兔颈动脉血栓模型超声表现的初步研究

目的 超声观察兔颈动脉血栓早期形态学变化.方法 对7只白兔采用3V直流电刺激其颈动脉壁,制备颈动脉血栓的动物模型.模型制备成功后即刻、3 d及1周后分别进行常规超声及超声造影检查.1周后将动脉血栓模型行病理检查,对比分析病理结果与常规超声及超声造影结果.结果 兔颈动脉血检建立后即刻,超声检查颈动脉管腔内见低回声充填,未探及血流信号,超声造影未见血栓内造影剂灌注.3 d后行超声检查,血栓仍呈低回声,周边可见窄条样血流信号,超声造影可见造影剂通过.1周后行超声检查,血栓处管腔内径增宽,血栓回声较前增强,周边可见条样血流信号,超声造影可见造影剂通过.病理检查:颈动脉内血栓形成,部分血栓机化.结论 通过常规超声、超声造影及病理学的观察,颈动脉血栓在短期(1周)内即发生形态学的变化.     

术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值

目的探讨术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值。 方法选取2017年10月至2019年3月解放军总医院收治的发现肾肿瘤伴下腔静脉癌栓并行腹腔镜手术治疗的患者60例，所有患者均于术前及术中行超声造影检查，以典型增强模式判断癌栓是否合并血栓，并最终取得术后病理结果。以术后病理结果为"金标准"，计算术前及术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值和阴性预测值。 结果60例下腔静脉癌栓患者均接受了机器人辅助腹腔镜下根治性肾切除联合下腔静脉内癌栓切除术。根据病理结果，下腔静脉癌栓合并血栓者10例（16.7%），其中术前超声造影漏诊2例，另有2例癌栓头部坏死组织被术前及术中超声造影误诊为血栓。术前与术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为80.0%、96.0%、93.3%、80.0%、96.0%和100.0%、96.0%、96.7%、83.3%、100.0%。 结论术前及术中超声造影对下腔静脉癌栓是否合并血栓有较好的鉴别诊断效能，可为手术方式的选择提供重要信息和依据，具有较高的临床应用价值。     

Diagnosis of portal vein tumor thrombus by pulsed Doppler ultrasonography.

The blood flow of portal vein thrombus was studied by pulsed Doppler ultrasonography in 21 patients with tumor thrombus and 14 with blood clot thrombus. Pulsatile waves were observed in 19 of the 21 with tumor thrombus, with backward continuous waves in 3, and forward/backward continuous waves in 2. In contrast, forward continuous waves were observed in 2 of the 14 with blood clot thrombus. By color imaging, the blood flow could be observed in 9 of 14 with tumor thrombus, but in 1 of 7 with blood clot thrombus. Pulsatile and backward continuous waves were characteristic of tumor thrombus.     

血栓活化血小板放射性核素显像研究进展

血栓活化血小板放射性核素显像能够显示血栓,确定血栓部位,鉴别新鲜与陈旧血栓。本文对血小板活化机制、血栓活化血小板放射性核素显像的研究进展进行综述。     

脊髓损伤患者下肢静脉血栓分析

目的：了解脊髓损伤患者下肢静脉血栓特点及溶栓效果。方法：对207例下肢肿胀的脊髓损伤患者进行彩色多普勒超声检查。结果：207例患者中，发现血栓66例，阳性率31％，急性血栓58例，亚急性栓1例，慢性血栓7例。结论：彩色多普勒超声对下肢静脉血栓的定性诊断为临床治疗提供了重要依据，对临床选择治疗方案具有一定的指导意义。     

下肢深静脉血栓形成与介入手术股动脉穿刺术相关性研究

目的研究介入手术股动脉穿刺术与下肢深静脉血栓形成之间的相关性。方法对80例介入手术股动脉穿刺术后诊断为肺栓塞,并且术后下肢深静脉血栓形成的患者进行回顾性分析,分析介入手术导致下肢深静脉血栓形成的直接原因。结果介入手术并发下肢深静脉血栓形成为本组患者常见危险因素,介入手术导致下肢深静脉血栓形成的首要原因是平卧时间长。结论介入手术股动脉穿刺术与下肢深静脉血栓形成密切相关,介入手术术后应尽量减少平卧时间预防下肢深静脉血栓形成。     

