胎心监护联合彩色多普勒超声检查在胎儿宫内窘迫诊断中的临床价值分析

目的探究胎心监护联合彩色多普勒超声检查在胎儿宫内窘迫诊断中的临床价值。方法选择本院收治的120例发生胎儿宫内窘迫的孕产妇作为观察组,并选择同期在本院正常妊娠的140例孕产妇作为对照组。观察比较两组孕产妇的胎心监护情况及其脐动脉、大脑中动脉血流动力学情况,并对诊断效果进行分析。结果观察组胎儿的胎心异常率为88.33%,明显高于对照组(19.29%,P0.05)。观察组胎儿的脐动脉收缩期最大流速(PSV)、舒张末期血流速度(EDV)水平以及舒张压血流峰速比值(S/D)比值明显低于对照组,搏动指数(PI)、阻力指数(RI)水平明显高于对照组(P0.05)。观察组的大脑中动脉PSV、EDV水平以及S/D比值显著高于对照组,其PI、RI水平则明显低于对照组,两组差异比较有统计学意义(P0.05)。联合检查对胎儿宫内窘迫的确诊率明显高于单纯胎心监护,误诊率及漏诊率明显低于单纯胎心监护,比较差异均有统计学意义(P0.05)。结论产前胎心监护联合彩色多普勒超声测定胎儿的脐动脉及大脑中动脉,能够较好地对宫内情况进行了解和预测。     

彩色多普勒超声在高龄孕妇中对泌尿系统畸形胎儿的产前诊断价值分析

目的 分析不同类型泌尿系统畸形胎儿的彩色多普勒超声声像图的特征,评价彩色多普勒超声对高龄孕妇在产前诊断泌尿系统畸形胎儿的临床研究和诊断价值.方法 随机选择2014年3月至2016年2月本院接收的1 642例平均年龄为35.2岁且孕周为14~38周的孕妇,进行彩色多普勒常规检查,同时观测孕妇腹中胎儿的健康状况,收集对孕妇以及胎儿的临床资料和彩色多普勒超声声像特征并进行统计分析,并对怀疑为泌尿系统畸形的胎儿进行随访验证.对检测出泌尿系统畸形胎儿、疑似泌尿系统畸形胎儿和漏诊的病例,在分娩后进行彩色多普勒超声诊断和随访,将随访的结果与产前彩色多普勒超声检查的统计结果相对照.结果 通过彩色多普勒超声检测1 642例孕妇,对其超声声像特征的资料进行分析,根据超声声像图特征做出诊断.检测发现有42例泌尿系统畸形的胎儿,包含肾发育不良胎儿4例,占9.5%;多囊性发育不良8例,占19.04%;肾盂扩张15例,占35.7%;肾积水6例,占14.3%;肾缺如7例,占16.7%;巨膀胱1例,占2.4%;尿道下裂1例,占2.4%;进行产前彩色多普勒超声检测的诊断结果与分娩后检查和随访结果一致,其中一例被误诊,产妇分娩后病症消失.结论 产前对高龄孕妇进行彩色多普勒超声检查,诊断出泌尿系统畸形胎儿的准确率较高.利用彩色多普勒超声检测,使得泌尿系统畸形胎儿在产前即可作出诊断,为临床诊断、采取措施和预后评估提供了可靠且重要的依据.     

