心脏瓣膜术后的运动康复

目的探讨心脏瓣膜术后患者运动训练的疗效。方法26例心脏瓣膜术后患者进行全面身心评测,制定个体的康复运动训练方案。结果经过20d的治疗,26例患者心功能提高1～2级;运动负荷增加及运动时间延长(P<0.01);安静状态下、运动时间及负荷相等时其心率、收缩压、舒张压及2项乘积(HR×SBP)比较均差异有显著性(P<0.01、P<0.05),ST段压低显著改善(P<0.01)。结论康复运动训练可以减少心脏瓣膜术后并发症,增加心脏贮备能力,降低心肌耗氧量,改善心肌缺血,提高心肺功能。     

Insights from CTA with Comparison to Modalities of Intravascular Ultrasound Imaging

Noninvasive imaging of atherosclerosis by cardiac CT continues to rapidly evolve. A large collection of data has emerged on detection and quantification of coronary plaque in vivo with cardiac CT with comparison to the gold standard of clinical plaque assessment, intravascular ultrasound. Given inherent spatial limitations, although the correlation is significant, the variability and limits of agreement of these measurements are wide. More recently, focus has shifted to detecting plaque stability, or rather high-risk features of plaque, and identifying those “vulnerable” to rupture. This is a concept originated in histopathology and translated clinically into invasive plaque characterization through virtual histology, or IVUS-VH. We will review the literature regarding methods of plaque assessment, as well as plaque progression and outcomes data, in cardiac CT with regard to its correlation with IVUS and IVUS-VH. The potential in cardiac CT lies within the noninvasive detection of coronary artery disease, its ability to help distinguish those plaques and thus, those patients most vulnerable, which ultimately may be utilized for risk stratification, direction of aggressive therapy, and even as a way to evaluate effects of medical therapies.     

未育女性盆膈裂孔的三维超声影像学观察

目的应用三维超声观察未育正常女性盆膈裂孔的形态、结构,为女性盆底结构的形态学观察提供一种有效的影像学方法。方法选择50例未育女性进行观察,受检者取仰卧位,选用三维探头经会阴部进行探测,获得三维盆底超声重建声像图,横断面上取耻骨联合内下缘和肛管直肠连接部平面用于观察盆膈裂孔的形态、结构、组成及大小。结果所有受检者均能清晰显示盆膈裂孔,正常未育女性的盆膈裂孔形态呈菱形,结构完整紧凑,盆膈裂孔内从前至后呈直线依次排列尿道、阴道、直肠,盆膈裂孔两侧耻骨内脏肌对称且连续性好。盆膈裂孔前后径、左右径和面积分别为(4.31±0.72)cm、(3.98±0.61)cm、(11.22±2.61)cm2。结论三维超声是观察女性盆底结构的一种有效的影像学手段。     

膝关节粘连性功能障碍的手术和康复治疗：附20例病例分析

20例因创伤或某些病变后致膝关节纤维性僵直的住院患者,关节活动范围平均40°,影响工作及生活.采用手术分离膝关节内粘连及术后康复治疗,结果,膝关节活动范围平均达110°,较术前增加 70°.15例经平均27个月的随访,优者10例,良者3例,可者2例.     

Ultrafast Ultrasound Imaging for Super-Resolution Preclinical Cardiac PET

Purpose

Physiological motion and partial volume effect (PVE) significantly degrade the quality of cardiac positron emission tomography (PET) images in the fast-beating hearts of rodents. Several Super-resolution (SR) techniques using a priori anatomical information have been proposed to correct motion and PVE in PET images. Ultrasound is ideally suited to capture real-time high-resolution cine images of rodent hearts. Here, we evaluated an ultrasound-based SR method using simultaneously acquired and co-registered PET-CT-Ultrafast Ultrasound Imaging (UUI) of the beating heart in closed-chest rodents.

Procedures

The method was tested with numerical and animal data (n?=?2) acquired with the non-invasive hybrid imaging system PETRUS that acquires simultaneously PET, CT, and UUI.