溶栓治疗后辅以物理因子对下肢深静脉血栓的效应

INTRODUCTION The objective of resist coagulating treatment is prevent a spread of thrombus and new thrombus form, hasten a connect again of vein and in same is an assistant treatment for dissolve thrombus and operation.It is the first way presently that dissolve thrombus cure DVT.     

血浆单核细胞趋化蛋白-1和组织因子在血液透析患者内瘘血栓形成中的意义

目的探讨自体动静脉内瘘成形术后患者血浆中单核细胞趋化蛋白-1和组织因子水平的变化及这两种因子与自体动静脉内瘘血栓形成的关系。方法应用酶联免疫吸附双抗体夹心法（ELISA法）对50例自体动静脉内瘘成形术后患者定量测定血浆单核细胞趋化蛋白-1（MCP-1）、组织因子（TF）的水平,并进一步比较内瘘血栓形成（失功组）与内瘘畅通的患者（畅通组）血浆中MCP-1、TF水平的差异。结果与畅通组相比,失功组患者血浆MCP-1和TF的含量较畅通组明显增高,差异具有统计学显著性（P〈0.01）。结论自体动静脉内瘘血栓形成患者血浆MCP-1和TF的水平明显升高,并且这种升高与内瘘血栓形成关系密切。     

Color Doppler imaging of inferior vena cava: identification of tumor thrombus.

Color-coded Doppler sonography (CCDS) was used for the examination of tumor thrombus (n = 7) and benign thrombosis (n = 6) of the inferior vena cava. Tumor thrombus was due to hepatocellular carcinoma in two cases and to renal cell carcinoma in five cases. Whereas no specific information about the nature of thrombus formation could be gained by gray scale sonography, a typical patchy vascularization pattern was noted within tumor thrombi in six of seven cases using CCDS. This ws due to marked neovascularization within the tumor thrombi, confirmed by histologic examination in all cases. In one patient no vascularization within the tumor thrombus could be observed by CCDS because the thrombus was relatively small. In patients with bland thrombosis, either no vascularization of the thrombus was seen (n = 5) or linear recanalization of the thrombus occurred (n = 1). Therefore, it might be possible to differentiate tumor from nontumor thrombus in the inferior vena cava by using CCDS. Further studies are needed to confirm this preliminary hypothesis.     

手术治疗肾癌合并下腔静脉瘤栓

目的评价手术治疗肾细胞癌合并下腔静脉瘤栓的疗效。方法回顾分析38例经手术治疗的肾细胞癌合并下腔静脉瘤栓患者的临床资料。结果 38例患者中,男28例,女10例,平均年龄56岁;右肾癌伴腔静脉瘤栓31例,左肾癌伴腔静脉瘤栓7例;Ⅰ级瘤栓8例,Ⅱ级24例,Ⅲ级3例,Ⅳ级3例。所有患者均行肾癌根治切除及取瘤栓术,其中35例下腔静脉阻断下切除下腔静脉瘤栓,3例瘤栓达右心房,在体外循环腔静脉心房分流下取瘤栓。围手术期无死亡病例。随访6～114个月,平均41个月,21例无瘤生存（55.2%）,2例复发转移带瘤生存（5.2%）,13例肿瘤转移死亡（34.2%）,2例失访。结论没有转移的肾细胞癌合并下腔静脉瘤栓如能完整切除,并非手术禁忌和愈后不良的因素。     

Enhanced Visualization of Intravascular and Left Atrial Appendage Thrombus with the Use of a Thrombus-Targeting Ultrasonographic Contrast Agent (MRX-408A1): In Vivo Experimental Echocardiographic Studies

