数字减影血管造影对脑梗死患者颈部血管的诊断价值研究

目的:分析数字减影血管造影(DSA)对脑梗死患者颈部血管的诊断价值。方法:选取医院收治的30例行DSA诊断和介入手术治疗的脑梗死患者,所有患者均行CT血管造影(CTA)和磁共振血管造影(MRA)检查,分别比较DSA、CTA及MRA对颈部血管的诊断情况。结果:DSA对脑梗死患者颈部血管狭窄程度的检出率明显高于CTA检查,其差异有统计学意义(x^2=4.71,P<0.05)。DSA对脑梗死患者颈部血管狭窄程度的检出率高于MRA检查,其差异有统计学意义(x^2=8.44,P<0.05)。患者术后颈部血管狭窄率较术前明显下降,其差异有统计学意义(x^2=8.06,P<0.01),神经功能症状明显改善。随访3~24个月,患者均无颈部血管狭窄的发生,其中短暂性脑缺血发作2例,心肌梗死1例,发生新的梗死灶4例,死亡1例。结论:DSA对脑梗死患者颈部血管狭窄程度的检出率高于CTA及MRA检查,对术前诊断脑梗死患者颈部血管狭窄程度具有重要的评估价值;且经介入手术治疗后具有良好的临床疗效,可有效降低颈部血管狭窄率,减轻患者的神经功能症状。     

Acceptability of willingness to pay techniques to consumers

Objective The purpose of this study was to assess and compare the proportion of usable responses and protest votes obtained with two willingness to pay (WTP) techniques, contingent valuation (CV) and discrete choice experiment (DCE) and to assess the acceptability of the techniques to respondents. Setting and participants Pregnant women attending the public antenatal clinics of a Sydney teaching hospital were surveyed. Main variables studied Preference for either Treatment A (artificial rupture of the membranes followed by intravenous oxytocin) or Treatment B (prostaglandin E₂ gel followed by oxytocin if necessary) was assessed. Then WTP for the preferred treatments was assessed using CV and WTP for specific attributes of the treatments in the DCE. In addition, the acceptability of the two techniques was compared in terms of responses deemed to be valid according to defined criteria, protest votes and comments recorded by consumers. Results With the CV, 74% of respondents chose gel and their maximum WTP was Aus$178 compared with $133 for the alternative. A total of 68% of responses were deemed to be valid including 5% who may have been expressing a protest vote. With the DCE, respondents were WTP $55 for every 1 h reduction in the length of time from induction to delivery. A total of 72% of responses were deemed valid and only two of these 258 women were considered to have expressed a protest vote. Conclusions Only a small number of women expressed objections to the use of WTP questions in health‐care and the majority of women completed both questions successfully.     

CT血管造影与数字减影血管造影对颅内动脉瘤的诊断价值分析

目的探讨CT血管造影(CTA)与数字减影血管造影(DSA)诊断颅内动脉瘤的价值。方法对2009年1月一2014年3月我院收治的经手术病理证实的32例颅内动脉瘤患者的临床资料进行回顾性分析,32例均进行CTA与DSA检查比较CTA与DSA颅内动脉瘤诊断率及所测量瘤体大小,并观察CTA与DSA对不同部位动脉瘤的显示情况。结果CTA所测量的瘤体直径、对颅内动脉瘤诊断率及对不同部位的颅内动脉瘤诊断率与DSA比较差异无统计学意义(P0.05)。结论 CTA可对颅内动脉瘤进行早期确诊,联合DSA可进一步确诊。     

Measuring the value of time for methadone maintenance clients: willingness to pay,willingness to accept,and the wage rate

Three measures of the value of time - willingness to pay (WTP) for a reduction in travel time, willingness to accept (WTA) a monetary compensation to forgo it, and the wage rate - are evaluated and compared. WTP and WTA were estimated from the two-part regressions of time price, using contingent valuation methods with primary survey data. Systematic differences are found in comparisons of WTP and WTA with the wage rate.     

