M型彩色多普勒超声心动图评价冠心病和高血压病的左室舒张功能

目的：研究冠心病（CAD）和原发性高血压（EH）患的左室舒张功能。方法：采用M型彩色多普勒超声心动图研究了36例正常人（I组），33例冠心病患（Ⅱ组）和74例原发性高血压患（Ⅲ组）。测定了从二法瓣到心尖的早期充盈峰速传播速率（Vp），早期充盈峰速时间（TD）和Vp/E比值，同时测定左室舒张早期、晚期跨二尖瓣血流峰速（E峰和A峰）、早晚期血流峰速比（E／A）和舒张晚期跨二尖瓣血流速度时间（AD），并测定左室结构与收缩功能。结果：3组在性别、年龄和心率方面无统计学差异。Ⅱ组、Ⅲ组与Ⅰ组比较，E、A、E／A，Vp、TD和Vp/E差异有统计学意义（P＜0．05）或P＜0．01）；Ⅱ组与Ⅰ组比较，左室内经（LVID）、左室质量指数（LVMI）、射血分数（EF）、缩短分数（SF）差异有统计学意义（P＜0．01）；Ⅱ组与Ⅲ组比较，LVID、EF、SF差异有统计学意义（P＜0．01）。结论：冠心病和原发性高血压患存在左室功能障碍，M型彩色多普勒超声心动图测定的Vp、TD和Vp/E参数是评价左室舒张功能更敏感的指标。     

冠心病左室收缩功能不全患者等容舒张时间及肺静脉血流频谱变化的研究

目的：研究冠心病左室收缩功能不全患者左室等容舒张时间（IRT）和肺静脉血流频谱变化。方法：心尖双平面Simpson法测定左室射血分数（LVEF）；脉冲多普勒测右上肺静脉血流频谱（S、Si、D、Di、PA、PAi、S/D）及二尖瓣口前向血流频谱（E、Ei、A、Ai、E/A）；连续多普勒测定IRT；对各组数据进行统计学分析。结果：当左室收缩功能不全时IRT延长、肺静脉血流频谱S峰变慢、二尖瓣血流频谱假性正常化。相关分析结果表明左室收缩功能与舒张功能变化显著相关。结论：冠心病左室收缩功能不全患者存在左室舒张功能异常，IRT延长与肺静脉血流频谱S波减低比二尖瓣血流频谱更为敏感地反映了舒张功能异常。     

多普勒超声对无症状左室舒张功能不全的探讨

目的：探讨无心功能不全临床表现的高血压、冠心病患的心脏结构及心功能的变化。方法：对56例无心功能不全临床表现的高血压，冠心病患及46例对照组进行多普勒超声检查，着重观察心脏结构及二尖瓣、肺静脉血流频谱变化。结果：病例组在左室收缩功能尚处于正常范围时，可能已存在无症状左室舒张功能不全（SDDF）。与对照组比较，主要表现为松弛型左室舒张功能减退（P＜0．01－0．001），并有左房增大，室壁增厚及左室肌重量指数（LVMI）增加趋势（P＜0．01）。结论：松弛型左室舒张功能减退合并心脏结构变化是超声诊断无症状舒张功能不全的参考指标。     

高血压不同左室构型左室舒张功能的超声心动图研究

目的联合应用二维、M-型超声心动图与脉冲多普勒技术评价高血压左心室不同构型的舒张功能。方法采用M-型和二维超声技术测量高血压患者左室几何构型，测量各组左房功能指标及二尖瓣、肺静脉血流频谱。结果与对照组相比，高血压各组左室舒张功能均有不同程度损害，向心性肥厚及离心性肥厚组受损最严重。高血压早期即可出现舒张功能异常，表现为正常构型组舒张功能的异常改变。左房灌注分数(LAT)是比二尖瓣及肺静脉血流频谱更加可靠地反映早期左室舒张功能异常的指标。结论左室舒张功能异常特别是左房灌注分数(LAT)的异常，可以早期体现左室重构超声心动图变化。     

