“3+1”复合超声切面在胎儿心脏畸形筛查中的应用

目的探讨"3+1"复合超声切面(四腔心切面+左、右心室流出道切面+三血管切面)在胎儿心脏畸形筛查中的应用价值。方法收集接受产前超声检查的孕妇4 802例,均为单胎。对每一个胎儿分别扫查四腔心基本切面、左、右心室流出道切面和三血管切面,并对图像进行评价。超声诊断为CHD的胎儿及其疾病类型均经产前诊断中心或尸体检查证实。结果 4802胎中共检出CHD胎儿35胎。3种方法对CHD的检出率由低到高依次为:四腔心切面、四腔心切面+左、右流出道切面、四腔心切面+左、右流出道切面+三血管切面[68.57%(24/35),77.14%(27/35)、100.00%(35/35),P0.05]。四腔心切面+左、右心室流出道切面+三血管切面对永存左上腔及右位主动脉弓的检出率均高于四腔心切面、四腔心+左、右心室流出道切面[100.00%(3/3)、100.00%(5/5),0(0/3)、0(0/5),0(0/3)、0(0/5);P0.05];四腔心切面+左、右心室流出道切面和"3+1"复合超声切面,对双主动脉弓的检出率相同[100.00%(1/1)、100.00%(1/1)],且均高于四腔心切面[0(0/1)、P均0.05)]。结论 "3+1"复合超声切面可快速、准确筛查胎儿CHD,具有较高临床应用价值。     

彩色多普勒超声筛查胎儿先天性心脏病的临床价值

目的探讨胎儿心脏超声在先天性心脏病筛查中的应用价值。方法对接受产前系统胎儿2892例孕妇采用彩色多普勒超声诊断仪进行胎儿四腔心、左右室流出道及三血管切面的四切面扫描,进行对比研究。结果产前经超声筛查出先天性心脏畸形13例,10例经产后超声心动图证实,3例经引产后尸解证实,漏诊1例小的室间隔缺损,1例主动脉弓缩窄,发病率为0.52%(15/2892)。胎儿心脏超声筛查胎儿心脏畸形准确率为86.67%(13/15),产前经超声检出的先天性心脏畸形13例,其中8例(61.54%)表现为四腔心切面异常,4例(30.77%)表现为左心室流出道切面、右心室流出道切面异常,1例(7.69%)表现为三血管或三血管气管切面异常。结论产前胎儿心脏超声筛查在胎儿心脏具有重要的临床意义。     

超声检查胎儿严重先天性心脏畸形12例漏诊及误诊的分析

目的:探讨超声筛查胎儿心脏及大动脉异常的检出率和诊断率的有效方法及注意事项。方法:应用二维超声图像对胎儿心脏进行四腔切面、左室流出道、右室流出道切面等心脏解剖结构检查,再用彩色多普勒血流图对胎儿心脏进行血流方向及速度的观察。结果:12例严重先天心脏畸形,其中误诊8例,漏诊4例。结论:超声医生对先天性心脏病知识的系统学习是提高筛查质量的关键。     

体外循环下发绀型先心病复杂畸形矫形术麻醉1例

病例女,4岁7个月,体重14kg。术前诊断：发绀型先心病、法洛四联征（室间隔缺损、主动脉骑跨、右心室流出道梗阻和右心室肥厚）、房间隔缺损、动脉导管未闭、左肺动脉缺如（左肺血流由主动脉分出的动脉导管供给）、肺动脉高压、心功能Ⅳ级。患者入院后多次因哭闹发生紫绀,术前1个月需持续应用正性肌力药物维持生命,鼻导管吸氧治疗。     

100例法洛氏四联症心血管造影表现

作者对100例经过外科完全性纠正手术的婴幼儿法洛氏四联症的心血管造影进行分析。年龄为六月到三岁之间,男58例,女42例。所有资料通过电子计算机处理。对右心室流出道、室间隔交通及主动脉移位、各心腔及室间隔、以及伴有的其他畸形等四个方面,分别进行了详细的分析及探讨。右心室流出道:(1)漏斗部狭窄——仅一例正常,广泛性狭窄12例,局限性狭窄占极大多数,87例。狭窄位于口部最多,64例,中部21例,位于远侧的仅2例。为瞭解漏斗部狭窄的程度,可进行“漏斗指数”的测量,方法如下:侧位片舒张期,测量狭窄段最小间距,以毫米为单位,乘以100作为分子;测量佛氏窦上方主动脉宽度作为分母。本组能进行测量的98例,所得平均比值为49%。指数     