彩超监测脐动脉与子宫螺旋动脉对高危妊娠的研究

目的：通过彩色多普勒超声联合监测晚孕期高危妊娠患者胎儿脐动脉（UA）及子宫螺旋动脉（SA）血流参数指标,探讨晚孕期高危妊娠胎儿脐动脉、子宫螺旋动脉血流动力学的变化,以及两者联合监测对预测围产儿结局的临床应用价值。方法应用彩色多普勒超声对120例单胎晚期妊娠妇女胎儿的脐动脉及母体子宫螺旋动脉的血流进行检测,分别测量以下血流参数：收缩期峰值速度与舒张期末速度之比值（S/D）,阻力指数（RI）及搏动指数（pulsatility index,PI）,80例高危妊娠与40例正常妊娠组作对照分析。结果（1）高危妊娠组胎儿脐动脉及子宫螺旋动脉血流S/D、RI、PI值高于正常妊娠组,差异有统计学意义（P＜0.05）;（2）高危妊娠组围产儿结局异常的百分比明显高于正常妊娠组,差异有统计学意义（P＜0.05）;（3）当胎儿脐动脉和子宫螺旋动脉血流参数指标都异常时,围产儿结局不良发生率为80.00%,明显高于胎儿脐动脉或子宫螺旋动脉单独异常组,且各组间比较差异均有统计学意义（P＜0.05）。结论妊娠晚期彩色多普勒超声检测胎儿脐动脉、子宫螺旋动脉的血流状态,对预测妊娠结局的发生有临床价值;两者联合检测比单纯胎儿脐动脉或子宫螺旋动脉监测对预测高危妊娠胎儿不良结局更有价值;子宫螺旋动脉可以作为脐动脉预测不良妊娠结局的补充。     

彩色多普勒超声在胎儿畸形诊断中的应用

目的:探讨彩色多普勒超声检查确诊胎儿畸形的应用价值。方法:采用彩色多普勒超声仪对孕18～40周的孕妇进行系统检查。结果:本次检查的125例孕妇患者中,共有6例胎儿畸形,畸形发生率为4.8%,共检查出5例胎儿畸形,1例漏诊,检出的胎儿畸形符合率为100%。结论:彩色多普勒超声确诊胎儿畸形诊断率高、分辨性强,在胎儿畸形产前筛查中具有重要的诊断价值,值得临床推广。     

产前超声联合MRI诊断胎儿先天性食管闭锁

目的探讨产前超声联合MRI对胎儿先天性食管闭锁(CEA)的诊断价值。方法回顾性分析31胎经引产后尸体解剖或出生后手术及影像学检查证实的CEA胎儿(CEA组)的产前超声及MRI资料,并与31胎产后正常胎儿(正常对照组)进行对照。以病理结果为金标准,分析产前超声联合MRI诊断胎儿CEA的阳性率。比较2组间产前超声指标胎儿双顶径(BPD)、头围(HC)、腹围(AC)、股骨长(FL)、羊水深度(AFD)、羊水指数(AFI)、胎盘厚度、脐动脉峰谷比(S/D)、胎儿吞咽指数及估算胎儿体质量(EFW)的差异。结果产前超声联合MRI诊断胎儿CEA的阳性率为67.74%(21/31)。CEA组胎儿HC、AC、吞咽指数、EFW均低于正常对照组(P均0.05),S/D、AFI均高于对照组(P均0.05);2组间BPD、FL、AFD、胎盘厚度差异均无统计学意义(P均0.05)。结论产前超声无法直接诊断胎儿CEA,当发现胃泡持续72h不显示(间隔72h复查)或羊水过多时,结合MRI对产前诊断胎儿CEA具有一定价值。产前超声指标中,胎儿HC、AC、AFI、S/D、吞咽指数、EFW可能对CEA具有一定提示作用。     

彩色多普勒超声在婴幼儿肝移植术后肝动脉检测中的意义

目的探讨彩色多普勒超声在婴幼儿肝移植术后肝动脉检测的意义。方法应用彩色多普勒超声对57例婴幼儿肝移植患者术后进行肝动脉检测,观察有无血流信号,肝动脉收缩期流速(S)、舒张期流速(D)及S/D情况。随访时间最短2个月,最长9个月。收集所有患者的动脉检测数据进行分析。结果 52例患儿彩色多普勒超声提示肝动脉血流通畅,未见明显异常;5例患儿分别在术后5~8天内彩色多普勒超声检查于肝门部及肝内均未探及到动脉血流信号,考虑肝动脉血栓形成,3例经血管造影证实、1例经超声造影及增强CT证实,1例超声出现假阳性,血管造影显示肝动脉未见明显异常。彩色多普勒超声对肝动脉检测的诊断符合率达98%。结论彩色多普勒超声为婴幼儿肝移植术后动脉的监测及并发症的早期诊断提供重要的依据。     

