即时床旁超声心动图在急性胸痛患者病因鉴别诊断中应用价值

目的 探讨即时床旁超声心动图在急性胸痛患者病因鉴别诊断中的应用价值。方法 选取北部战区总医院自2022年11月至2023年2月收治的114例因急性胸痛就诊患者为研究对象。所有患者均在胸痛中心收治30 min内行床旁超声心动图检查。记录床旁超声心动图检查结果与床旁超声心动图检查误诊病例情况。记录并比较床旁超声心动图检查结果与临床确诊结果。结果 114例患者中,床旁超声心动图检测到阳性结果的患者107例,占比93.86%(107/114)。其中,急性心肌梗死90例,主动脉夹层11例,急性肺动脉栓塞6例。床旁超声心动图检查结果与临床确诊结果一致103例,诊断准确率为96.26%(103/107)。急性心肌梗死、主动脉夹层、急性肺动脉栓塞患者的床旁超声心动图诊断准确率比较,差异无统计学意义(P>0.05)。结论 即时床旁超声心动图能快速有效辅助临床明确诊断常见急性胸痛的病因,可对急性心肌梗死、主动脉夹层、急性肺动脉栓塞等常见急性胸痛疾病进行有效鉴别诊断。     

经胸超声心动图诊断肺动脉血栓栓塞症的临床研究

目的探讨经胸超声心动图诊断肺动脉血栓栓塞症（PTE）的价值。方法经临床综合确诊PTE患者61例作为病例组,排除PTE诊断的45例为正常对照组。经胸超声心动图观察肺动脉内有无血栓、各房室腔大小、肺动脉频谱和三尖瓣反流。结果PTE组直接征象右室血栓1例,肺动脉主干及左右分支内血栓28例,间接征象右房、右室扩大,右室壁运动幅度降低,右室射血分数降低,肺动脉内径增宽,下腔静脉呼吸变化率减低,与正常对照组相比较,均有显著性差异（P〈0.01）;肺动脉血流频谱形态呈“拳指征”21例,呈肺高压直角三角形改变者31例,加速时间和减速时间缩短,右室射血前期与右室射血时间比值（RPEP/RVET）增大;不同程度的三尖瓣反流和肺动脉高压。根据临床诊断标准确诊PTE29例,PTE可能性大17例,可疑PTE8例,7例表现右室轻度扩大或轻度肺动脉高压。结论经胸超声心动图作为PTE的诊断方法,安全、无创,有利于PTE的诊断和鉴别诊断。     

彩色多普勒超声心动图在肺动脉栓塞诊断中的应用

目的:探讨经胸彩色多谱勒超声心动图诊断急性肺动脉栓塞的应用价值。材料和方法:对15例经临床综合诊断为急性肺栓塞的患者行经胸超声心动图和周围血管超声检查,并与螺旋CT、肺动脉造影结果相对照,对其中13例患者进行了治疗后超声随访。结果:超声心动图发现单侧肺动脉内附壁栓子7例(左侧3例、右侧4例),双侧肺动脉内及右房和上腔静脉内栓子1例,7例仅表现为右心负荷过重和肺动脉高压,肺动脉内未见明确栓子回声。螺旋CT及肺动脉造影检查结果均与超声心动图相符。结论:经胸彩色多谱勒超声心动图是急性肺栓塞影像学诊断的重要检查手段之一,对临床诊断有很大帮助。     

超声检查在急性肺栓塞诊断中的应用价值

目的 探讨超声检查在急性肺栓塞诊断中的应用价值。方法 对临床综合诊断为急性肺栓塞的15例病人行超声心动图检查，综合分析。结果 经超声心动图检查15例患者，发现右房内血栓1例，肺动脉内血栓1例。15例均有右心负荷过重表现，伴有不同程度的三尖瓣返流，返流速度加快，肺动脉压明显增高。7例发现下肢深静脉内血栓。结论 超声心动图在肺动脉栓塞病人的筛查、评价患者的右心功能及疗效方面有重要价值。     

超声心动图在PDA合并中、重度PH患者封堵术后心脏形态结构变化评估中的价值

目的 探讨超声心动图在动脉导管未闭(PDA)合并中、重度肺动脉高压(PH)患者封堵术后心脏形态结构变化评估中的价值.方法 选取2017年1月～2018年6月在我院治疗的PDA患者50例,其中合并中度PH患者30例,重度PH患者20例,均给予PDA封堵术治疗,手术前后给予超声心动图检查.结果 合并重度PH患者左心房最大前...     