彩色多普勒诊断先心病551例的经验总结

本文报告了551例手术证实的先心病的彩色多普勒诊断（彩超），旨在分析彩超对各种先心病的诊断价值。包括室间隔缺损（VSD），房间隔缺损（ASD），动脉导管未闭（PDA），法乐氏四联症（F4），法乐氏三联症（F3），主动脉窦瘤破裂（ASAR），心内膜垫缺损（ECD），房壁瘤（AWA），双腔右心室（DCRV）九种畸形。方法本组551例，男305例，女246例，年龄2～37岁（平均8．5岁）。使用Hp77020彩色超声诊断仪，探头频率为2．5～3．5MHz。病人平卧位或左侧卧位，取胸骨旁左室长轴、心底短轴、主肺动脉长轴、胸骨套四腔、心尖四腔和二腔、…     

超声筛查胎儿心脏畸形

目的: 探讨超声筛查胎儿先天性心脏畸形的可行性及应用价值.材料和方法: 对5000例产前超声检查者常规观察胎儿心脏四个切面,即四腔心、左室流出道、右室流出道、三血管平面,疑有异常者行超声心动图检查.结果: 超声检查发现25例先天性心脏畸形,其中22例引产尸解证实,3例出生后超声心动图复查证实.漏诊室间隔缺损3例,房间隔缺损3例.结论: 胎儿心脏四个切面筛查能发现绝大部分先天性心脏畸形,包括大血管畸形,但易漏诊小的室间隔缺损及房间隔缺损.     

彩色多普勒超声在胎儿先天性心脏病筛查中的临床价值分析

目的探讨产前彩色超声在胎儿先天性心脏病筛查中的临床价值。方法对3267例孕妇的胎儿心脏进行四腔心、左右室流出道、三血管切面、主动脉弓及动脉导管弓等切面进行扫查,并与引产后胎儿尸检结果或产后新生儿超声心动图检查结果进行对比研究。结果产前经超声筛查出先天性心脏畸形12例,9例经产后超声心动图证实吻合,3例经引产后尸解证实,漏诊2例室间隔缺损,1例主动脉弓缩窄,发病率为0.46%。胎儿心脏超声筛查胎儿心脏畸形准确率为80%。产前经超声检出的先天性心脏畸形12例,其中7例(58.33%)表现为四腔心切面异常,7例(58.33%)表现为左、右心室流出道切面异常,7例(58.33%)表现为三血管或三血管气管切面异常。结论产前行彩色多普勒超声筛查可发现心脏畸形,对优生优育有重要意义。     

产前超声筛查胎儿先天性心脏病的临床价值分析

目的探讨胎儿超声心动图(FECG)产前筛查胎儿先天性心脏病(CHD)的临床应用价值。方法采用四腔心、左室流出道、右室流出道、三血管切面四切面法,对6 500例孕20～41周孕妇进行产前FECG筛查,以引产后尸解或产后新生儿ECG作为对照标准。结果 6 500例胎儿中,检出胎儿心脏异常69例,包括复杂性先天心脏病部分合并心外畸形39例。结论四切面检查方法简便可靠,是显示胎儿心脏结构及产前筛查胎儿CHD的重要影像诊断方法。     

正常单胎孕11～14^＋6周胎儿超声心动图研究

目的探讨孕11-14^＋6周行胎儿超声心动图扫查的可行性。方法经腹扫查322例11～14^＋6周正常单胎胎儿心脏,尽量取得四腔心切面、左右室流出道切面及三血管切面、主动脉长轴切面,分析不同孕周各切面的显示情况。结果相同孕周心脏各主要切面显示率不同,不同孕周同一切面显示率亦不同。随孕周增大,各切面显示率逐渐提高。孕11～11^＋6周、12-12^＋6周及13-13^＋6周各切面显示率组间比较差异有统计学意义（P〈0．05）,但13—13^＋6周与14～14^＋6周四腔心切面显示率差异无统计学意义（P〉0．05）。不同孕周,四腔心切面显示率最高,三血管切面显示率最低。13周后,心脏各个切面显示率可达80～90％。结论于早孕晚期和中孕早期行胎儿超声心动图扫查,有利于早期发现胎儿严重先天性心脏病。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.