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.     

应用VFM技术评价扩张型心肌病收缩期左心室心腔内血流动力学变化

目的 探讨血流向量成像(VFM)技术在评价扩张型心肌病(DCM)收缩期左心室心腔内血流动力学变化及收缩功能变化中的应用价值。方法 病例组:DCM患者30例;对照组:健康志愿者40名。在VFM成像模式下测量并比较两组收缩期峰值流速(Vs)、峰值流量(Fs)和收缩期负向总流量(SQ-);应用Simpson双平面法获取左心室射血分数(LVEF),与三腔心的Vs、Fs、SQ-均值进行相关性分析;同时观察并描述病例组收缩期左心室心腔内涡流的分布特征。结果 病例组基底段、中间段及心尖段Vs、Fs、SQ-均值明显低于对照组(P＜0.01);两组组内比较各项指标均由基底段至心尖段逐渐递减(P＜0.05);LVEF与Vs、Fs、SQ-均值呈明显正相关,相关系数分别为0.727、0.698、0.709(P＜0.01);病例组在收缩期3个时相均有涡流出现,直径及圈数较对照组增多。结论 VFM技术可直观、定量评价DCM患 者左心室内血流流场变化,进而显示其与左心室收缩功能的关系,有望成为临床检测DCM左心室收缩功能的一种新方法。     

速度向量成像技术评价妊娠期糖尿病胎儿左室心肌节段功能的探讨

目的 探讨VVI技术检测妊娠期糖尿病胎儿左室心肌6节段功能的临床意义.方法 采集98例妊娠期糖尿病胎儿和135例正常对照组胎儿四腔观,利用VVI软件测量左室各节段收缩期峰值速度(Vs)、舒张期峰值速度(Vd)、收缩期峰值应变(S)、收缩期应变率(SRs)和舒张期应变率(SRd).结果 233例胎儿中207例被成功分析.妊娠期糖尿病组胎儿Vs、Vd随孕周的增加而增大(P＜0.05),基底段、中间段、心尖段心肌的Vs、Vd依次逐渐减低(P ＜0.05).32+0周后妊娠期糖尿病胎儿Vs、28+0周后Vd、24+0周后S、SRs、SRd均较相应的正常胎儿组减低(P＜0.05).结论 VVI技术可以检测妊娠期糖尿病胎儿左室长轴6节段心肌功能的变化.

Abstract：

Objective To investigate the clinical value of velocity vector imaging in the assessment of regional left ventricular longitudinal myocardial function in fetuses with gestational diabetes mellitus (GDM). Methods Digital dynamic four-chamber views of 98 fetuses with GDM and 135 normal fetuses were collected and analyzed using velocity vector imaging. The regional tissue velocity, strain and strain rate of the interventricular septum and left lateral wall were measured in systole and diastole. Results Two hundred and seven of 233 cases were analyzed successfully. Systolic velocity(Vs) and diastolic velocity(Vd)were age-dependent, Vs and Vd were both gradually decreased from the basal segment to the apical segment in the left ventricle( P ＜0. 05). The Va after 32+0 weeks and Vd after 28+0 weeks and systolic strain(S),systolic strain rate(SRs) and diastolic strain rate(SRd) in left ventricle of fetuses with GDM after 24+0weeks were obviously lower than the corresponding parameters of normal fetuses ( P ＜0. 05). Conclusions Velocity vector imaging can evaluate the fetal regional left ventricular longitudinal myocardial function.     

