对比研究胎儿复杂心脏畸形的超声心动图特点与病理检查结果

目的 探讨应用超声心动图胎儿序列切面、系统扫查方法在诊断胎儿复杂先天性心脏畸形方面的临床应用价值。方法 借鉴美国超声心动图学会所提供的胎儿超声心动图检查的标准和规范性指南,对352例胎儿进行产前心脏超声心动图检查,并对因严重心脏畸形引产的胎儿产前超声心动图结果与胎儿病理解剖结果进行对比。结果 352例中产前胎儿超声心动图检出18例胎儿存在复杂心脏畸形,合计58处心脏畸形,均经引产病理解剖证实,解剖时还发现产前超声心动图漏诊心脏畸形5处（1处主动脉弓缩窄、2处永存左上腔静脉、2处右位主动脉弓）、诊断略有偏差心脏畸形3处（2处动脉发出略有偏差、1处主动脉与肺动脉间异常通道）, 胎儿超声心动图产前诊断心脏畸形的准确度为94.83% (55/58),敏感度为92.06%（58/63）,对严重心脏畸形诊断的检出率可达100% (18/18)。结论 胎儿超声心动图序列切面系统检查方法,对多数严重胎儿心脏畸形可做出明确诊断,其对胎儿复杂心脏畸形的检出率与病理诊断结果无显著性差异,故其可作为诊断复杂胎儿心脏畸形的推荐方法。     

胎儿心脏畸形在高危与低危孕妇中超声检出率的研究

目的 通过比较胎儿心脏畸形在高危与低危孕妇人群中的超声检出率,为制定胎儿心脏超声筛查的策略提供依据.方法 将7165例受检孕妇分为高危组(2147例)和低危组(5018例).以四腔心、左右室流出道为主要筛查切面,对疑有异常者行详细超声心动图检查.统计分析两组胎儿心脏畸形的超声检出率以及有关危险因素的分布.结果 共检出胎儿心脏畸形95例(1.33%),其中高危组检出32例(1.49%),高龄妊娠位居高危因素的第一位.低危组检出63例(1.26%).高危组与低危组孕妇其胎儿心脏畸形的超声检出率比较差异无统计学意义(X2=0.635,P=0.426).对23例心脏畸形胎儿进行了脐血或羊水穿刺染色体检查,其中染色体异常11例(47.83%).结论 胎儿心脏畸形在高危与低危人群中的超声检出率相近,应提倡对所有胎儿行心脏超声筛查,以便在产前尽早发现胎儿严重的心脏畸形.     

超声心脏五横切面在胎儿产前心脏畸形筛查中的应用价值

[目的]探讨超声心脏五横切面在胎儿产前心脏畸形筛查中的应用价值.[方法]选择2011年1月至2014年6月在本院行产前常规检查孕妇8156例作为研究对象,对胎儿进行心脏五横切面(腹部横切面、心脏四腔心切面、左室流出道切面、右室流出道切面、三血管-气管切面)检查,将检查结果与尸检、新生儿超声心动图结果对比,并分析其染色体核型异常情况.[结果]8156例孕妇均顺利完成超声心脏五横切面检查,43例被检出有先天性心脏畸形,检出率为0.53％;新生儿经尸检或产后超声心动图检查发现有5例漏诊,误诊3例,其中2例心内膜垫缺损误诊为单纯室间隔缺损,1例法洛四联征误诊为单纯房间隔缺损.心脏五横切面检查的特异度、敏感度、阴性预测值、阳性预测值分别为99.96％(8088/8091)、88.89％ (40/45)、99.93％ (8088/8093)、93.02％(40/43);43例心脏畸形胎儿中,有19例进行染色体核型检查,9例存在染色体核型异常.[结论]超声心脏五横切面产前常规检查可较为准确的筛查出胎儿心脏畸形,有利于推断胎儿是否有染色体异常.     

产前超声筛查五步检查法对胎儿心脏畸形的诊断价值

目的:探讨五步检查法用于产前超声筛查胎儿心脏发育畸形的有效性。方法:孕15～40周行超声检查,分娩或终止妊娠孕妇2 038名,均应用五步检查法筛查胎儿心脏畸形,并进行随访。结果:产前超声诊断心脏畸形胎儿21例,检出率1.03%;11例引产后行尸体解剖,10例正常分娩后行超声心动图复查,产前、产后诊断符合率100%。超声筛查四腔心切面显示率100%,左、右心室流出道切面及三血管切面显示率98.7%,主动脉弓切面显示率95.9%,动脉导管弓切面显示率92.4%,肺动脉及其分叉长轴切面显示率93.1%。结论:五步检查法有助于筛查胎儿心脏畸形。     

四个基本切面法快速筛查胎儿心脏畸形的临床价值

目的探讨采用胎儿超声心动图的四个基本切面快速筛查胎儿心脏畸形的临床价值。方法采用四腔心切面、左、右室流出道切面、三血管切面对5 876例孕妇进行快速胎儿心脏畸形的筛查,有异常者进一步做胎儿超声心动图详细检查确诊。结果 5 876例胎儿中发现先天性心脏病35例,漏诊3例,敏感性92.1%。结论四个基本切面法是产前筛查胎儿心脏畸形的一种快速、准确的筛查方法。     