Patients' willingness to pay for autologous blood donation

Most cost-effectiveness analyses of autologous blood donation show very small health benefits for a substantial increase in resource utilization. However, these analyses do not consider the psychological benefits of peace of mind to patients participating in the program. In order to quantitate these benefits, we employed contingent valuation methodology to measure the willingness of patients undergoing elective surgery, to pay for autologous blood donation. The internal consistency of patient responses was investigated through correlations of willingness-to-pay values with risk perceptions and patient characteristics. Two hundred and thirty-five patients completed the self-administered questionnaire which included demographic, willingness-to-pay and risk perception questions. Median population willingness to pay for autologous blood donation was approximately $900 per patient. In multivariate analysis, willingness to pay varied significantly with dread of allogenic transfusion, perceived risk of requiring a blood transfusion and income. Patients who participate in autologous blood donation programs value the procedure highly and state they are willing to pay significant amounts out of pocket to assure themselves of available autologous blood. Willingness to pay correlated significantly with factors expected to influence value decisions.     

原发性肝癌血管成像诊断的对比分析

目的：探讨CTA、MRA与DSA在原发性肝癌诊断中的表现及价值。方法：对某医院已确诊为原发性肝癌的29例患者,通过比较分析CTA、MRA与DSA在原发性肝癌诊断之间的共性及差别,探求诊断原发性肝癌的全面、有效方法,便于在临床工作中更有效地选择诊断手段。结果：29例肝癌患者,无论是MSCTA的检出率还是其准确率均明显高于MRA。结论：现阶段MSCTA以其快捷、方便、检出率高等优点,已经成为肝癌血管成像的首选检查方法,其临床应用价值较高。     

CT血管造影在颅内动脉粥样硬化诊断中的应用价值

目的 探讨CT血管造影（CTA）在颅内动脉粥样硬化诊断中的应用价值.方法 以68例拟诊缺血性脑血管疾病患者为研究对象,所有患者均行CTA检查,并行图像处理,观察患者的CTA特点,并与数字减影血管造影（DSA）检查结果作对比.结果 68例患者共检查376条血管.CTA发现112条病灶,诊断正常血管数264条;颅内动脉粥样硬化斑块主要分布于颈内动脉（53条）,大脑前、中、后动脉（共39条）及椎-基底动脉（20条）.狭窄动脉段中,狭窄伴钙化的斑块32条,大部分位于大脑中动脉、颈内动脉的海绵窦段及床突上段、椎动脉的颅内段.对于非钙化斑块,CTA显示模糊.DSA共显示128条病灶,诊断正常血管248条.CTA显示中重度狭窄率[9.31％（35/376）]与DSA[9.31％（35/376）]一致.38例患者临床诊断正确.结论 CTA为一种微创伤的颅内动脉粥样硬化诊断方法,检查耗时少,费用低,且空间分辨率高,适合临床普及应用.     

The comparative information value of radiodiagnostic methods in the detection of stenosing lesions of the major arteries of the head

To define the comparative informative value of different radiation diagnostic techniques, such as transcranial Doppler study (TCDS), duplex scanning (DS) of the great arteries of the head, magnetic resonance angiography (MRA) of vessels of the vessels of Willis and great arteries of the head, digital subtraction angiography (DSA), the authors analyze the results of examination of 15 patients with stenotic lesions of common carotid bifurcations and upper segments of inferior carotids. A full agreement of DSA and MRA findings was revealed in 6 patients; of them 5 and 1 patients had inferior carotid occlusion and subocclusion, respectively. There was mainly a discordance of data on lesion re-evaluation in < 90-99% (MRA revealed a complete lack of blood flow) and < 70% stenosis (changes were estimated as physiological turbulence in the bulb of the inferior carotid while analyzing MR images). A combination of MRA and DS of the great arteries of the head for diagnosis the presence and extent of stenosis and TCDS for evaluation of the activation of collateral circulatory pathways and a cerebrovascular reserve may virtually replace DSA which must probably be used only when the data obtained by different methods.     