超重和肥胖者多普勒超声心动图左室功能分析

目的：研究超重和肥胖人群左室收缩、舒张功能的改变。方法：用多普勒超声心动图测定左室收缩功能参数、舒张功能参数，分析超重和肥胖人对左室收缩和舒张功能的影响。结果：左室收缩功能参数，肥胖组主动脉瓣最大血流速度、流速积分、平均血流加速度、每搏量及心排血量均较正常组显著增高（P＜0．01）。超重组每搏理、心排血量、主动脉瓣最大血流速度较正常组增高（P＜0．01）。左室舒张功能参数，肥胖组等容舒张时间，舒张早期快速充盈峰速度（E峰）、舒张晚期充盈峰速度（A峰）、A／E、舒张早期减速度均显著改变（P＜0．01）。超重组等容舒张时间、A峰、A／E显著改变（P＜0．01）。超重和肥胖组左室收缩功能增强和舒张功能受损与体重指数有显著相关性（P＜0．01）。结论：起重和肥胖可导致左室收缩增强和舒张功能下降，左室增大和左室充盈障碍。     

超声心动图对肺静脉血流变化评价急性心肌梗死患者左室舒张功能的应用价值

目的 探讨多普勒超声心动图肺静脉血流频谱参数变化评价急性心肌梗死患者左室舒张功能的临床应用价值.方法 急性心肌梗死组32例,正常对照组30例.应用彩色多普勒超声心动图记录二尖瓣血流频谱,并选择测量参数：舒张早期峰值流速E峰（m/s）、舒张晚期峰值流速A峰（m/s）、E/A、A峰时限Ad （ms）;记录肺静脉血流频谱,并选择测量参数：收缩期前向峰值流速S波（m/s）、舒张早期前向峰值流速D波（m/s）、S/D、左房收缩期最大逆向血流速度PA波（m/s）及PA波时限PAd （ms）.结果 急性心肌梗死组二尖瓣血流频谱各项指标与正常对照组比较无显著性差异;肺静脉血流频谱参数中D波减低,S/D、PA、PAd-Ad明显增大,PA＞0.3 m/s,PAd-Ad＞0与正常对照组比较有非常显著性差异.结论 肺静脉血流频谱与二尖瓣血流频谱联合应用可以比较准确全面地评价左室舒张功能,尤其当二尖瓣血流频谱呈“伪正常化”时,结合肺静脉血流频谱可以判断左室舒张功能障碍.     

多普勒超声心动图评价左室舒张功能

用脉冲多普勒和彩色多普勒检测二尖瓣血流速度和方式来估测左心室舒张功能,已日益受到人们的关注,逐渐用于科研、临床。本文就其检测方法,临床应用价值及影响因素等作一综述。(一)左室舒张功能的脉冲多普勒检测方法脉冲多普勒超声心动图是通过检测二尖瓣口的血流速度和方式来评估左室舒张功能。二尖瓣血流频谱图中的E峰表示左室舒张早期血流由左房进入左室;A峰表示左室舒张晚期,左房收缩使血流由左房被动进入     

彩色多普勒超声对限制型左室充盈频谱的观察(附31例报告)

彩色多普勒超声对限制型左室充盈频谱的观察（附３１例报告）张友耿，高淑英，张青萍，毕小军，吴环清近年来临床上对各种心脏疾病时的左室舒张功能改变日益重视，应用多普勒超声通过与心导管的血流动力学检测相结合，对左室舒张期血流充盈状态进行研究，发现二尖瓣口血流...     

多普勒超声心动图检测肺静脉及二尖瓣血流评价左室舒张功能

目的　探讨经胸多普勒超声心动图检测肺静脉血流频谱（ＰＶＦＰ）及二尖瓣血流频谱（ＭＶＦＰ） 的变化无创评价左室舒张功能的价值。方法　选择４０ 岁以上的无心脏疾患者３０ 例为对照组;高血压病左房不大组３０ 例;冠心病左房不大组３０ 例;高血压或冠心病左房扩大组３０ 例共１２０ 例为研究对象。使用经胸多普勒超声心动图记录肺静脉及二尖瓣血流频谱,观察各组病人肺静脉及二尖瓣血流速度的变化和左室舒张功能的关系。结果　高血压或冠心病左房不大组与对照组比较,ＭＶＦＰ 中Ｅ 峰速度减低,Ｅ 峰减速时间延长,Ａ 峰速度增高,Ｅ／Ａ 比值减低。ＰＶＦＰ中Ｓ峰速度增快,ＳＦ增大,二组之间有明显差异（ Ｐ＜ ００１） ;高血压或冠心病左房扩大组与对照组比较ＰＶＦＰ中Ｓ峰速度减低,ＳＦ减低,ＰＡ 速度增快、间期延长,ＰＡｄ ＞ Ａｄ（ Ｐ＜ ００１） ,而ＭＶＦＰ除ＥＤＴ 缩短以外,Ｅ、Ａ 峰速度、Ｅ／Ａ 比值二者近似（ Ｐ＞ ００５） 。结论　超声心动图记录肺静脉及二尖瓣血流变化能够较全面地评价左室舒张功能。     

