超声心动图对主肺动脉间隔缺损的诊断价值探讨

目的分析主肺动脉间隔缺损(APSD)的超声心动图特征,探讨超声心动图对APSD的诊断价值。方法回顾性分析经心导管及手术结果证实的49例APSD患者的超声心动图资料,总结其特征,包括APSD分型、部位、大小、房室大小、分流情况,以及是否合并其他心脏畸形情况。结果①49例患者中,术前超声准确诊断APSD 45例,漏诊4例,诊断准确率91.8%。②超声心动图诊断Ⅰ型11例(22.4%),Ⅱ型24例(49.0%),Ⅲ型14例(28.6%),其中45例分型与经心导管及手术结果相符。③二维超声心动图表现为主肺动脉间隔连续性中断,缺损范围约5～50mm。左心系统增大22例(44.9%),右心系统增大4例(8.2%),全心扩大(左心为著)21例(42.9%),右室壁增厚4例(8.2%),主动脉、肺动脉内径均增宽,以肺动脉内径增宽为著。彩色多普勒超声表现为左向右分流12例(26.7%),双向分流25例(55.6%),右向左分流8例(17.7%)。轻度肺动脉高压3例(6.1%),中度肺动脉高压10例(20.4%),重度肺动脉高压36例(73.5%)。结论超声心动图是诊断APSD的有效方法,能在术前对其进行详细评估,有助于临床制定治疗方案,具有较好的应用价值。     

经食管超声心动图在重度肺动脉高压中的应用价值

目的探讨经食管超声心动图(TEE)在重度肺动脉高压病因诊断和鉴别诊断中的应用价值.方法对47例原因不明的重度肺动脉高压患者进行了经胸超声心动图(TTE )和TEE检查.结果 47例肺动脉高压患者中,TEE诊断分流性先天性心脏病17例,其中房间隔缺损9例,主肺动脉间隔缺损1例,在降主动脉短轴切面检出动脉导管未闭7例;左肺动脉和右肺动脉远段附壁血栓形成4例(继发性肺动脉高压组).余26例原因不明(原发性肺动脉高压组).继发性肺动脉高压组和原发性肺动脉高压组比较,TTE测量指标和主要临床资料无显著性差异.结论 TEE技术在不明原因重度肺动脉高压的病因诊断和鉴别诊断中具有重要临床应用价值.     

多普勒超声心动图诊断主肺动脉间隔缺损

目的　分析多普勒超声心动图诊断主肺动脉间隔缺损的准确率 ,提高超声心动图检查对主肺动脉间隔缺损的首次检出率。方法　本文总结了 15例先心患儿有关主肺动脉间隔缺损的超声检测结果 ,并与其外科手术结果相对照。结果　超声心动图诊断主肺动脉间隔缺损与外科手术结论一致者 6例 (占 40 % ) ;不一致 9例 (占 60 % ) ,其中漏诊 5例 (3 3 .3 % ) ,误诊 4例 (2 6.7% )。结论　多切面显示主肺动脉间隔回声中断 ,缺损边缘呈“T”字征 ,结合脉冲及彩色Doppler表现 ,多普勒超声心动图可以较准确地诊断主肺动脉间隔缺损。     

主-肺动脉间隔缺损及右肺动脉起源于升主动脉合并主动脉弓离断的影像学诊断

目的:探讨多种影像技术对主-肺动脉间隔缺损及右肺动脉起源于升主动脉合并主动脉弓离断的诊断价值。方法:2005—2013年武汉亚洲心脏病医院先后收治7例主-肺动脉间隔缺损及右肺动脉起源于升主动脉合并主动脉弓离断的患者,对其超声心动图及CT图像、导管检查结果进行回顾性分析。结果:7例患者均行超声心动图及CT检查,诊断为Ⅱ型主-肺动脉间隔缺损(Ho分型法),均合并右侧肺动脉起源于升主动脉及A型主动脉弓离断(Celoria与Patton分型法)。4例患者行导管检查,3例考虑为阻力型肺动脉高压,放弃手术治疗,余4例均行一期手术矫治。结论:超声心动图结合CT检查是诊断本病的可靠手段。手术指征的判断需结合心导管检查、心血管造影。肺动脉压力及阻力是影响手术时机和预后的关键因素。     

