、阳性预测值和阴性预测值分别为84.5%、92.6%; 59.5%、75.7%;95.7%、98.9%,所有指标均有显著差异(χ~2＝15.54)(P<0.01).结论: P-MPTI可以早期发现冠状动脉内支架术后再狭窄,诊断效率高于R-MPTI,有利于准确判断病情和指导治疗.     

肥厚型心肌病左室局部心肌收缩功能的应变率成像研究

目的:应用应变率成像(SRI)评价肥厚型心肌病(HCM)患者左室纵向局部心肌收缩功能。方法:应变率成像模式下,分析18例HCM患者和17例健康对照组左室各室壁基底段、中段、近心尖段局部心肌纵向应变率曲线,测量收缩期峰值应变率。结果:HCM组各室壁节段收缩期峰值应变率均显著低于正常对照组相应室壁节段;室间隔中段收缩期峰值应变率与室间隔厚度以及室间隔-左室后壁厚度比值(IVS/PW)之间均具有显著相关性(rSR-IVS=0.776,rSR-IVS/PW=0.734,P<0.01)。结论:HCM患者左室局部心肌收缩功能受损,且左室形态学异常与局部心肌功能的异常具有相关性;应变率成像能够定性、定量地评价局部心肌收缩功能。     

门控心肌灌注显像筛选冠心病介入治疗及其疗效的评价

目的探讨腺苷负荷/静息99mTc-MIBI门控心肌灌注显像(G-MPI)联合硝酸甘油(NTG)介入心肌灌注显像,筛选冠心病患者进行经皮冠状动脉介入治疗(PCI),并且用腺苷负荷/静息99mTc-MIBI G-MPI评价治疗后的疗效。方法238例疑诊的冠心病患者均行腺苷负荷/静息G-MPI,间隔1～2天后对确诊为心肌梗死的68例患者继续行NTG介入心肌灌注显像,筛选出具有存活心肌的患者进行PCI治疗。治疗后6～12个月复查腺苷负荷/静息G-MPI,比较PCI术前及术后随访期G-MPI的定性与定量分析的结果。结果 68例心肌梗死患者NTG介入显像提示心肌存活患者51例,静息显像的524个异常灌注节段,NTG介入显像发现有242个节段灌注得到改善,改善率为46. 2%(242/524),NTG介入显像所获得的总评分SS低于静息显像SS(14. 62±5. 81 vs 18. 82±6. 37,P 0. 05)。51例心肌存活患者中33例患者行PCI术,术后腺苷负荷/静息G-MPI显示可逆性缺损区节段数、固定性缺损区节段数及负荷静息评分差值SDS均低于术前(204 vs 113,134 vs 92,5. 37±1. 96 vs 2. 49±1. 13,P值均0. 05)。患者PCI术后左室射血分数高于术前(55. 39±11. 71vs 48. 56±10. 27,P 0. 05),术后左室舒张末容积和左室收缩末容积低于术前(97. 98±29. 25 vs 112. 82±30. 38,45. 96±20. 77 vs 55. 64±21. 12,P值均0. 05)。结论负荷/静息G-MPI联合NTG介入显像能提高对心肌梗死患者存活心肌的检出,从而对PCI患者进行更为准确、合理的筛选,同时负荷/静息G-MPI对于术后患者预后及长期随访中也具有一定意义。     

冠心病患者PTCA术前后核素心脏显像结果对比分析

目的　应用99Tcm 甲氧基异丁基异腈心肌灌注断层显像及心室显像随访经皮冠状动脉腔内成形术 (PTCA)及支架置入术后的效果。方法　患者在成功的PTCA及支架置入术前及随访期进行负荷 /静息或静息 /含硝酸甘油心肌灌注断层显像及心室显像检查。结果　 44例患者在术前及术后平均 11.4个月进行了心肌灌注断层显像 ,其中 40例患者进行了心室显像。结果显示 ,术后患者心肌缺血及不可逆缺损节段数减少 ,分别为 2 .5± 0 .4与 1.5± 0 .3(P =0 .0 6 )及 3.5± 0 .5与 2 .3± 0 .4(P <0 .0 5 ) ;左室射血分数、高峰射血率及高峰充盈率无明显变化 ,运动低下节段数有所下降 ,但未达到统计学差异。结论　成功的PTCA及支架置入术后心肌缺血明显改善 ,左室功能无明显变化 ,部分节段运动改善     