Results

We showed that ultrasound-based SR drastically enhances the quality of PET images of the beating rodent heart. For the simulations, the deviations between expected and mean reconstructed values were 2 % after applying SR. For the experimental data, when using Ultrasound-based SR correction, contrast was improved by a factor of two, signal-to-noise ratio by 11 %, and spatial resolution by 56 % (~?0.88 mm) with respect to static PET. As a consequence, the metabolic defect following an acute cardiac ischemia was delineated with much higher anatomical precision.

Conclusions

Our results provided a proof-of-concept that image quality of cardiac PET in fast-beating rodent hearts can be significantly improved by ultrasound-based SR, a portable low-cost technique. Improved PET imaging of the rodent heart may allow new explorations of physiological and pathological situations related with cardiac metabolism.

     

综合康复治疗多指断离再植术后功能障碍

采用综合康复疗法治疗多指断离再植术后功能障碍58例(194指),治疗后关节总屈伸度较治疗前增加30～130°,所测10项日常实用功能均完成3/4以上,平均治疗3个月,优良率为87.4％。通过早期综合康复治疗可获得较好的效果。     

踝关节骨折术后踝关节功能的康复治疗

目的探讨对踝关节骨折术后进行个性化康复运动治疗的临床疗效。方法将80例踝关节骨折患者随机分为试验组与对照组,每组40例。对照组术后采取传统康复等常规治疗;试验组根据骨折患者早期运动康复安全性评定量表制定个性化康复运动处方进行康复治疗。对其进行随访问卷调查．X线检查．并采用AOFAS踝关节功能评估系统分别评估术后6个月及12个月的踝关节功能。结果试验组踝关节功能优良率术后6、12个月分别为80．0％、85．0％,均显著高于对照组的62．5％、75．0％（P〈0．05）。结论根据骨折患者早期运动康复安全性评定量表制定个性化康复运动处方进行康复治疗对踝关节骨折术后踝关节功能恢复安全、有效。     

婴幼儿心脏手术后膈肌麻痹的超声诊断

目的 回顾研究探讨膈肌麻痹的超声诊断方法及超声诊断在临床诊疗中的意义.方法 2005年5月～2009年5月小儿心脏手术后监护室内二维及M型床旁超声检查诊断婴儿心脏术后膈肌麻痹39例,患儿手术平均年龄(22±11)个月(5 d～3岁5个月).结果 膈肌麻痹的超声表现为患侧膈肌的正常舒缩运动消失,呈无运动状态或扑动,不同程度向胸腔膨升.所有患儿均行膈肌折叠术,术中探查证实超声诊断,术后恢复均良好.结论 超声诊断婴幼儿心脏术后膈肌麻痹具有准确、安全、方便的特点,可作为临床确诊该症首选的影像学方法.     

Short-Lag Spatial Coherence Imaging of Cardiac Ultrasound Data: Initial Clinical Results

Short-lag spatial coherence (SLSC) imaging is a novel beamforming technique that reduces acoustic clutter in ultrasound images. A clinical study was conducted to investigate clutter reduction and endocardial border detection in cardiac SLSC images. Individual channel echo data were acquired from the left ventricle of 14 volunteers, after informed consent and institutional review board approval. Paired B-mode and SLSC images were created from these data. Contrast, contrast-to-noise, and signal-to-noise ratios were measured in paired images, and these metrics were improved with SLSC imaging in most cases. Three cardiology fellows rated the visibility of endocardial segments in randomly ordered B-mode and SLSC cine loops. SLSC imaging offered 22%–33% improvement (p < 0.05) in endocardial border visibility when B-mode image quality was poor (i.e., 80% or more of the endocardial segments could not be visualized by the three reviewers). The percentage of volunteers with poor-quality images was decreased from 21% to 7% with the SLSC beamformer. Results suggest that SLSC imaging has the potential to improve clinical cardiac assessments that are challenged by clutter.     