冠状动脉慢血流现象的冠状动脉血流成像分析

目的 应用冠状动脉血流成像(CFI)无创性评估冠状动脉慢血流现象患者的冠状动脉血流速度变化.方法 冠状动脉无明显狭窄且心肌梗死溶栓试验(TIMI)提示慢血流现象患者21例,冠状动脉造影无明显狭窄且TIMI血流正常者9例作为对照组.采用校正的TIMI血流计帧法(CTFC)评价冠状动脉血流速度.常规超声心动图测量左室舒张末期内径、收缩末期内径、左室射血分数、E峰、A峰、E/A值.CFI测量冠状动脉前降支远端舒张期峰值血流速度(Vmax)、舒张期平均流速(Vmean)和血流速度时间积分(VTI).结果 慢血流组前降支CTFC为(45.37±8.62)帧,对照组为(15.94±4.66)帧,二者差异有统计学意义(t=-9.596,P=0.000).慢血流组与对照组常规超声心动图测值差异均无统计学意义.慢血流组前降支Vmax为(22.86±3.04)cm/s,Vmean为(17.62±2.89)cm/s,VTI为(8.49±2.01)cm;对照组前降支Vmax为(31.78±9.28)cm/s,Vmean为(23.67±7.60)cm/s,VTI为(10.91±4.47)cm,两组差异均有统计学意义(P＜0.05).对照组及慢血流组前降支CTFC与Vmax和Vmean呈负相关,对照组前降支CTFC与VTI呈负相关,慢血流组前降支CTFC与VTI无相关性.结论 冠状动脉慢血流现象患者冠状动脉前降支远端血流速度减慢,CFI能够反映冠状动脉造影TIMI血流的变化,但诊断冠状动脉慢血流现象有局限.

Abstract：

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.     

E-flow显像评价系统性硬化病患者指端微循环变化

目的 探讨高频超声结合E-flow显像评价系统性硬化病(systemic sclerosis,SSc)患者指端微循环病变的临床价值.方法 SSc患者 24 例,正常对照组 29 例,均行高频超声检查并结合E-flow显像,观察各组受试者左右手中指末节指端血管分布特征、走行,测量指掌侧固有动脉、指腹动脉及甲床动脉收缩期峰值流速(PSV)、舒张末期流速(EDV)、平均血流速度(MV)、阻力指数(RI)及搏动指数(PI).结果 对照组末节指端血流信号丰富,可清晰显示指掌侧固有动脉、指腹动脉、甲床动脉及其细小分支;SSc末节指端血流显示欠清晰,连续性欠佳,血流分布明显减少.与对照组相比,SSc组中指末端指掌侧固有动脉、指腹动脉及甲床动脉PSV、EDV、MV均减低(P＜0.01),而RI及PI增高(P＜0.05).对照组左右侧指端动脉血流参数无明显差异(P＞0.05),而SSc组左侧指掌侧固有动脉PSV、EDV及MV指标较右侧增高,差异均有统计学意义(P＜0.05).结论 高频超声结合E-flow显像可敏感、准确地反映SSc患者的指端微循环变化,为临床评价SSc患者微血管病变情况提供了新方法.

Abstract：

Objective To investigate the clinical value of high frequency ultrasonography with E-flow imaging in the evaluation of fingertip's microcirculation changes in patients with systemic sclerosis(SSc).Methods Twenty-four SSc patients and 29 healthy subjects were involved.High frequency ultrasonography with E-flow imaging was used to observe the configuration and distribution of digital arteries in the last segment of left and right middle finger.Peak systolic velocity (PSV),end diastolic velocity (EDV),mean velocity(MV),vascular resistance index (RI) and pulsatility index(PI) of digital palmar propria arteries,nail bed arteries and finger ventral arteries were measured.Results In control group,rich blood supply was revealed within the fingertips.Digital palmar propria arteries,nail bed arteries and finger ventral arteries and their small branches were displayed clearly and continuously by E-flow imaging.While in SSc patients,the definition and continuity of fingertip's small vascular flow images were not as good as that in the control group,with the distribution of blood flow markedly reduced.compared with the control group,PSV,EDV and MV of digital palmar propria arteries,nail bed arteries,finger ventral arteries were decreased in SSc group(P＜0.01),but both RI and PI were increased(P＜0.05).There were no statistically significant differences between left and right fingertip's arteries index in normal control group (P＞0.05).But PSV,EDV and MV of left digital palmar propria arteries in SSc group were higher than that of the right(P＜0.05),whose differences bear statistic significance.Conclusions High frequency ultrasonography with E-flow imaging is sensitive and reliable to reflect fingertip's microcirculation changes and provide a new method to assess microvascular changes in SSc patients.     