冠心病患者PTCA前后双核素心肌显像结果对比分析

目的应用~(99)Tc~m-甲氧基异丁基异腈(MIBI)/~(18)F-脱氧葡萄糖(FDG)心肌灌注断层显像及代谢显像评价经皮冠状动脉腔内成形术(PTCA)及支架置入的效果。方法 33例冠心病患者在成功的 PTCA 及支架置入术前及术后(平均)3个月进行心肌灌注/代谢显像。结果术前、术后患者心肌缺血节段数分别为2.7±0.4与1.7±0.3(P<0.05);心肌细胞代谢低下节段数分别为1.9±0.3与1.2±0.3(P<0.05)。术后较术前心肌缺血及心肌细胞代谢低下节段平均减少数分别为0.98±0.2与0.65±0.2(P<0.05)。结论成功的 PTCA 及支架置入术后心肌缺血和心肌细胞代谢明显改善,但心肌细胞代谢改善程度远不如血流灌注。     

应用图象定量分析研究大肠癌的血管生成

目的：探讨血管生成与大肠癌的发生、发展的关系，评估图象定量分析系统在对血管生成程度（MVD值）分析的应用价值。方法：取45例大肠癌石蜡标本和10例正常大肠组织标本，以抗Ⅷ因子相关抗原抗体对所选的标本的血管内皮细胞进行免疫组化染色，应用计算机图象分析系统和人工计数的方法测定微血管密度。结果：微血管人工计数和图象定量分析均反映，在正常大肠组织、大肠癌组织之间血管生成程度有明显的差别，并且MVD值与大肠癌的临床分期、转移有关。结论：血管生成是大肠癌的发生、发展的一个重要阶段，应用图象定量分析系统可以更精确、更客观地对血管生成程度进行评估。     

Possibility of using the spot camera in the documentation of the arterial phase in urography

32 patients have been examined with sequential angiourography (AUS) and image subtraction, utilizing a spot-camera instead of a rapid seriograph, for the visualization of the vascular phase of the renal artery. Satisfactory results have been obtained since in 96.9% of the cases (31/32) it has been possible to obtain representation of those structures sufficient for a clinical evaluation. This technique for its low cost and simplicity of execution can therefore be proposed as a routine examination in the suspect of vascular renal pathology. This method and the more diffuse AUS with rapid seriograph offer, with respect to digital subtraction angiography (DSA), the advantage of a better nephrographic and urographic phase due to the higher quantity of contrast medium injected.     

MRI in the assessment of the supportive soft tissues of the cervical spine in acute trauma in children

We carried out a retrospective analysis of imaging and clinical findings in 52 children with a history of cervical spinal trauma. No patient had evidence of a fracture on plain films or CT. All had MRI at 1.5 T because of persistent or delayed symptoms, unexplained findings of injury or instability, or as further assessment of the extent of soft-tissue injury. Clinical follow-up ranged from 6 months to 3.5 years. MRI was evaluated for its influence on therapy and outcome. MRI was positive in 16 (31 %) of 52 patients. Posterior soft-tissue or ligamentous injury was the most common finding in the 10 patients with mild to moderate trauma, while acute disc bulges and longitudinal ligament disruption, each seen in one case, were uncommon. MRI was superior to CT for assessment of the extent of soft-tissue injury and for identification of spinal cord injuries and intracanalicular hemorrhage in the six patients with more severe trauma. MRI specifically influenced the management of all four patients requiring surgery by extending the level of posterior stabilization. No patients with normal MRI or any of the 10 with radiographically stable soft-tissue injury on MRI, developed delayed clinical or radiographic evidence of instability or deformity. Received: 5 August 1997 Accepted: 13 October 1997     

Evaluation of the second-generation Meniscus Arrow in the fixation of bucket-handle tears in the vascular area of the meniscus

The purpose of this prospective study was to evaluate whether the shorter degradation time of the second-generation Meniscus Arrow would be adequate to allow meniscal healing and whether equally good results could be achieved compared to the first generation implant. We also wanted to assess whether some of the implant related complications could be avoided with the altered absorption time. A total of 20 patients were included in this study. The mean follow-up was 26 months. The average Lysholm score at the final follow-up was 90. There were 13 second-look arthroscopies performed during the follow-up and in them two failures of the repaired menisci to heal were seen. Seven patients were found with some degree of chondral irritation of the femoral condyle corresponding to the repair site. The second generation Meniscus Arrow seems to give results comparable to the first generation Meniscus Arrow. The potential complications caused by the implant reported in the earlier literature using the first generation arrow are possible also using this implant. In seven of the 13 second-look arthroscopies some degree of chondral irritation corresponding to the repair site was seen. The clinical relevance of these lesions remains to be seen.