超声心动图检查主-肺动脉间隔缺损9例经验教训

主-肺动脉间隔缺损的术前确诊率较低。本文分析了经手术证实的本病患者9例术前超声资料(UCG仅诊断1例),探讨了UCG误诊或漏诊的原因:ME可发现心脏容量负荷增加,不能观察缺损直接征象;2DE可观察主-肺动脉间隔回声脱失,但与该处回声减弱界限不清:由于本病肺动脉高压形成早、发展快,CDFI仅在早期可发现典型左向右分流信号;而声学造影是观察右向左分流的较好方法。虽然本组资料中     

主肺动脉窗初诊超声心动图误诊分析

目的 探讨主肺动脉窗初诊超声心动图误诊原因及确诊方法.方法 对38例主肺动脉窗患者的初诊超声心动图资料进行回顾性分析.结果 38例中,初诊超声心动图正确诊断21例,误诊17例,误诊率44.74％(17/38).17例误诊病例中,6例经心导管检查确诊,5例经心脏CT确诊(其中3例结合再次超声心动图综合诊断),1例经心导管及心脏CT联合确诊,3例经手术确诊,1例经心脏MRI确诊,1例经TEE检查确诊.结论 主肺动脉窗临床易于误诊,出现超声心动图检查结果难以解释的重度肺动脉高压或左心增大时,应首先考虑主肺动脉窗的可能,最终确诊有赖于心导管、心脏CT、心脏MRI和(或)反复超声心动图检查.     

超声心动图对主肺动脉间隔缺损的诊断价值

主肺动脉间隔缺损(Aortopulmonary septal defect,APSD)是一种罕见的先天性心脏血管畸形.由于APSD分流量大,较早即出现肺动脉高压,若不治疗后期发展至双向或右向左分流而丧失手术机会.约50%患者于幼年即死于充血性心力衰竭、肺炎.因此,早期诊断对患者的预后至关重要.本文总结APSD患者的超声心动罔的图像特征,旨在进一步提高超声心动图对APSD的诊断准确率.     

超声心动图在室间隔缺损经导管封堵术中的价值

经心导管介入方法治疗室间隔缺损(VSD)是近年来非外科治疗VSD的一种新方法[1 - 2 ] 。本文旨在探讨超声心动图在Amplatzer封堵器封堵VSD术前、术中、术后的作用及手术并发症的原因。1　对象和方法1.1　对象　VSD2 9例、ASD VSD2例,均为膜周型,行经导管介入Amplatzer封堵器封堵术。男13例,女18例,年龄2～15岁,平均(8.1±4 .5 )岁。所有病例均经超声心动图确诊,室间隔缺损间距为3～12 mm,不合并有需手术矫正的心血管畸形和严重肺动脉高压导致的右向左分流,选用封堵器型号为4～14mm。使用仪器为东大阿尔派2 0 0 0型彩色多普勒超声诊断…     

Berry综合征的超声心动图诊断价值分析及思路

目的:通过总结Berry综合征超声心动图图像特征,评估超声心动图对Berry综合征的诊断价值及思路。方法:回顾性分析6例在我院经CT检查或手术确诊为Berry综合征患儿的超声心动图图像特征,并通过相关文献复习,对超声心动图诊断价值及思路进行总结和分析。通过心尖五腔心、胸骨旁大动脉短轴及肺动脉分支等多切面可探查主肺动脉间隔、室间隔、肺动脉分支等情况,胸骨上窝主动脉弓长轴切面可显示主动脉弓的情况。结果:6例Berry综合征均包括:主肺动脉间隔缺损(远端型)、右肺动脉异常起源于升主动脉、主动脉弓离断(A型)、室间隔完整,均合并动脉导管未闭,4例合并房间隔缺损(Ⅱ),1例合并卵圆孔未闭,其中1例漏诊右肺动脉异常起源于升主动脉,1例合并心外畸形(尿道下裂)。结论:超声心动图可作为Berry综合征的首选诊断方法,可合并心外畸形,但可能会发生漏诊,需要明确超声诊断思路。     

先天性主肺动脉间隔缺损的超声诊断

目的回顾性分析超声心动图对10例主肺动脉间隔缺损（APSD）的诊断价值。 方法运用二维及多普勒超声多切面观察APSD的大小、部位、分型、血流动力学改变、肺动脉高压的程度及有无合并其他畸形。 结果10例患者中8例经手术证实为APSD，超声确诊8例，1例误诊为动脉导管未闭，1例漏诊。合并畸形有动脉导管未闭、主动脉瓣下膜样狭窄、主动脉缩窄、室间隔缺损及肺动脉瓣狭窄等。 结论APSD易漏诊或误诊，仔细分析声像图仍能做出正确诊断，超声在APSD的诊断与鉴别诊断中具有重要价值。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.