活动性强直性骶髂关节炎的彩色多普勒超声表现

Objective To evaluate the color Doppler ultrasonographic findings of active ankylosing sacroiliitis.Methods Thirty three patients (66 sacroiliac joints in total) with active ankylosing sacroiliitis identified by MRI and twenty eight healthy volunteers (56 sacroiliac joints) underwent color Doppler ultrasound examinations of sacroiliac joints.Degree of blood flow within and around the sacroiliac joints was evaluated by semi-quantitative scale (0 - 4 grade).For arteries, resistive index was also measured.Statistical analyses were performed to compare blood flow demonstration rate, blood flow signal scale distribution,degree of blow flow and RI value between the two groups.Results Higher blood flow demonstration rate was found in patients with active ankylosing sacroiliitis(60/66,90.1%) than control group (25/56,44.6%)( P = 0.000).The scale distribution and degree of blow flow between these two groups were statistically different (all P = 0.000) ,with mainly 2～3 grade for the patients and 0～1 grade for the control.Mean value of RI in the patients was 0.57 ± 0.07, which was lower than the control (0.66 ± 0.04, P = 0.000).Conclusions Patients with active ankylosing sacroiliitis tend to have higher degree of blood flow in sacroiliac joints and lower RI values of artery.Color Doppler ultrasound may help to evaluate the activity of ankylosing sacroiliitis.     

活动性强直性骶髂关节炎的彩色多普勒超声表现

Objective To evaluate the color Doppler ultrasonographic findings of active ankylosing sacroiliitis.Methods Thirty three patients (66 sacroiliac joints in total) with active ankylosing sacroiliitis identified by MRI and twenty eight healthy volunteers (56 sacroiliac joints) underwent color Doppler ultrasound examinations of sacroiliac joints.Degree of blood flow within and around the sacroiliac joints was evaluated by semi-quantitative scale (0 - 4 grade).For arteries, resistive index was also measured.Statistical analyses were performed to compare blood flow demonstration rate, blood flow signal scale distribution,degree of blow flow and RI value between the two groups.Results Higher blood flow demonstration rate was found in patients with active ankylosing sacroiliitis(60/66,90.1%) than control group (25/56,44.6%)( P = 0.000).The scale distribution and degree of blow flow between these two groups were statistically different (all P = 0.000) ,with mainly 2～3 grade for the patients and 0～1 grade for the control.Mean value of RI in the patients was 0.57 ± 0.07, which was lower than the control (0.66 ± 0.04, P = 0.000).Conclusions Patients with active ankylosing sacroiliitis tend to have higher degree of blood flow in sacroiliac joints and lower RI values of artery.Color Doppler ultrasound may help to evaluate the activity of ankylosing sacroiliitis.     

降糖药物对新发2型糖尿病患者胫前动脉弹性影响的初步探讨

目的 探讨降糖药物对新发2型糖尿病患者胫前动脉弹性的影响.方法 随机选取新发2型糖尿病患者100例,分为对照组50例和病例组50例.计算胫前动脉的应变-血压指数(SBPI),所有患者服用降糖药物6个月后再次计算胫前动脉的SBPI,并进行组间和组内对比分析.结果 对照组胫前动脉SBPI治疗后高于治疗前(P<0.05).病例组胫前动脉SBPI治疗前后比较差异无统计学意义(P>0.05).病例组胫前动脉SBPI在治疗前和治疗后均低于对照组(P<0.05).结论 降糖药物对不合并血管并发症的新发2型糖尿病患者胫前动脉弹性有较好的保护作用.

Abstract：

Objective To investigate the effects in elasticity of anterior tibial artery in new patients with type 2 diabetes caused by medicines of reducing blood sugar. Methods One hundred patients with type 2 diabetes were involved. The patients were divided into control group(50 cases) and case group(50 cases) according the vascular complications (including macroangiopathy and microangiopathy). Maxmum of circumferential strain(CSmax) of anterior tibial artery was acquired through strain and strain rate imaging. Local blood pressure which included local systolic blood pressure(LSBP) and local diastolic blood pressure (LDBP) of anterior tibial artery was measured at the same time. Strain-blood pressure index(SBPI) of anterior tibial artery was calculated, SBPI = CSmax/[(LSBP - LDBP)/LDBP] × 100%. It took six months for each patient to take medicines of reducing blood sugar. Then SBPI of anterior tibial artery was calculated again. Parameters were compared inter- and intra-groups. Results SBPI of anterior tibial artery after therapy was higher than that before therapy in control group( P<0. 05). There was no significant difference between SBPI of anterior tibial artery before therapy and that after therapy in case group( P >0. 05). SBPI of anterior tibial artery in case group was lower than that in control whatever before and after therapy( P < 0. 05). Conclusions The protection of medicines of reducing blood sugar on elasticity of anterior tibial artery in new diabetic patients without vascular complications was better.     