超声产前诊断胎儿畸形

目的探讨超声在产前诊断胎儿畸形的临床价值。方法采用彩色多普勒超声诊断仪对2230例孕11～40周的孕妇进行系统超声检查并随访。结果2230例孕妇中，超声诊断胎儿畸形28例，漏诊8例。发生畸形位居前三的是心血管畸形，神经管畸形。泌尿系统畸形。漏诊病例多为心血管畸形及较小畸形。结论超声检查可以对胎儿形态结卞句方面的明显畸形作出明确的产前诊断，明显减少出生缺陷，提高人口素质。对于心血管畸形及较小畸形还有待于改进方法，加强规范操作。     

产前超声诊断胎儿尿道下裂进展

尿道下裂是胎儿常见泌尿系统先天畸形。产前二维及三维超声检查均可用于诊断胎儿尿道下裂,二者联合可提高诊断效能;在此基础上进行彩色多普勒超声检查可进一步明确尿道开口位置,提高诊断准确率,降低误诊率。本文对产前超声诊断胎儿尿道下裂进展进行综述。     

硬膜外分娩镇痛对胎儿脐动脉和大脑中动脉血流的影响

目的运用多普勒超声观察硬膜外分娩镇痛对胎儿脐动脉和大脑中动脉血流的影响。方法选择要求硬膜外分娩镇痛的产妇59例(R组),同时选取拒绝分娩镇痛产妇25例(N组)。记录产妇产程时间、出血量、分娩方式、新生儿情况。当宫口开至2 cm时,R组记录镇痛前(T0)、镇痛后15 min(T1)、镇痛后30 min(T2)和镇痛后60 min(T3)胎儿大脑中动脉、脐动脉阻力指数(RI)、搏动指数(PI)和最大峰值血流速度/舒张末期血流速度(S/D),N组在相同时间间隔记录上述参数。结果两组产妇产程时间、出血量及分娩方式差异无统计学意义。T0~T2时,R组胎儿大脑中动脉、脐动脉PI和S/D有下降趋势,大脑中动脉RI有增加趋势,但组内差异无统计学意义。N组在各时点无明显改变,组间差异无统计学意义。结论硬膜外分娩镇痛对母婴无明显影响,不良反应少,有很好的临床应用价值。     

先天性血管环产前超声诊断价值和意义

目的探讨产前超声诊断及鉴别诊断先天性血管环中完全性血管环的临床价值和意义。方法将经超声产前检查结合产后影像学检查或者引产后病理确诊的完全性血管环胎儿12例为研究对象,分析其产前超声的主要表现。结果本组中1例双主动脉弓构成完全性血管环,9例右主动脉弓、左位动脉导管、左锁骨下动脉构成完全性血管环,2例右位主动脉弓、左位动脉导管、迷走左无名动脉构成完全性血管环。结论临床产前诊断先天性完全性血管环最重要的切面为三血管气管,产前超声检查能较准确的诊断以及鉴别诊断常见的先天性完全性血管环,临床应用价值肯定。     

医源性股动脉假性动脉瘤的超声诊断与治疗

目的评价彩色多普勒超声在医源性股动脉假性动脉瘤诊治中的价值。方法对13例股动脉插管术后穿刺部位触及搏动性肿物、闻及血管杂音的患者,采用Philipsiu22彩色超声诊断仪进行二维、彩色多普勒、频谱多普勒超声检查,观察其大小、形态、内部回声及血流形态、频谱特征,对明确诊断者,在超声引导下进行压迫。结果13例临床上高度怀疑假性动脉瘤形成的患者均通过彩色多普勒超声检查明确诊断,且在超声引导下进行压迫,成功闭合动脉破裂口。结论彩色多普勒超声是医源性股动脉假性动脉瘤的首选诊断、治疗方法。     

Umbilical artery Doppler velocimetry in the prediction of intrapartum fetal compromise.

The value of early intrapartum umbilical artery Doppler velocimetry in the prediction of fetal compromise was studied. One hundred patients were recruited into the study and fetal compromise was diagnosed by abnormal first- or second-stage fetal heart rate traces, a 5-minute Apgar score less than 7, or the development of hypoxic ischaemic encephalopathy. Fetal compromise developed in 30 patients. An umbilical artery resistance index (RI) of 0.66 or less did not predict fetal compromise (sensitivity 13%, specificity 89%, positive predictive value 25%, negative predictive value 70%). Since the mean umbilical artery RI was identical in the compromised and the non-compromised groups, we conclude that early intrapartum Doppler velocimetry is of very little clinical value in predicting fetal compromise at term.     

