X综合征11例临床分析

本文报告１１例Ｘ综合征的临床特征，均有典型劳累性心绞痛，有心肌缺血客观依据（静息心电图示心肌缺血６例，运动试验阳性８例，发射型计算机断层心肌显像（ＥＣＴ）示心肌缺血４例）。冠脉和左室造影均正常，无冠脉痉挛表现，左室ＥＦ平均０．７９（０．７１￣０．８７），超声心动图及胸片正常，硝酸酯和钙拮抗剂可缓解症状，预后良好。文中对Ｘ综合征的诊断标准作了探讨。     

心肌超声造影与静息99m锝心肌显像评价区域性心肌灌注的对比研究

为评价心肌声学造影（ＭＣＥ）判定心肌灌注的可靠性，本文对２７例冠心病人和可疑冠心病人进行ＳＣＡ、经冠脉ＭＣＥ和静息ＳＰＥＣＴ等三项检查。ＭＣＥ采取计分法判定心肌灌注：１分为心肌回声均匀增强；０．５分为回声不均匀；０分为无心肌显影。ＳＰＥＣＴ采取圆周剖面曲线分析法。结果：与ＳＣＡ对照，２７例病人ＭＣＥ和ＳＰＥＣＴ评价心肌缺血的敏感性和特异性高度一致，分别为９０．０％、８７．０％和６６．７％、７５．０％（Ｐ值＞０．０５）；两者与ＳＣＡ的符合率均为８５．０％。２７例中１２支正常冠脉和３２支病变冠脉所属的１８１个心肌节段，ＭＣＥ和ＳＰＥＣＴ对评价心肌灌注有极好的相关性（ｒ＝０．８２，Ｐ值＜０．００１）。     

同步等负荷运动心电图,二维超声心动图及心肌灌注断层显？…

评价等负荷运动心电图（运动ＥＣＧ）、二维超声心动图（２－ＤＥ）及心肌灌注断层显像（ＥＣＴ）的单项试验和三项联合应用对冠心病的诊断价值。对２８例冠脉造影阳性（冠心病组）和１８例冠脉造影阴性（正常组）患者进行同步等负荷运动ＥＣＧ、２－ＤＥ及ＥＣＴ试验。运动ＥＣＧ、２－ＤＥ及ＥＣＴ对冠心病诊断的敏感性分别为８２．１％、７１．４％及９６．４％；特异性为７７．８％、８８．９％及５５．６％。在冠心病组三项负荷     

胸痛,运动试验阳性,冠脉造影正常15例并X综合征文献复习

胸痛、冠脉造影正常患者２７例，均已除外引起胸痛的非心脏疾病，并除外其他心脏疾病及引起运动试验假阳性的左心肥厚，心肌病，左束枝传导阻滞，激综合征，药物作用，电解质紊乱等，均给予心电图运动负荷试验，其中５例尚接受＾９９ｍ锝心肌负荷试验ＳＰＥＣＴ检查，１５例阳性，平均年龄５２．４６岁为Ａ组１２例阴性，平均年龄４７．２５岁为Ｂ组，按冠脉造影顺序取得同期确诊冠心病者１２例，平均年龄５６．２５岁为Ｃ组，以静息     

心肌超声造影与静息99m锝心肌显像评价区域性心肌灌注的 …

为评价心肌声学造影（ＭＣＥ）判定心肌灌注的可靠性，本文对２７例冠心病人和可疑冠心病人进行ＳＣＡ，经冠脉ＭＣＥ和静息ＳＰＥＣＴ等三项检查，ＭＣＥ采取计分法判定心肌灌注：１分为心肌回声均匀增强；０．５分为回声不均匀；０分为无心肌显影，ＳＰＥＣＴ采取圆周剖面曲线分析，结果：与ＳＣＡ对照，２７例病人ＭＣＥ和ＳＰＥＣＴ评价心肌缺血的敏感性和特异性高度一致，分别为９０．０％，８７．０％和６６．７％，７５．０％     

心肌肥厚对冠脉循环影响的超声研究

目的： 探讨心肌肥厚患者冠脉循环血流动力学变化的特点。方法： 应用多平面经食管超声心动图（ＴＥＥ） 技术探测３０ 例心肌肥厚患者的冠状窦血流动力学改变, 并与１０ 例正常对照进行对比。结果： 所有受检者均可记录到满意的冠状窦血流频谱 （１００％ ）。心肌肥厚组收缩压、左室重量指数 （ＬＶＭ Ｉ）、冠状窦收缩期血流流速积分 （ＶＴＩ－Ｓ）、净前向血流流速积分 （ＶＴＩｎｅｔ） 和前向血流 （ＣＳＦ） 及其直径明显高于正常组 （Ｐ 均＜ ０．０５）, 余各项参数无显著性差异; 与正常组相比, 心肌肥厚患者有症状组收缩压、舒张压、ＬＶＭ Ｉ、ＶＴＩｎｅｔ 及冠状窦直径明显增加 （Ｐ＜ ０．０５～０．００１）; 无症状组ＬＶＭ Ｉ、收缩压、舒张期血流峰值 （Ｄ）、ＶＴＩ－Ｓ、舒张期血流流速积分 （ＶＴＩ－Ｄ）、ＶＴＩｎｅｔ、ＣＳＦ 亦明显增加 （Ｐ＜ ０．０５～０．００１）; 但有症状组Ｄ、ＶＴＩ－Ｄ、ＣＳＦ 低于无症状组 （Ｐ 均＜ ０．０５）。结论： 心肌肥厚患者冠状窦前向血流增加, 但有症状组冠状窦前向血流低于无症状组, ＴＥＥ 探测冠状窦血流以评价心肌肥厚患者冠脉循环的改变具有较高的临床应用价值。     