Endothelial progenitor cells modulated by IL-1β in multiple organ dysfunction syndrome in porcine

Objective To investigate the modulation of EPCs by interleukin 1β (IL-1β) and p38 mitogen activated protein kinase (p38MAPK) and the pathogenesis resulting from their dysdifferenfiation after trauma.Method Thirty pigs were divided into a control group (n = 15) and a multiple organ dysfimction syndrome (MODS) group (n = 15), the latter of which were subjected to a "two-hit" injury including hemon'hagic shock and endotoxemia. Phosphorylation of p38MAPK in peripheral blood mononuclear cells was monitored by western blotting. The concentration of IL-1β in peripheral blood plasma was determined by ELISA and the numbers of EPCs with FCM in peripheral blood plasma were monitored. The morbidity rates in the two groups were compared by chi square test. The levels of phosphorylation of p38MAPK in peripheral blood mononuclear cells, the concentmtions of IL-1β in peripheral blood plasma and the numbers of EPCs in the peripheral blood were compared between groups using with Student's t lest. Results The level of p38MAPK phosphorylation was more augmented and the concen-tration of IL-1β higher in peripheral blood mononuelear cells and plasma from MODS pigs compared with those from control pigs; nevertheless the mauler of EPC conspicuously decreased in the peripheral blood (P <0.01). The morbidity rate in the MODS group was much higher than that in the control group (P < 0.01). There were fewer EPCs in the peripheral blood of animals in group M than in the peripheral blood of animals in group C (P <0.01). Conclusions p38MAPK phosphorylation is important for the pathogenesis of MODS. p38MAPK phospho-rylation might cause the concentration of IL-1β in the peripheral blood plasma to rise and could cause a drop in the numbers of EPCs, thereby aggravating the inflanmmatory reaction in MODS.     

超声血流向量成像技术评价扩张型心肌病左心室血流状态的变化

目的 应用超声血流向量成像(VFM)技术探讨心腔内血流的结构变化及其与左室功能之间的关系.方法 选取扩张型心肌病患者26例、正常对照44例为观察对象,利用VFM软件采集左室内血流向量图像,应用VFM分析软件DSA-RS1测量收缩期心尖部-主动脉瓣口速度阶差(△Vs)、心尖部-主动脉瓣口距离(Ds)、半距对应速度(Vs1/2);舒张期二尖瓣口-心尖部速度阶差(△Vd)、二尖瓣口-心尖部距离(Dd)、半距对应速度(Vd1/2).结果 与对照组相比,DCM组收缩期△Vs、Vs1/2与舒张期△Vd、Vd1/2明显降低,收缩期Ds与舒张期Dd明显延长,差异均具有统计学意义(P＜0.05).Ds、Dd与舒张末期容积、收缩末期容积、左室内径呈正相关(r＞0.4,P＜0.01),与收缩功能呈负相关(r＞0.3,P＜0.01);Vs1/2、Vd1/2与舒张末期容积、收缩末期容积、左室内径呈负相关(r＞0.3,P＜0.01),与收缩功能呈正相关(r＞0.3,P＜0.01).结论 扩张型心肌病患者心腔内血流速度明显低于正常人,VFM是一种无创评价扩张型心肌病左室内血流动力学变化的新方法.     

定量组织速度成像技术对肥厚型心肌病收缩及舒张功能的评价

目的应用定量组织速度成像技术(QTVI)评价肥厚型心肌病(HCM)患者左心室长轴方向上的收缩和舒张功能。方法应用QTVI技术离线分析24例HCM患者和22例正常对照者左心室各心肌节段长轴方向上的速度曲线,测量收缩期峰值(Vs)、舒张早期峰值(Ve)和舒张晚期峰值速度(Va),并计算Ve/Va及收缩期和舒张早期心肌速度梯度(MVG)。结果HCM组收缩期和舒张早期MVG及各室壁基段、中段和部分尖段的Vs、Ve及Ve/Va均小于对照组,而Va与对照组间的差异无统计学意义;肥厚最为明显的节段(后室间隔中段)的Vs与相应侧壁节段的比值小于对照组,后室间隔中段的Vs、Ve与该节段的厚度呈负相关。结论HCM患者左心室长轴方向上的收缩及主动舒张功能受损,并同时累及肥厚及非肥厚的室壁,以肥厚的室壁最为明显。肥厚心肌的舒缩功能与心肌的厚度呈负相关。     