彩超辅助下的皮下深部软组织内海绵状血管瘤的诊治

目的　准确、有效地对皮下深部软组织内海绵状血管瘤进行诊治。方法　 1996年以来对 15例海绵状血管瘤患者采用彩色多普勒超声仪 (CD)确定血管瘤的诊断、定位 ;并在直接引导下行铜针栓塞治疗或者手术切除治疗。术后 2周～ 1年再以 CD对治疗效果进行判定与监测。结果　 10例患者行直接引导下铜针穿刺 ,2例在 CD引导下直接铜针穿刺进行栓塞治疗 ,3例患者经手术切除 ,均取得满意效果。结论　在非创伤性的 CD辅助下 ,皮下深部软组织内的海绵状血管瘤可以明确诊断 ,采用铜针栓塞治疗或切除术可以达到更准确而有效的治疗效果     

超声对泼尼松治疗亚急性甲状腺炎停药指标的判断价值

目的探讨二维超声结合彩色多普勒血流显像（CDFI）对亚急性甲状腺炎的诊断价值和泼尼松停用指标的判断。方法66例亚急性甲状腺炎患者应用二维超声结合CDFI效应动态观察甲状腺声像图,在使用泼尼松治疗后,随机分为超声观察停药组36例和临床症状停药组30例,观察两组复发情况。结果声像图主要表现为病灶区回声减低,CDFI示病变周边血流较丰富,病灶内动脉血流特点为低速低阻型。超声观察停药组复发率8．33％（3／36）,明显低于临床症状停药组的26．67％（8／30）,两组比较差异有统计学意义（P〈0．05）。结论二维超声结合CDFI可以诊断和指导亚急性甲状腺炎的治疗,为病情评价提供客观依据。     

A case of jugular phlebectasia: usefulness of color Doppler ultrasonography in the diagnosis

We present a rare case of jugular phlebectasia, which was able to be diagnosed by a color Doppler sonography. A 69-year-old female patient complained of a painless neck mass on the left side and consulted our hospital. MRI showed a round and regular mass with a diameter of 2.5 cm. B-mode ultrasonography showed a soft, tubular mass in addition to the common carotid artery. In addition, color Doppler sonography revealed a very slow (about 6 cm/sec) turbulent flow in the mass. Valsalva maneuver immediately stopped the slow flow in the mass and increased the diameter. These findings were immediately resolved after the termination of the Valsalva maneuver. The patient was diagnosed as having jugular phlebectasia, and was conservatively followed up. The specific findings of ultrasonography and color Doppler sonography were very useful to diagnose, non-invasively, jugular phlebectasia, a very rare disorder.     

二维及彩色多普勒超声诊断桥本甲状腺炎

目的评价二维及彩色多普勒超声对桥本甲状腺炎（HT）的诊断价值。方法收集确诊为HT的患者65例（病例组）行甲状腺超声检查,另选取60名甲状腺正常者作为对照组,记录甲状腺的大小、回声、甲状腺实质的血流分布状况、伴发结节情况、甲状腺上动脉血流参数、病理改变和临床化验指标等。结果病例组甲状腺体积明显大于对照组（t=10.748,P〈0.001）,甲状腺回声不同程度弥漫性对称减低（51/65,78.46%）,甲状腺内弥漫分布线样强回声（46/65,70.77%）,单发或多发桥本结节（6/65,9.23%）;彩色多普勒血流显像（CDFI）表现为血流明显增加（36/65,55.38%）、血流轻度增加（25/65,38.46%）、血流减少或未见明显变化（4/65,6.15%）。3种现象间的T3、T4、TSH、Vmax差异有统计学意义（P〈0.001）。结论HT的二维超声影像、CDFI表现、临床生化及病理表现关系密切,超声对于HT的诊断及鉴别诊断具有较高的价值。     