两种影像检查对短暂性脑缺血发作颈动脉狭窄的诊断价值

目的 评价颈部血管彩色多普勒超声(彩超)、磁共振血管成像(MRA)对短暂性脑缺血发作(TIA)患者颅外段颈动脉狭窄的价值.方法 选择同时经彩超、MRA检查,并且至少1项检查发现有颅外段颈动脉狭窄的45例TIA患者,再进行全脑数字减影血管造影(DSA),按照北美症状性颈动脉狭窄内膜切除试验(NASCET)计算颅外段颈动脉狭窄率.结果 以DSA诊断为金标准,45例TIA患者180条颅外段颈动脉狭窄分级,诊断的敏感度93.51%,特异度95.15%,准确度94.44%,Kappa=0.735;MRA诊断的敏感度92.21%,特异度94.17%,准确度93.33%,Kappa=0.681;彩超联合MRA诊断的敏感度97.40%,特异度99.03%,准确度98.33%,Kappa=0.872.结论 彩超诊断颅外段颈动脉狭窄的敏感度、准确度均高于MRA,适用于人群初选检查;彩超联合MRA诊断颅外段颈动脉狭窄与DSA一致性较好,但不能完全取代DSA.     

颅内动脉粥样硬化性狭窄CTA与DSA检查的对比分析

目的：探讨CT血管成像（CTA）与数字减影血管造影（DSA）在诊断颅内动脉粥样硬化狭窄中的应用价值。方法：选取缺血性脑血管病患者42例,先行CTA检查,按照狭窄程度的不同,将病变血管分为基本正常（0％～9％）,轻度狭窄（10％～49％）,中度狭窄（30％-69％）和重度狭窄（70％-100％）。其后根据DSA检查作为标准,比较CTA对脑血管狭窄程度的敏感性和特异性。结果：42例患者中CrA发现狭窄血管249条。将CTA诊断结果与DAS结果比较,显示CTA在诊断基本正常、轻度、中度及重度血管狭窄的敏感性和特异性分别为98％和100％、96％和96％、94％和98％、100％和100％。结论：CTA对诊断脑内动脉狭窄具有较高的敏感性和特异性,可作为颅内动脉粥样硬化性狭窄筛选的常规检查方法。     

Convergent validity between a discrete choice experiment and a direct, open-ended method: comparison of preferred attribute levels and willingness to pay estimates

The Discrete Choice Experiment (DCE) has become increasingly popular as a method for eliciting patient or population preferences. If DCE estimates are to inform health policy, it is crucial that the answers they provide are valid. Convergent validity is tested in this paper by comparing the results of a DCE exercise with the answers obtained from direct, open-ended questions. The two methods are compared in terms of preferred attribute levels and willingness to pay (WTP) values. Face-to-face interviews were held with 292 women in Calgary, Canada. Similar values were found between the two methods with respect to preferred levels for two out of three of the attributes examined. The DCE predicted less well for levels outside the range than for levels inside the range reaffirming the importance of extensive piloting to ensure appropriate level range in DCEs. The mean WTP derived from the open-ended question was substantially lower than the mean derived from the DCE. However, the two sets of willingness to pay estimates were consistent with each other in that individuals who were willing to pay more in the open-ended question were also willing to pay more in the DCE. The difference in mean WTP values between the two approaches (direct versus DCE) demonstrates the importance of continuing research into the different biases present across elicitation methods.     