超声应变显像技术评价肥厚性心肌病局部心肌功能的探讨

目的探讨超声组织应变显像(SI)技术评估肥厚性心肌病(HCM)患者局部心肌收缩与舒张功能的价值.方法 HCM患者30例,25例正常人为对照组.选取标准的心尖四腔切面,在心动周期中分别测量室间隔与左室侧壁基底段、中间段、心尖段沿心脏长轴方向上的收缩期峰值应变(εet),观察HCM组出现的收缩期反向应变节段;统计两组室间隔中段和后壁中段的收缩后应变(PSS)节段数并计算其幅度值;将室间隔中段的应变值与室壁厚度进行相关分析.结果①正常组各节段εet从心底至心尖呈逐渐减低趋势,但节段间差异无显著性意义(P＞0.05);②HCM组与正常组εet比较,HCM组各节段应变均显著降低(P＜0.05);③HCM组内室间隔中段应变最低,与基底段、心尖段比较差异有显著性意义(P＜0.05),本组病例大约40%的肥厚节段收缩期可见反向应变;④病变组和正常组均存在PSS,然而与病变组比较正常组PSS节段少、幅度低(P＜0.05);⑤HCM组和正常组室间隔中段的εet与室壁厚度密切相关(r＝0.83).结论 HCM患者无论肥厚节段或非肥厚节段均存在收缩舒张功能减低,且以肥厚节段病损更重,应变显像技术能对其进行准确评价.     

Left ventricular energy loss and wall shear stress assessed by vector flow mapping in patients with hypertrophic cardiomyopathy

The aim of this study was to assess left ventricular (LV) summation of energy loss (EL-SUM), average energy loss (EL-AVE) and wall shear stress (WSS) using vector flow mapping (VFM) in patients with hypertrophic cardiomyopathy (HCM). Forty HCM patients, and 40 controls were evaluated by transthoracic echocardiography. Conventional echocardiographic parameters, summation and average of energy loss (EL-total, EL-base, EL-mid and EL-apex), and WSS in each segment were calculated at different phases. Compared with controls, conventional diastolic measurements were impaired in HCM patients. HCM patients also showed increased EL-SUM-total and EL-AVE-total at the peak of LV rapid ejection period as well as decreased EL-SUM-total and EL-AVE-total at the end of early diastole. In controls, EL-SUM and EL-AVE showed a gradual decrease from the basal segment to the apex, this regularity was not observed in HCM patients. Compared with controls, HCM patients showed increased WSS at the peak of the LV rapid ejection period and the atrial contraction period as well as decreased WSS at the end of early diastole (all p?<?0.05). WSS was increased slightly at the peak of the LV rapid filling period in HCM patients (p?=?0.055). EL and WSS values derived from VFM are novel flow dynamic parameters that can effectively evaluate systolic and diastolic hemodynamic function in HCM patients.     

二维应变超声心动图定量评价左心室整体和局部心肌应变的价值

目的探讨二维应变超声心动图（2D-SE）定量评价心肌局部和整体应变的临床应用价值。方法分别采集25例心力衰竭患者与30例正常对照者心尖左室长轴、心尖四腔和心尖左室二腔观的二维灰阶动态图像。应用自动功能成像软件自动测量长轴方向左室18节段收缩应变（εs）和心尖左室长轴观总应变（GLS-LAX）、四腔观总应变（GLS-A4C）、二腔观总应变（GLS-A2C）及左室长轴平均总应变（GLS-Avg）。同时采用二维Simpson法分别测量三个切面观的左室射血分数（2D-EF）。比较心力衰竭组与对照组各参数测值,分析2D-EF与二维应变（2D-GLS）的相关性。结果心力衰竭组18个节段的εS、GLS-LAX、GLS-A4C、GLS-A2C及GLS-Avg均显著低于正常组（P〈0.001）。2D-EF与2D-GLS有良好的相关性（r=0.94）。正常对照组各室壁自基底段向心尖段εS逐渐增加,各壁间差异无统计学意义;扩张型心肌病组各段室壁εS绝对值均明显低于正常对照组（均P〈0.05）,各节段间差异无统计学意义;前壁心肌死梗组中左前降支供血节段的εS绝对值明显低于正常对照组。结论2D-SE可用于定量测量左室整体和局部心肌的应变,为临床提供了一种快速准确、操作简便、可重复性好的无角度依赖的定量左室功能的新方法。     