Echocardiographic evaluation for the recognition of intravascular and left atrial appendage thrombus remains a difficult problem. A thrombus-specific ultrasonographic contrast agent has the potential for an alternative approach for their delineation. The aim of this study was to investigate the usefulness of thrombus-specific contrast agent MRX-408A1 for the detection of acute experimentally created intravascular and intracardiac thrombus. In the first study, we created inferior vena cava thrombus in 9 dogs. With the use of fundamental 2-dimensional echocardiography imaging, we recorded images of the inferior vena cava thrombus at baseline (n = 9), with the thrombus-specific contrast agent MRX-408A1 (n = 9), and with nonspecific contrast agent MRX-113 (n = 6). In the second study, we created a left atrial appendage thrombus in 8 dogs. We imaged left atrial appendage thrombus at baseline and during MRX-113 and MRX-408A1 infusion. Thrombus was successfully created in all dogs in study 1 and in 6 of 8 dogs in study 2. MRX-408A1 produced a visually apparent increase in ultrasonographic contrast enhancement of the thrombus in all cases in which thrombus was found on autopsy. In both studies, MRX-408A1 increased the videointensity of the thrombus significantly compared with baseline images and images obtained during MRX-113 infusion. The size of the visually detectable thrombus on the image was also significantly larger during MRX-408A1 infusion than at baseline and during MRX-113 infusion. These data provide in vivo demonstration of the efficacy of a thrombus-specific contrast agent, MRX-408A1, in the detection of acute intravascular and intracardiac thrombus. It has the potential to improve the diagnostic accuracy of ultrasonography for the detection of acute thrombi at various cardiovascular sites in the clinical setting.     

Therapeutic Approach in Patients with a Floating Thrombus in the Right Heart

Background

The occurrence of a floating thrombus in the right heart, although rare, is a life-threatening condition requiring a specific approach. In most cases, these thrombi are a result of embolization from deep venous thrombosis, and have lodged temporarily in the right heart. The management of this condition is variable, depending on whether or not there is a thrombus entrapped within a foramen ovale (FO).

Objectives

To present the management of 2 patients with a free-floating thrombus in the right heart, and a third patient with an entrapped thrombus in the FO.

Case Reports

Two patients with a free-floating thrombus in the right atrium who were treated with thrombolytic therapy had an immediate excellent outcome. The patient with a thrombus entrapped within the FO was scheduled for surgical removal of the thrombus due to an unacceptable risk of systemic embolization if treated with thrombolytic and anticoagulant therapy. Unfortunately, he developed an ischemic stroke on the fifth day of presentation, just a few hours before the scheduled surgery, despite meticulous monitoring of continuous heparin infusion with activated partial thromboplastin time.

Conclusion

Thrombolytic therapy is recommended in patients with a free-floating thrombus in the right heart. However, in patients with a thrombus entrapped within an FO, delaying surgical removal of the thrombus may be deleterious due to unpredictable systemic embolization.     

In vitro investigation of a new thrombus aspiration and autologous blood reinfusion system

PurposeThe aim of the study was to evaluate the feasibility of a new venous-thrombus aspiration and autologous blood (auto-blood) reinfusion system.Materials and methodsWe constructed the venous model from polyvinyl chloride (PVC) tubes and three-way unions using a fresh clot of chicken blood as the venous thrombus. Eight French and 12F aspiration catheters were used to aspirate the thrombus in the right–pulmonary-artery model, 8 French and 14F aspiration catheters were used in the inferior–vena cava model, and 8 French and 10F aspiration catheters were used in the left–iliofemoral-vein model. A thrombus filtration and auto-blood reinfusion bottle was used to filter the thrombus and re-infuse auto-blood. We evaluated the thrombus aspiration capability of each catheter by comparing pre-aspirated with the post-aspirated thrombus volume, and we evaluated the difference in aspiration capability between the two catheters in each model by comparing their thrombus aspiration rates. We used Student's t-test for statistical analysis.ResultsDifferences between pre-aspirated and post-aspirated thrombus volumes for each catheter were insignificant, as were those between the thrombus aspiration rates of the two catheters in each venous model. Using the thrombus aspiration and auto-blood reinfusion system, each aspiration catheter could fluently aspirate the thrombus out of the venous model.ConclusionIn this study, we designed a new venous-thrombus aspiration system. This system could be used to aspirate acute venous thrombi and re-infuse autologous blood.     