Convergent validity between a discrete choice experiment and a direct,open-ended method: Comparison of preferred attribute levels and willingness to pay estimates

The Discrete Choice Experiment (DCE) has become increasingly popular as a method for eliciting patient or population preferences. If DCE estimates are to inform health policy, it is crucial that the answers they provide are valid. Convergent validity is tested in this paper by comparing the results of a DCE exercise with the answers obtained from direct, open-ended questions. The two methods are compared in terms of preferred attribute levels and willingness to pay (WTP) values. Face-to-face interviews were held with 292 women in Calgary, Canada. Similar values were found between the two methods with respect to preferred levels for two out of three of the attributes examined. The DCE predicted less well for levels outside the range than for levels inside the range reaffirming the importance of extensive piloting to ensure appropriate level range in DCEs. The mean WTP derived from the open-ended question was substantially lower than the mean derived from the DCE. However, the two sets of willingness to pay estimates were consistent with each other in that individuals who were willing to pay more in the open-ended question were also willing to pay more in the DCE. The difference in mean WTP values between the two approaches (direct versus DCE) demonstrates the importance of continuing research into the different biases present across elicitation methods.     

双能量脑动脉CT血管造影在脑动脉瘤诊断中的应用

目的 探讨双能量脑动脉CT血管造影（CTA）在脑动脉瘤诊断中的价值.方法 以数字减影血管造影（DSA）结果为金标准,回顾性分析30例经DSA证实为脑动脉瘤患者的双能量脑动脉CTA影像学特点,比较双能量脑动脉CTA和DSA检查对脑动脉瘤诊断准确性.结果 双能量脑动脉CTA能较好地显示脑动脉瘤的直接征象,对颈内动脉虹吸段的动脉瘤征象显示优于常规脑动脉CTA扫描.对瘤体及瘤颈的测量与DSA有较高的一致性,两种方法比较差异无统计学意义（P＞0.05）.双能量脑动脉CTA辐射剂量为19.1～25.4（21.7±0.5） mSv.结论 双能量脑动脉CTA能够清晰显示脑动脉瘤的瘤体大小及瘤颈,对脑动脉瘤的诊断有较高的临床应用价值.     

血管腔内修复术治疗主动脉夹层动脉瘤

目的 探讨血管腔内修复术治疗主动脉夹层动脉瘤的手术指征，术前评估方法、手术操作技巧、并发症防治原则及临床应用前景。方法 对26例行Stanford-B型主动脉夹层动脉瘤腔内修复术患者的临床资料进行分析。全组均为Stanford-B型，其中4例在不同部位有2个以上裂口，术前采用CT血管造影（CTA）或数字减影（DSA）时主动脉夹层动脉瘤进行评估全组均以带膜支架型人工血管在DSA下行腔内修复术。结果 带膜支架型人工血管成功值入26例（100%）术后随访1-18月，无并发症，无内漏，夹层消失。结论 血管腔内修复术治疗Stanford-B型夹层动脉瘤是一种创伤小、恢复快、安全而有效的方法。     

大脑中动脉闭塞性病变CTA与MRA对照研究

目的：探讨CT血管造影（CT coronary angiography,CTA）及磁共振血管成像（magnetic resonance angiography,MRA）对大脑中动脉闭塞性病变（middle cerebral artery occlusive diseases,MCAOD）的临床诊断价值,并进行对比。方法：医院收治的150例脑血管病患者（300条受检血管）,均经CT血管造影,并结合多平面重组、曲面重组等方法来显示颅内脑动脉狭窄情况,7 d内进一步行MRA检查,并将CTA与MRA的显示情况和结果进行对照分析。结果：在150例患者300条受检的大脑中动脉中,经MRI检查为正常或轻度、中度、重度狭窄的血管条数分别为76、114、110条;经CTA检查正常或轻度、中度和重度的血管条数为66、94、90条,两组差异具有统计学意义,P〈0.01。MRA检查还得到3组之间的平均收缩峰流速,差异有统计学意义,P〈0.01,以重度狭窄流速最快;重度狭窄的CTA表现为主动脉壁呈新月型或环形增厚。结论：CTA和MRA是诊断大脑中动脉闭塞性病变准确性较好的无创性检查方法,而检测的侧重面不同,所以应将两者结合以提高诊断的准确率。     