Clinical implications of power Doppler three-dimensional ultrasonography

Power Doppler ultrasonography displays an estimate of the entire power contained in that part of the received radiofrequency ultrasound signal for which a phase shift corresponding to the motion of the target is detected. In contrast, conventional color Doppler imaging displays Doppler frequency shift information. Few reports have been published on the clinical utility of three-dimensional power Doppler ultrasonography in vascular patients. This study analyzed our experience of the clinical utility of this technology. Fifty-three patients selected out of 281 who were referred to our vascular laboratory underwent both conventional color duplex ultrasonography and power Doppler ultrasonography for the following indications: the question of subtotal versus total arterial occlusion, tortuous artery with limited imaging on color duplex ultrasonography, the presence of significant disease by Doppler ultrasonography with limited imaging, deep-lying arteries with an obscure orifice (e.g., renal artery), and heavily calcified arteries. The power Doppler ultrasonography portion of the examination was considered of positive diagnostic value if the final impression was different from that of conventional color duplex ultrasonography. A positive diagnostic value was achieved in 22 of 29 (76%) carotid artery examinations, 10 of 14 (71%) peripheral artery examinations, 4 of 5 (80%) renal artery examinations, and 3 of 5 (60%) aortoiliac examinations. Overall, positive diagnostic value was achieved by adding power Doppler ultrasonography in 39 of 53 patients (74%). Five of six patients (83%) who were felt to have carotid occlusion by color duplex ultrasonography were confirmed to have subtotal occlusion by power Doppler ultrasonography. Similarly, 6 of 8 patients (75%) with questionable subtotal versus total peripheral arterial occlusion by color duplex ultrasonography were confirmed to have subtotal occlusion by power Doppler ultrasonography. Four of five patients' (80%) renal examinations had a positive diagnostic value, which included three patients in whom the orifice of renal arteries was not seen by color duplex ultrasonography. Three-dimensional power Doppler ultrasonography can be more readily applied to clinical practice. Power Doppler ultrasonography is capable of defining the severity or extent of vascular disease, particularly in differentiating subtotal from total arterial occlusion.     

超声影像及彩色多普勒血流显像技术在成骨肉瘤诊断中的应用价值

作者通过１０１例成骨肉瘤的超声影像对比分析，论述了成骨肉瘤的超声图像及彩色多普勒血流显像的特征与结果。证实此种检查不仅能显示其骨质破坏、骨膜反应的特异性表现，而且还能清晰显示其周围软组织肿物，证实了超声影像在成骨肉瘤诊断中的应用价值。     

Increased locoregional blood flow in brain tumors after cervical spinal cord stimulation

OBJECT: Patients with high-grade gliomas have poor prognoses following standard treatment. Generally, malignant brain tumors have a decreased blood flow that results in increased resistance to radiation and reduced delivery of chemotherapeutic agents and oxygen. The aim of the present study was to assess the effect of spinal cord stimulation (SCS) on locoregional blood flow in high-grade tumors in the brain. METHODS: Fifteen patients (11 with Grade III and four with Grade IV brain tumors) had SCS devices inserted prior to scheduled radiotherapy. Both before and after SCS, the patients underwent the following procedures: 1) single-photon emission computerized tomography (SPECT) scanning; 2) middle cerebral artery (MCA) blood flow velocity measurements (centimeters/second) with the aid of transcranial Doppler (TCD) ultrasonography; and 3) common carotid artery (CCA) blood flow volume quantification (milliliters/minute) based on time-domain processing by using color Doppler ultrasonography. The indices demonstrated on SPECT scanning before SCS were significantly lower (p < 0.001) in tumor sites compared with those in peritumoral sites (32%) and healthy contralateral areas (41%). Poststimulation results revealed the following: 1) a mean increase of 15% in tumor blood flow in 75% of patients (p = 0.033), as demonstrated on SPECT scanning: 2) a mean increase of greater than 18% in systolic and diastolic blood flow velocities in both tumorous and healthy MCAs in all but one patient (p < 0.002), as exhibited on TCD ultrasonography; and 3) a mean increase of greater than 60% in blood flow volume in tumorous and healthy CCAs in all patients (p < 0.013), as revealed on color Doppler ultrasonography studies. CONCLUSIONS: Preliminary data show that SCS can modify locoregional blood flow in high-grade malignant tumors in the brain, thus indicating that SCS could be used to improve blood flow, oxygenation, and drug delivery to such tumors and could be a useful adjuvant in chemoradiotherapy.