彩色多普勒超声心动图评价冠心病左室舒张功能的临床价值

目的应用彩色多普勒超声心动图测定冠心病左室舒张功能，为临床提供可靠的诊断及治疗依据。方法分别测定冠心病组及对照组的左室舒张功能：二尖瓣口左室快速充盈峰值血流速度即E峰；左室舒张晚期峰值速度即A峰；E／A值，左室等容舒张时间（IVRT），E峰减速时间（DT），二尖瓣前叶E峰与室间隔左室面的距离（EPSS）。结果冠心病组与正常对照组相比，E峰明显降低，A峰相对较高，E／A值明显降低，IVRT明显延长，EPSS有所延长。结论彩色多普勒超声心动图评价冠心病左室舒张功能具有临床诊断价值。     

彩色多普勒超声估测肾血流

90例正常人应用彩色多普勒超声方法估测肾血流,其中74例检出,说明这一方法检出率高。应用体外实验的两种方法对彩色多普勒超声估测肾血流的可靠性验证,实验结果相关密切,提示彩色多普勒超声测定肾血流可靠性好。从实验数据散点图的离散度小可看出彩色多普勒超声测定肾血流这一方法是可信的。     

Effects of flow rate on hemodynamic parameters and agent consumption in low-flow desflurane anesthesia: An open-label, prospective study in 90 patients

Background:

In surgical patients, decreasing the fresh gas flow rate in anesthesia may minimize costs, reduce environmental pollution, and preserve heat and humidity in the respiratory system.

Objective:

The aim of this study was to investigate the effects of 3 low-flowdesflurane rates on perioperative hemodynamic stability, end-tidal desflurane concentration, emergence and recovery characteristics, and agent consumption.

Methods:

This open-label, prospective study was conducted at the Departmentof Anesthesiology and Reanimation, University of Gaziantep, Gaziantep, Turkey. Nonpremedicated adult patients scheduled to undergo surgery (ureterolithotomy, cholecystectomy, pyelolithotomy, or thyroidectomy) were enrolled. Patients were anesthetized with propofol and fentanyl and intubated after neuromuscular blockade with vecuronium. Patients were randomly allocated to 1 of 3 groups according to the fresh gas flow rate: medium flow (2 L/min), low flow (1 L/min), and minimal flow (0.5 L/min). Intraoperative fentanyl volume was recorded. Heart rate, mean arterial pressure, and end-tidal desflurane concentration were recorded before (baseline) and after anesthesia induction; immediately before incision; and 5, 10, 15, 30, 45, and 60 minutes after incision. Emergence time and desflurane consumption after extubation were recorded. Aldrete scores were recorded at 5, 15, and 30 minutes after extubation.

Results:

Ninety patients (46 women, 44 men; mean [SD] age, 39.74 [13.73] years; 30 patients per treatment group) participated in the study. Means of hemodynamic parameters, intraoperative volume of fentanyl, end-tidal desflurane concentration, emergence time, and Aldrete score were statistically similar between the 3 groups. Mean (SD) desflurane consumption was significantly higher in the medium-flow group compared with the low- and minimal-flow groups (110.43 [28.18] g vs 98.40 [23.62] g and 79.80 [17.54] g, respectively; both, P < 0.01). Mean (SD) desflurane consumption was also significantly higher in the low-flow group compared with the minimal-flow group (P < 0.01).

Conclusion:

The results of the present study in adult surgical patients suggestthat desflurane may be used in low-flow anesthesia, even with the minimal fresh gas flow rate.     

Flow velocity analysis of umbilical and uterine artery flow in pre-eclampsia treated with propranolol or pindolol.

In a double blind study, 20 gravidas with pre-eclampsia were randomly allocated to treatment with either propranolol 120 mg/day or pindolol 15 mg/day for 7 days. Flow velocimetry was performed before and after treatment to assess the influence of these two regimens of beta blocker on the feto-placental circulation. A continuous wave Doppler unit was used to measure umbilical and uterine artery flow velocity waveforms. The systolic/diastolic (A/B) ratio and the systolic minus diastolic divided by systolic (A-B)/A ratio (resistance index) were used as indexes of blood flow resistance in the umbilical and uterine arteries, respectively. A resistance to flow in the uteroplacental circulation was significantly less in patients treated with pindolol compared to those treated with propranolol (P less than 0.01). The same pattern was also found in umbilical velocimetry, although the statistical significance was borderline (P = 0.06). Although both drugs were equally effective in reducing blood pressure at rest, their effect on the peripheral resistance was different. Pindolol appears to act in part through a peripheral vascular mechanism. Our data support this assumption because the flow in the uteroplacental bed, as reflected by a decrease in resistance index, improved when patients were treated with the drug pindolol.     