风湿性心脏病并发左心房血栓的危险因素探讨

目的　探讨风湿性心脏病并发左心房血栓的发生率及危险因素。方法　采用非条件Logistic回归模型分析二尖瓣狭窄患者并发左心房血栓的危险因素。结果　风湿性心脏病并发左心房血栓的发生率为 10 .77% ;二尖瓣狭窄、二尖瓣关闭不全、主动脉瓣病变和联合瓣膜病的发生率分别为 15 .6 3%、1.2 5 %、0和 2 .11%。二尖瓣狭窄并发左心房血栓的预测因子是左房自发性超声对比现象 (leftatrialspontaneousechocontrast ,LASEC) (相对危险比3.0 9,P<0 .0 0 0 0 )和房颤 (相对危险比 1.74 ,P =0 .0 0 2 3)。结论　风湿性心脏病二尖瓣狭窄患者最易发生左心房血栓 ;LASEC和房颤是决定二尖瓣狭窄发生左心房血栓的危险因素。二尖瓣狭窄伴房颤、LASEC的患者应积极抗凝治疗     

扩张型心肌病左心室血栓形成影响因素的超声心动图研究

目的 探讨扩张型心肌病时左心室血栓形成的影响因素,及二尖瓣反流对左心室血栓形成的影响。方法 65例扩张型心肌病患者根据有无左室血栓分成A组（无左室血栓组）和B组（左室血栓组）,对两组患者的临床资料及超声心动图进行比较分析。结果 A组57例,B组8例,两组患者年龄、性别、临床资料以及凝血象差异均无显著性意义。B组左房内径、左室收缩末内径均较A组明显增大,而左室射血分数较A组明显减低。存在二尖瓣反流的患者两组间无明显差别,但重度二尖瓣反流只存在于A组患者中。结论 扩张型心肌病时左室血栓的形成与多种因素有关,左室射血分数是影响左室血栓形成的最重要促进因素,严重二尖瓣反流在防止左室血栓形成中可能起保护作用。     

彩色多普勒超声鉴别诊断下肢动脉血栓的新旧程度

目的判断分析下肢动脉血栓的新鲜程度和陈旧程度,评价彩色多普勒超声对其诊断价值,为临床提供有效的治疗方案。方法应用彩色多普勒超声对下肢动脉进行检查,根据血栓的范围大小、回声强度及血管侧支循环的形成、血栓近端及远端频谱,进行定量分析,评价与血栓新旧程度的关系,并按其程度分成Ⅲ级,为临床治疗提供必要的指导信息。结果本组59例70支下肢血管血栓均经彩色多普勒超声等明确诊断,血栓的新旧程度在病程、管壁结构改变及有无侧支循环建立方面有差别,两组病变近端、远端最高血流速度和近端阻力指数有明显的差异(P<0.05),远端阻力指数无明显差异(P>0.05)。结论彩色多普勒超声是下肢动脉血栓新旧程度鉴别诊断的最佳的无创检查方法。     

超声在颈动脉血栓诊断及鉴别诊断中的应用价值

目的分析颈动脉血栓超声特点及其与动脉硬化斑块的鉴别诊断。方法颈部动脉超声检查的患者41417例,颈动脉血栓患者行CT或MRI检查,并超声随访。结果41417例中,检出血栓870例,检出率2．10％。其中血栓呈无回声2例,低回声393例,等回声195例,混合回声280例。附壁血栓9例,血栓性闭塞或近闭塞42例,颈动脉硬化斑块合并血栓性闭塞或近闭塞819例。颈动脉血栓和血栓合并斑块的男性患者均较女性患者少,附壁血栓组和血栓性闭塞组的患者年龄较血栓合并斑块组小,差异均有统计学意义（P〈0．01）。结论超声检查可以用于颈动脉血栓的诊断,并与颈动脉硬化斑块鉴别,为临床的诊治提供依据。     

Characterization of portal vein thrombus with the use of contrast-enhanced sonography.