心脏康复治疗对冠脉支架术后患者心脏功能的效果研究

冠状动脉支架植入术(PCI)为临床救治冠心病的主要手术治疗方法,具备微创、疗效优良等优势。但PCI无法完全解除诱发冠心病的所有因素,20～30%的患者PCI后3～6个月中可能出产生支架内再狭窄问题,影响预后。优化冠心病PCI术后远期疗效,改善心功能,降低再狭窄发生率,是PCI术后急需处理的问题,心脏康复是心脏病的一级预防、二级预防与三级预防的重要构成部分,本文对心脏康复治疗在改善冠脉支架术后患者心脏功能效果做出综述研究。     

Cardiac Magnetic Resonance Imaging: Recent Advances and New Insights in Cardiovascular Disease

Cardiac magnetic resonance (CMR) is increasingly employed as a diagnostic test in the evaluation of cardiovascular disease. This article provides an update on recent developments in diagnostic and prognostic applications of CMR in clinical practice. Specifically, advances in the evaluation of myocardial diseases of both ischemic and nonischemic etiology are emphasized. New data on less frequent indications such as constrictive pericarditis, valvular heart disease, or pulmonary hypertension are also summarized. Finally, the emerging roles of novel techniques, like myocardial T1-mapping or molecular imaging, are discussed.     

Coronary Artery Disease Progression: Insights from Cardiac CT

Coronary plaque progression is a multi-faceted process influenced by cardiovascular risk factors, as well as the presence, extent, stenosis, morphology, and vulnerability of plaque, which may ultimately result in myocardial infarction or death. Traditionally, intravascular ultrasound (IVUS) has been the primary modality to study atherosclerosis progression. However, it is invasive and impractical for screening or monitoring. While coronary artery calcium (CAC) scoring has been widely studied as a non-invasive method to measure plaque progression, it is limited to visualization of stenosis and non-calcified plaque. Coronary computed tomographic angiography (CCTA) allows for visualization of the severity of stenosis, plaque burden, plaque morphology, and ability to differentiate between plaque types. Furthermore, certain CCTA plaque features are useful in identifying vulnerable plaque including low attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. This review covers multiple aspects of plaque progression—its pathophysiology, clinical implications, and use of novel non-invasive technology for the assessment of plaque progression over time.     

脑出血术后患者早期康复的护理

目的探讨脑出血术后患者早期康复护理的方法。方法回顾并总结2008年2月至2010年2月哈尔滨医科大学附属第一医院神经外科收治的97例脑出血术后患者的临床资料。结果本组97例患者中,存活92例,死亡5例;完全恢复日常生活自理18例;部分恢复生活自理或可独立生活37例;需要他人帮助、扶拐可走19例;卧床但意识清醒9例;植物生存状态4例。结论科学、有效的早期康复护理,可提高脑出血术后患者的治疗效果,降低病死率。     

肘关节外伤后功能障碍早期康复的临床意义

目的比较肘关节创伤后及时康复与延迟康复对功能恢复的影响。方法选择创伤后7～30d行康复治疗的患者26例为及时康复组,创伤30d后行康复治疗的患者20例为延迟康复组。于系统康复前后行Mayo肘关节评分及关节活动度(ROM)评定。结果及时康复组Mayo评分明显优于延迟康复组(P<0.01),ROM评测优于延迟康复组(P<0.05)。结论肘关节创伤后应及时进行系统康复。     

术中彩色多普勒超声的应用

目的:探讨彩色多普勒超声在心脏手术中的应用价值。方法:在14例心脏病手术中,于心脏修复完成后经心外膜超声检查。结果:一例先天性心脏病室间隔缺损修补片周少量残余漏;一例风湿性心脏病二尖瓣、主动脉瓣置换术后,主动脉瓣下少量返流;因不构成血流动力学的改变,未行二次修复。结论:可即时、准确地为外科医生提供相关信息,评价手术效果。