基层医院开展胎儿超声心动图筛查的作用分析

目的:探讨基层医院开展胎儿超声心动图筛查的作用。方法:选取2017年1月—2019年6月在北京市昌平区妇幼保健院建档并进行胎儿超声心动图筛查的孕妇10763例,其中10117例产后行新生儿超声心动图筛查,对产前检查出心脏异常病例转诊,与产前诊断机构诊断结果、生后新生儿超声心动图筛查结果、尸检及手术结果进行对比,并对常规扫查切面进行回顾性分析、讨论。结果:经产前超声心动图5切面法筛查出胎儿心脏异常共136例,确诊134例,诊断准确率98.5%(134/136),检出率1.2%(134/10763),漏诊1例,为完全型肺静脉异位引流。误诊2例,1例主动脉弓曲折误诊为主动脉弓离断;1例正常心脏误诊为主动脉缩窄。结论:基层医院常规开展规范化胎儿超声心动图筛查,对及早发现并诊断先天性心脏病具有重要的临床价值。     

常见胎位主要切面筛查胎儿唇腭裂的探讨

目的 探讨常见胎位主要切面筛查胎儿唇腭裂的可行性及价值.方法 应用超声诊断仪对近20 000例16周以上胎儿鼻唇部结构,采用常见胎位主要切面进行扫查,筛查出的唇腭裂畸形与产后及引产后结果进行对比,将漏诊病例在引产后模仿宫内环境进行多切面扫查,分析漏诊原因.结果 21例唇腭裂畸形中,产前超声共检出胎儿唇腭裂畸形19例,口唇畸形共40处,产前超声诊断35处,漏诊5处,确诊率为87.5％.结论 常见胎位主要切面对筛查胎儿唇腭裂有重要的诊断价值.     

彩色多普勒超声检查在孕中晚期胎儿心脏畸形筛查中的应用

目的分析彩色多普勒超声检查在孕中晚期胎儿心脏畸形筛查中的应用价值。方法对6850例中晚期孕妇进行超声筛查,观察胎儿心脏不同切面的超声表现,分析胎儿心脏畸形确诊率和漏诊率。结果 6850例孕产妇中,产后检出29例心脏畸形胎儿,畸形率0.42%。其中超声检出26例,24例经心脏检查证实,2例经尸检证实;漏诊3例(室间隔缺损2例,房间隔缺损1例)。超声诊断准确率89.66%(26/29),漏诊率10.34%(3/29)。结论彩色多普勒超声能发现大多数胎儿心脏结构异常,在孕中晚期胎儿心脏畸形筛查中具有十分重要的价值。     

四维超声成像技术诊断孕中期胎儿心脏畸形的价值

目的探讨四维超声成像技术诊断孕中期胎儿心脏畸形的临床价值。方法选取济源市人民医院2017年3月至2020年3月接待的高危孕中期产检孕妇300例进行研究,均接受胎儿心脏畸形筛查,包括常规二维超声检查与四维超声成像技术检查。将产后超声心动图或心脏病理解剖结果作为标准,比较常规二维超声与四维超声成像技术检查采集时间、孕妇满意度、胎儿心脏畸形检出率,以及心脏结构异常检出率。结果产后超声心动图或心脏病理解剖结果证实有胎儿心脏畸形54例,其中四维超声成像技术检查孕妇时,采集时间更短,孕妇满意度评分更高,组间差异有统计学意义(P<0.05)。四维超声成像技术胎儿心脏畸形检出率更高,组间差异有统计学意义(χ^(2)=5.698,P<0.05)。产后超声心动图或心脏病理解剖结果证实有胎儿心脏畸形54例,共计心脏结构异常97处,其中四维超声成像技术检出心脏结构异常95处,检出率为97.94%,常规二维超声检查检出心脏结构异常80处,检出率为82.47%,四维超声成像技术检出率明显高于常规二维超声检查(χ^(2)=6.557,P<0.05)。结论孕中期胎儿心脏畸形检查中应用四维超声成像技术诊断,可减少影像采集时间,从而减少了不必要的损害,同时可以提高胎儿畸形检出率与心脏结构异常检查率,促使孕妇对检查更满意,值得在胎儿心脏畸形筛查中应用。     

四腔心切面联合三血管气管切面彩色多普勒超声在孕11~13+6周胎儿严重先天性心脏畸形筛查中的应用价值

目的探讨四腔心切面联合三血管气管切面彩色多普勒超声在孕11~13⁺⁶周胎儿严重先天性心脏畸形筛查中的应用价值。 方法选择2018年1月至12月在四川省妇幼保健院行孕期检查的9756例孕妇,分别于孕 11~13⁺⁶周及孕16~24周进行胎儿心脏超声检查。采用四腔心切面联合三血管气管切面彩色多普勒超声对孕11~13⁺⁶周胎儿筛查心脏畸形,采用标准化胎儿超声心动图筛查孕16~24周胎儿心脏畸形,并对分娩后所有新生儿及引产胎儿进行随访。 结果9756例胎儿孕11~13⁺⁶周超声筛查发现心脏畸形38例（51.4%,38/74）,其中非严重心脏畸形5例（14.2%,5/35）,严重心脏畸形33例（84.6%,33/39）。出生或引产后诊断先天性心脏畸形74例,其中严重先天性心脏畸形39例,非严重心脏畸形35例。 结论运用四腔心切面联合三血管气管切面彩色多普勒超声能筛查出大部分严重胎儿心脏畸形,可为临床咨询、预后提供及时有力的证据。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

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.     

Digital imaging among medical facilities

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.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

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.     

Clinical Pharmacokinetics of Morphine

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.