急性肺血栓栓塞症的介入综合治疗

目的评价介入综合治疗急性肺血栓栓塞症(PTE)的疗效。方法7例PTE病人,经肺动脉造影进一步明确栓塞部位后,即采用介入综合治疗(经导管碎栓、抽吸取栓、局部溶栓及下腔静脉滤器置入),观察临床症状、肺动脉开通情况、动脉血氧分压(PaO2)、血氧饱和度(SaO2)、肺动脉平均压(PAPm)。结果所有PTE患者临床症状显著改善,肺动脉完全开通率90%以上;PAPm术前平均31 mmHg降至术后25 mmHg;PaO2术前平均54 mmHg升至术后95 mmHg,SaO2术前平均80%升至术后94%,术后未有再发PTE者。结论介入综合治疗急性PTE能够快速改善血液动力学,降低右心室后负荷,预防PTE复发。     

儿童Berry综合征的影像学特征

目的 分析儿童Berry综合征的临床及影像学特征.资料与方法 回顾性分析5例Berry综合征患儿的临床资料,分析其超声心动图、CT血管成像(CTA)、心导管检查及手术治疗.结果 5例患儿中,2例合并手指畸形,1例合并全面发育落后.5例均行超声心动图及CTA检查,3例行心导管检查,超声心动图及CTA均检出主肺动脉窗Ⅲ型4...     

超声在完全性大动脉转位快速二期大动脉调转术中的临床价值

目的:评价超声心动图在完全性大动脉转位(D-TGA)患者快速二期大动脉调转手术术前、术中及术后的临床价值.方法:33例D-TGA患者行肺动脉环缩(pulmonary artery banding,PAB)锻炼左心室心肌,然后行大动脉调转术(ASO).应用超声心动图观察术前诊断、手术前后左心室的变化及手术结果.结果:33例患者术前诊断均正确.PAB期间,7例患者死亡;26例患者PAB后(10.44±4.07)天行ASO,24例手术成功,2例死亡.PAB前左心室压力较低,PAB后左、右心室压力比从0.46±0.13上升至0.95±0.17(P＜0.01),左心室质量指数从(32.54±9.93)g/m2上升至(58.06±16.94)g/m2(P＜0.01).出院时、术后1个月、术后3个月行超声心动图检查,24例患者主动脉、肺动脉吻合口血流通畅,左心室收缩功能正常.结论:超声心动图可以比较准确地诊断完全性大动脉转位;超声心动图在完全性大动脉转位快速二期大动脉调转术手术时机判断及术后随访中起十分重要的作用.     

肺动脉栓塞诊断的比较影像学

目的评价X线胸片、超声心动图、核素肺灌注扫描、电子束CT（EBCT）、MR肺动脉造影（MRPA）、肺动脉造影（PAG）在肺动脉栓塞（VIE）诊断中的应用价值。方法自2003年7月至2004年3月间临床确诊的PTE患者25例。常规行胸部正侧位摄片、超声心动图、EBCT肺动脉造影、核素肺灌注扫描、MRPA及PAG。PAG由2名有经验医师共同分析每一支肺动脉及其叶段分支，诊断意见作为标准并与其他方法进行对照。结果PAG技术成功率100％，775个受检肺动脉分支中共检出556个分支受累（71．7％）。25例患者中X线胸片提示诊断12例。超声心动图诊断9例，右房室增大21例，肺动脉高压18例。核素肺灌注显像结果显示500个肺段中有247个肺段受累（52．0％），与PAG对照对段的敏感度为64．66％。EBCT肺动脉造影（EBCTPA）的分析显示775个肺肺动脉分支中共有523个主干及叶段分支受累，段以上分支敏感度为94．06％；10例行MRPA的患者中8例检查成功，248各肺动脉分类中共155个分支受累（62．5％），段以上敏感度为81．29％。结论EBCT对PTE的诊断具有较高的敏感度，X线胸片和超声心动图为必不可少的检查手段，EBCT可作为一线影像学诊断方法，核素肺灌注扫描及MRPA可作为二线诊断方法。     

青海省海南州地区藏族肺动脉高压患者超声心动图分析

目的:探讨青海省海南州地区不同病因引起肺动脉高压患者的超声心动图特征.方法:收集2015年3月-2020年3月我院收住的300例肺动脉高压藏族老年患者,对其超声心动图进行分析.结果:300例肺动脉高压患者中以肺源性心脏病相关性肺动脉高压居首,超声表现为右心功能减退、右房右室增大、右房压增高;高血压心脏病相关性肺动脉高压...     