MRA检查在脑梗死诊断中的敏感性与特异性研究

目的：探讨MR血管造影术（MRA）在脑梗死中的应用价值。方法：选取120例已经过DSA检查确诊的脑梗死患者,并与其术前脑血管MRA检查结果进行分析比较。结果：以DSA为标准,MRA对诊断脑梗死的敏感性83.3%,特异性93.6%,符合率91.4%,MRA与DSA检出率有一致性。结论：MRA与DSA检查结果之间有较高的符合率,可作为脑梗死诊断的重要参考。     

颅脑血管病变的SCTA与DSA诊断价值对比分析

目的探讨螺旋CT血管造影（SCTA）与数字减影血管造影（DSA）技术在颅脑血管病变诊断中的价值和应用。方法选择本院接受CTA与SCTA检查的患者108例,其中98例患者同时进行DSA检查,进行分析。结果108例患者经SCTA检查发现有101例存在脑血管异常,其中动脉瘤39例,脑动脉狭窄48例,CCF10例,脑动静脉畸形4例,7例脑血管正常;98例行DSA检查,有4例与SCTA结果不符,其余与SCTA均相吻合,其中3例SCTA检查出脑动脉畸形,而DSA未发现,1例DSA检出了动脉瘤,而SCTA未检出,SCTA检查发现88例患者脑血管壁有钙化影,血栓附着与血管壁上。结论DSA与SCTA是确诊颅脑血管疾病的重要方法,两者两结合可互相弥补,提高诊断的敏感性和准确性,减低误诊和漏诊率,SCTA可作为确诊脑血管疾病的首选检查方式,利于在临床中使用。     

Test-retest reliability of willingness to pay

We describe the results of a survey designed to assess the test-retest reliability of a method of establishing willingness to pay. Willingness to pay values for a hypothetical intervention were elicited from a randomly selected, population sample by face-to-face interview on three occasions over a period of 5 weeks. Test-retest reliability was assessed by intraclass correlation and by generalizability analysis. Reliability was acceptable but not substantial, and there was a statistically significant shift in mean value between first and second assessments. The greatest source of variation in values was the participants. There was also a substantial interaction between time and participants, suggesting that some respondents changed their answers at follow-up. The results were sensitive to the high valuations provided by four of the participants, however.     

Subject variation more than values clarification explains the reliability of willingness to pay estimates

In a recent article in this journal, Smith offers additional evidence to support his claim that the test-retest reliability of willingness to pay measures increases along with willingness to pay because people take more time to consider their answers for the more highly valued (and therefore more 'expensive') goods. Unfortunately, by repeating a common misconception about what reliability actually measures, he overlooks an alternative explanation for the relationship he observed; namely, that subject variation increases with willingness to pay and that it is this, rather than any reduction in measurement error, that explains his findings. We show that 75% of the increase in reliability comes from increases in subject variation (that is different views about the value of good health), and that the relationship between measurement error and willingness to pay is not as simple as Smith suggests. However, our critique of Smith's paper should not be construed as criticism of the ideas being explored. We need to better understand the responses people give to contingent valuation exercises. Such understanding has to be based on a better appreciation of what reliability is and on more robust testing of alternative hypotheses.     

母婴保健保偿制项目供方提供意愿分析

为了解乡镇卫生和计生服务机构人员对母婴保健保偿制项目的供给意愿,本文用支付卡的形式对其进行了调查,结果表明乡卫生院和乡计生站都愿意提供保偿服务,其中住院分娩的供给意愿最大,平均为201.18元,其次是产前检查,平均为3.23元。另外,卫生服务提供者愿意提供包括较多服务项目的大的服务包,对包括所有服务项目在内的最大的服务包的供给意愿最大,平均为246元。