肥厚型心肌病冠脉血流的超声多普勒显像

本文利用冠脉血流显像技术分析９例肥厚型心肌病患者前降支、室间隔心肌内及后降支的冠脉血流及其冠脉血流与室壁厚度的比值，并与正常组（３７例）进行对照。结果显示，肥厚性心肌病患者前降支及室间隔心肌内冠脉血流速度时间积分（ＶＴＩ）、最大血流速度（Ｖｍａｘ）及平均血流速度（Ｖｍｅａｎ）均较正常对照组高（Ｐ＜０．００１），上述血流参数与室间隔厚度的比值则较对照组低（Ｐ值＜０．０１）；而后降支的血流ＶＴＩ、Ｖｍａｘ、Ｖｍｅａｎ及与室间隔厚度的比值与正常组无差异（Ｐ＞０．０５）。说明供应肥厚心肌的冠脉血流虽然加快，但与室间隔增厚的程度不相适应，而导致心肌缺血。     

利声显心肌声学造影显像在冠脉搭桥术中的应用

目的　评价经静脉注射利声显心肌声学造影间隙显像在冠脉搭桥术中的应用价值。方法　用经静脉注射利声显心肌声学造影间隙显像,对25例临床诊断为陈旧性心肌梗死准备行冠脉搭桥术患者手术前后的心肌灌注和心脏功能进行分析。结果　术前灌注正常、减弱和无灌注的节段分别为22、57和13个。术后灌注正常、减弱和无灌注的节段分别为55、35和2个。造影记分指数从术前的0.74±0.08增加到术后的0.89±0.06,差别有极显著性意义（P<0.001）。92个与搭桥相关的节段中,术后59个（64%）功能改善。室壁运动记分指数从术前的1.50±0.27减少到术后1.24±0.20（P<0.001）。左室射血分数从0.49±0.05增加到0.55±0.04（P<0.001）。手术前后室壁运动记分指数和左室射血分数的变化程度与心肌声学造影检测为存活心肌的节段数高度相关（r=0.96,0.82,P均<0.001）;术后室壁运动记分指数和左室射血分数与术前心肌造影记分指数相关（r=-0.64,0.60,P均<0.05）。心肌声学造影对冠脉搭桥术后心脏节段功能恢复的预测敏感性和特异性分别为98%和36%。结论　经静脉注射利声显心肌声学造影不仅可用于评价冠脉搭桥术的效果,还可预测术后左室功能的恢复。     

多巴芬酊胺超声心动图与心肌缺血

与冠脉造影及铊－２０１心肌ＳＰＥＣＴ显像对照研究疑冠心病患者２３例，评估多巴芬酊胺超声心动图在心肌缺血中的应用价值。结果表明多巴芬酊胺超声心动图检测冠脉狭窄及缺血后存活心肌的敏感度、特异度及符合率分别为７３％，７６％；７２％，８８％及７２％，８３％。评估左前降支供血节段缺血及缺血后存活心肌的能力较左旋支和右冠脉支供血节段强。     

冠脉造影正常者心室颤动原因分析(附3例报告)

冠脉造影正常者发生心室颤动少见 ,但本院在 1年内发生 3例 ,而同期冠脉造影中有冠脉病变 ,由于操作中导管嵌顿引起心室颤动的仅 1例。现报道如下。例 1,男 ,38岁 ,因发作性胸痛 3年入院。该患者 3年来反复发作性胸骨后闷痛 ,向后背部放散 ,静息时心电图为正常 ,运动心电图 (活动平板试验 )阴性 ,99m锝核素心肌显像 ,提示心肌缺血 ,诊断为冠心病 ,心绞痛 ;为进一步治疗 ,行冠脉造影 ;穿刺股动脉 ,Judkins法 ,先行左冠造影 ,多体位投照 ,左、右冠脉及各分支均未见异常 ,术毕将 JR4 .0退至升主动脉后 ,患者突然意识丧失 ,心电监护呈现心室颤…     

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.     

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。     

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.     

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。     

Measurement of blood flow by ultrasound: accuracy and sources of error

Doppler ultrasound has now developed to the point where the rate of flow of blood in a given vessel can be measured with appropriate instrumentation. The theoretical basis of Doppler flow measurement is reviewed in this paper, with particular emphasis on the potential and actual sources of error. Three distinct approaches are identified, and the strengths and weaknesses of each discussed. The separate errors involved in estimating the vessel cross-sectional area, the angle of approach, and the Doppler shift are analyzed, together with the question of the uniformity of scattering from the blood. In vivo and in vitro tests of the accuracy obtained using a number of Doppler flow measuring instruments are then reviewed. It is concluded that the Doppler methods are capable of good absolute accuracy when suitably designed equipment is used in appropriate situations, with systematic errors of 6% of less. There are, however, considerable random errors, attributable primarily to errors in measuring the cross-sectional area and the angle of approach. Repeating the measurement of flow several times and averaging the results can reduce these random errors to an acceptable level.     

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。