The relationship between pulmonary artery pressure and pulmonary artery diameter in pulmonary hypertension

The pulmonary arteries dilate in response to many factors, principally increased pressure and flow. In patients who have pulmonary arterial hypertension but no increase in flow, we have compared main pulmonary artery size at computed tomography with pulmonary haemodynamic data obtained during right heart catheterisation. In patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension, dilatation correlated with raised pulmonary vascular resistance and reduced cardiac output but not with mean arterial pressure. In patients with chronic lung disease no correlations were shown though a trend between raised pressure and size was observed. We speculate that pulmonary artery compliance is an important factor which determines the degree of dilatation in response to raised pressure. Estimations of pressure cannot be made from measurements of pulmonary artery size without knowledge of the underlying lung disease.     

Traumatic pulmonary artery pseudoaneurysm

Traumatic pulmonary artery pseudoaneurysm is an uncommon cause of a solitary nodule on a chest radiograph. Consideration of this abnormality is important as the lesion can cause fatal hemorrhage. We report a patient with a traumatic segmental pulmonary artery pseudoaneurysm detected by computed tomography and confirmed by intravenous digital subtraction angiography.     

Isolated agenesis of the right pulmonary artery with late manifestation of pulmonary artery hypertension

The case of a woman patient of 25 years of age with acute cardiac decompensation is presented. The chest x-ray as well as the lung scan showed the typical features of absence of the right pulmonary artery. The diagnosis was confirmed angiographically. The sudden and late onset of symptoms of pulmonary hypertension is a remarkable feature.     

肺动脉肉瘤与肺动脉血栓栓塞影像学对比分析

原发性肺动脉肉瘤（pulmonary arterial sarcoma,PAS）发病率非常低,自1923年Mandelstanma首次报道以来,英文文献共报道约200例,我院自2000年-2008年发现并确诊原发性肺动脉肉瘤3例。原发性肺动脉肉瘤在影像学上极易误诊为肺动脉血栓栓塞（puhnon aryarterial thromboembolism,PTE）。作者回顾性分析了此3例原发性肺动脉肉瘤的影像学表现,并与50例肺动脉血栓栓塞的影像学表现比较,初步总结两者的影像学鉴别诊断要点。     

Coronary artery to pulmonary artery collaterals in nonspecific aortoarteritis involving the pulmonary arteries

We report a patient with nonspecific aortoarteritis (Takayasu's disease) in whom occlusion of the right upper lobe pulmonary artery was associated with collateral flow from the left circumflex coronary artery. Coronary to pulmonary artery collaterals are rare in this disease but have important clinical implication because of their ability to produce coronary steal and myocardial ischemia. Awareness of these pathways is essential for their detection in patients with angina-like symptoms and for differentiation of myocardial ischemia due to direct coronary artery involvement by this disease.     

CT-determined pulmonary artery diameters in predicting pulmonary hypertension

This study was to determine if the diameters of pulmonary arteries measured from computed tomographic (CT) scans could be used 1) as indicators of pulmonary artery hypertension and 2) as a reliable base for calculating mean pulmonary artery pressure. The diameters of the main, left, proximal right, distal right, interlobar, and left descending pulmonary arteries were measured from CT scans in 32 patients with cardiopulmonary disease and in 26 age- and sex-matched control subjects. Diameters were measured using a special computer program that could display a CT density profile of the artery and its adjacent tissues. The upper limit of normal diameter for the main pulmonary artery was found to be 28.6 mm (mean + 2 SD). In the patient group, the diameters were correlated with data from cardiac catheterization. In these patients, a diameter of the main pulmonary artery above 28.6 mm readily predicted the presence of pulmonary hypertension. The calculated cross-sectional areas of the main and interlobar pulmonary arteries (normalized for body surface area [BAS]) were found to give the best estimates of mean pulmonary artery pressure (r = 0.89, P less than 0.001 and r = 0.66, P less than 0.001). Multiple regression analysis gave the useful equation: mean pulmonary artery pressure = -10.92 + 0.07646 X area of main pulmonary artery/BSA + 0.08084 X area of the right interlobar pulmonary artery/BSA (r = 0.93, P less than 0.0001). Because CT allows precise, noninvasive measurement of the diameter of pulmonary arteries, it can be of value in detecting pulmonary hypertension and estimating mean pulmonary artery pressure.