彩色多普勒超声检测双侧颈内动脉闭塞患者侧支循环及血流动力学

目的 探讨彩色多普勒超声检测双侧颈内动脉闭塞患者颅内动脉侧支循环代偿途径及血流动力学状况的价值.方法 对7例双侧颈内动脉闭塞患者(患者组)和对照组7名健康成人,应用彩色多普勒超声检测双侧眼动脉(OA)及颅内动脉,分别根据患者OA反向血流及大脑后动脉(PCA)P1段峰值血流速度(Vs)大于对照组((-x)+2s)来判断OA、Willis环后交通动脉侧支循环代偿途径,并比较患者组与对照组大脑中动脉(MCA)、大脑前动脉(ACA)的平均血流速度(Vm).结果 7例患者均存在双侧OA反向血流,双侧椎动脉、基底动脉Vm明显高于对照组(P均＜0.05);4例左侧PCA P1段和3例右侧PCA P1段Vs大干对照组;MCA、ACA Vm较对照组明显降低(P均＜0.05).结论 双侧ICA闭塞患者存在OA及后交通动脉两种侧支循环代偿途径,但其颅内动脉仍供血不足.彩色多普勒超声能实时评价颅内动脉侧支循环血供和血流动力学变化.     

应用血流向量图技术分析正常人左心室血流动力学特点

目的 应用血流向量图(vector flow mapping,VFM)技术分析正常人左心室血流动力学特点.方法 健康志愿者50例,心尖左室长轴观记录动态彩色多普勒血流图像,VFM技术分析不同心动时相左室内血流速度向量分布特点,观察左室内基本流和涡流的分布情况.结果 等容收缩期左室腔内以整体涡流为主;射血早期主动脉瓣下流出道血流首先加速射人主动脉,流人道一侧出现短暂的局部涡流,射血中、晚期心腔内涡流消失;主动脉瓣关闭前瞬间,左室内血流迅速转向心尖流动,并持续至等容舒张期结束;缓慢充盈期和左房收缩末期,左室出现整体涡流.结论 VFM技术能够检测各心动时相心腔血流向量分布,有望在分析病变心脏血流动力学变化中发挥重要作用.     

血流向量成像技术分析肥厚型心肌病患者左室血流动力学变化的临床研究

目的 应用血流向量成像（VFM）技术评价肥厚型心肌病患者左室血流动力学变化及室壁整体舒缩功能.方法 选取肥厚型心肌病患者（病变组）26例和对照组31例,应用VFM技术分析其快速射血期、减慢射血期及等容舒张期的涡流及流线特征,测量涡流横、纵径及快速射血期二尖瓣水平左室流出道与乳头肌水平左室心腔的速度阶差（ΔV）.结果 ①与对照组比较,病变组快速射血期、减慢射血期及等容舒张期显示涡流更大、更散乱、持续时间更长,两组间比较病变组涡流横径、纵径值明显大于对照组,差异有统计学意义.②对照组流线起止规律,流线齐整;病变组流线杂乱起止可在左室不同部位.③病变组收缩期左室流出道速度阶差显著高于对照组.结论 VFM技术可直观反映肥厚型心肌病患者左室血流动力学变化,从而为评估心功能提供早期参考.     

脉冲多普勒组织成像对正常右室心肌运动特点的研究

目的应用脉冲多普勒组织成像(PW-DTI)分析正常右室心肌舒缩运动的特点.方法通过PW-DTI记录39例健康成人右室游离壁各节段以及左室游离壁基底段的运动速度曲线.结果右室游离壁基底段收缩波运动速度最高,中间段次之,心尖段最慢.舒张波运动速度基底段与心尖段有显著性差异(P<0.05),基底段与中间段、心尖段与中间段差异不显著.右室游离壁基底段收缩波峰值速度高于左室(P<0.01),收缩波加速度低于左室(P<0.01),晚期舒张波峰值速度较左室为高(P<0.01),早期与晚期舒张波峰值速度比值较左室为低(P<0.05).结论 PW-DTI技术可以准确测定右室长轴运动的速度及时间指标,是一种无创性评价右室功能的新方法.