OBJECTIVES: To select an appropriate treatment regimen, it is essential to accurately characterize the nature of a thrombus. This study prospectively assessed the ability of contrast-enhanced sonography to differentiate between benign and malignant portal vein thrombosis in a population of high-risk patients. METHODS: Fifty-five patients (43 men and 12 women; mean age, 66 years; range, 55-83 years) with thrombi of the portal venous system were examined by power Doppler sonography and contrast-enhanced sonography with the intravenous contrast agent SH U 508A (Levovist; Schering AG, Berlin, Germany). Of the thrombi, 40 were characterized as malignant and 15 as benign. Pulsatile flow in the thrombus on power Doppler sonography and positive enhancement of the thrombus on contrast-enhanced sonography were judged as indications of a malignant thrombus. The sensitivity and specificity of both methods in differentiating the nature of the thrombus were evaluated. RESULTS: The detection of pulsatile flow in a portal vein thrombus as the criterion for diagnosing malignant portal vein thrombus yielded overall sensitivity of 82.5% and specificity of 100%, whereas positive enhancement of the portal vein thrombus itself as a criterion for diagnosing malignancy yielded overall sensitivity and specificity of 100% for each. CONCLUSIONS: Contrast-enhanced sonography can be helpful in discriminating between benign and malignant portal vein thrombi.     

Early ultrasonographic evaluation of tumor thrombus level during sunitinib therapy for renal cell carcinoma

A 72-year-old man presenting with a 14-cm left renal mass, an inferior vena cava (IVC) tumor thrombus, and pulmonary metastases underwent renal mass biopsy that revealed clear cell renal cell carcinoma. Because of metastases and the extent of the tumor thrombus, sunitinib was administered, which resulted in a marked reduction in the tumor thrombus (from level III to level II after 11 weeks of treatment). Ultrasonography, preceding computed tomography, showed a slight shrinkage of the tumor thrombus level in the first 2 weeks. Therefore, ultrasound may be advantageous to monitor the IVC tumor thrombus level during the early phase of targeted therapy.     

Differentiation between fresh and old left ventricular thrombi by deformation imaging

Background- Noninvasive echocardiographic differentiation between old and fresh left ventricular thrombi after myocardial infarction would be of clinical importance to estimate the risk for embolization and the necessity of anticoagulation. Methods and Results- Fifty-two patients, aged 41 to 87 years, with a thrombus after myocardial infarction were included in this 2-part study: In substudy-I, 20 patients, 10 each with a definite diagnosis of fresh or old thrombus, were included. In the subsequent prospective substudy-II, 32 consecutive patients with an incident thrombus after myocardial infarction but unknown thrombus age were started on phenprocoumon and followed for 6 months. Data on medical history, standard echocardiography, strain-rate (SR) imaging and magnetic resonance tomography were analyzed. In substudy-I, analysis of thrombus deformation revealed the most rapid change in SR during the isovolumetric relaxation period when cavity pressure decreases rapidly. Fresh (range: 5-27 days) and old thrombi (4-26 months) could be discriminated without overlap by peak SR during the isovolumetric relaxation period, using a cutoff value of 1 s(-1). Applying this threshold value in substudy-II, 17 thrombi were echocardiographically classified as fresh (=SR ≥1 s(-1)) and 15 as old. After 6 months in the fresh thrombus group, 16 of 17 thrombi had disappeared (94%), and in 1 patient the thrombus size was diminished by >50% (now presenting an old thrombus SR pattern). In contrast, 14 of the 15 old thrombi remained unchanged in size and deformation (1 thrombus disappeared). Conclusions- Fresh and old intracavitary thrombi can be reliably differentiated by deformation imaging. In fresh thrombi, anticoagulation with phenprocoumon results in thrombus resolution in most patients.