Determination of volume of arterial blood flow by an ultrasonic device

This paper describes the results of a reevaluation of the reliability of a newly developed ultrasonic volume flow meter which was developed by Yoshimura and his co-workers (1978). Measurements of volume blood flow (cc/sec) by this new technique were compared with measurement by the electromagnet flow meter. Experiments were performed with an in vitro model as well as with physiological pulsatile flow in an animal model. Results of the study indicated a high degree of correlation between values measured by both techniques with a correlation coefficient of 0.99 I believe that this is an important technical development in the field of noninvasive quantitative determination of blood flow.     

冠脉血流显像技术对急性主动脉瓣返流时冠脉血流及冠脉血流储备的实验研究

目的：应用冠脉血流显像技术探讨急性主动脉瓣返流对冠脉血流和冠脉血流储备的影响。方法：应用冠脉血流显像技术首先对７只健康犬开胸后的心外膜冠状动脉（以左前降支代表）的血流进行检测,记录舒张期血流速度峰值（ＣＰＶ）、加速时间（ＡＴ）、减速时间（ＤＴ）和全心动周期的速度时间积分（ＶＴＩ）及动脉舒张压（ＤＢＰ）做为对照组;然后用猪尾管经股动脉插入,至主动脉瓣口处造成轻、中、重度返流。记录各返流程度的舒张期血     

Color Doppler sonographic signs of respiration-dependent hepatofugal portal flow

PURPOSE: The role of respiration in modulating blood flow in the portal vein is unclear. The aim of this study was to investigate the phenomenon of respiration-dependent periodic hepatofugal portal venous blood flow as detected on color Doppler sonography. METHODS: Within 1 year, we identified 13 patients with respiration-dependent reversal of blood flow in the portal vein that was diagnosed on color Doppler sonography. This phenomenon was investigated by color Doppler sonographic examination of the portal venous flow during both mid-inspiration breath-holding and a respiratory cycle including deep inspiration; evaluation of hepatic vein Doppler waveforms as normal (triphasic) or decreased (flattened); and echocardiographic examination to determine the presence or absence of tricuspid regurgitation. RESULTS: The patients' median age was 53 years (range, 26-87 years). Seven of the 13 patients had heart disease (tricuspid regurgitation) with or without liver disease, 3 had liver disease without heart disease, and 3 had other diseases with no evidence of heart or liver disease. On Doppler sonography, 10 of the 13 patients had increased portal venous pulsatility (7 of the 10 had tricuspid regurgitation; the other 3 did not); the remaining 3 patients had neither increased pulsatility nor tricuspid regurgitation. Sonographic follow-up within 4 weeks in 4 of the 13 patients revealed loss of the respiration-dependent hepatofugal portal flow. CONCLUSIONS: Respiration-dependent hepatofugal portal flow is a rare finding associated with periodic portal hypertension in patients with right heart insufficiency and liver disease. Its clinical significance is unclear. Among our patients, its occurrence was predominantly associated with an increased venous pulsatility index due to tricuspid regurgitation or venous outflow obstruction. Further study is needed to investigate whether periodic respiration-dependent hepatofugal portal flow is predictive of the occurrence of continuous flow reversal.     

冠状动脉慢血流现象的冠状动脉血流成像分析

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.     

彩色多普勒超声估测肾血流

90例正常人应用彩色多普勒超声方法估测肾血流,其中74例检出,说明这一方法检出率高。应用体外实验的两种方法对彩色多普勒超声估测肾血流的可靠性验证,实验结果相关密切,提示彩色多普勒超声测定肾血流可靠性好。从实验数据散点图的离散度小可看出彩色多普勒超声测定肾血流这一方法是可信的。     

根据跨瓣压差选择适用于半球体血流会聚公式的最佳Nyquist速度

应用数字计算机分析彩色多普勒血流会聚区，证明计算流量与实际流量之比为１时，半球体血流会聚公式中所用速度与跨瓣压差间有明显的相关性，协方差分析示这种关系在不同瓣口间无明显差异。本研究为准确应用半球体血流会聚公式提供了一种根据临床可测跨瓣压差选择最佳Ｎｙｑｕｉｓｔ速度的方法。