缺血性脑血管病患者颅内与颅外颈动脉粥样硬化危险因素的对比分析

目的 对比分析缺血性脑血管病患者颅内和颅外颈动脉粥样硬化的危险因素,以更有针对性地进行干预治疗.方法 对124例缺血性脑血管病患者进行TCD、MRI和彩色多普勒超声检查,依据结果 分出颅内动脉粥样硬化组和颅外颈动脉动脉粥样硬化组,对比分析两组动脉粥样硬化的危险因素.结果 (1)颅内动脉粥样硬化组高血压病患病率65.8%高于颅外颈动脉粥样硬化组33.3%.(2)颅外颈动脉粥样硬化组血浆同型半胱氨酸(Hcy)浓度[17.51(21.13～12.68)μmol/L]和年龄(73.57±11.83 岁)均高于颅内动脉粥样硬化组[13.29(17.43～10.18)μmol/L、68.76±7.23岁],差异均有统计学意义(P ＜0.05).结论 缺血性脑血管病患者中,高血压病容易导致颅内动脉粥样硬化的形成;Hcy浓度增高和年龄增长更易导致颅外颈动脉粥样硬化的形成.     

急性缺血性脑血管病患者脑动脉粥样硬化的分布

目的 分析国内缺血性脑血管病人颅内外颈动脉粥样硬化的程度和分布,以指导脑血管病的治疗和预防。方法 通过经颅和双功能彩色多普勒超声检测颅内外血管,检测动脉粥样硬化程度,并参照其病史、CT或MRI检查及生化指标综合分析。结果 201例患者,颅内颈内动脉及分支狭窄75人,患病率为37%,颅外颈动脉大于50%狭窄的有50例,患病率为25%,其中12例为颈内动脉闭塞,患病率为6%,糖尿病是造成颅内外血管狭窄的危险因素之一。结论 脑梗塞患者颅内血管病变是发病的原因之一。同时发现颅外血管病变日益增多。     

脑梗死与颅外大动脉粥样硬化的关系

目的探讨急性脑梗死患者主动脉和颈动脉粥样硬化的发生情况及特点,以及颅外大动脉粥样硬化与脑梗死的关系。方法对120例急性脑梗死患者进行颈动脉和心血管系统的彩色超声多普勒检查。结果检出颈动脉粥样硬化斑块患者83例(69.17%)。颈动脉重度狭窄11例(9.17%),具有主动脉粥样硬化征象92例(76.67%)。脑梗死与颈动脉粥样硬化斑块非同侧组单纯主动脉硬化发生率80.43%(38/46),明显高于脑梗死与颈动脉斑块同侧组的63.51%(54/74,P<0.05)。结论主动脉粥样硬化是除颈动脉斑块外,脑梗死的一个重要危险因素。我国脑梗死患者颈动脉粥样硬化斑块发生率较高,而颈动脉狭窄程度则较低。     

颈动脉超声检查对缺血性脑血管疾病的预防意义

目的 探讨缺血性脑血管疾病与颈动脉粥样硬化之间的关系。方法缺血组为2001—10／2003-12期间平顶山煤业集团总医院神经内科的住院及门诊脑血管病患者201例，入院后立即行颈动脉超声检查。对照组为同期在门诊进行体检的单位职工，同样进行颈动脉超声检查，将两组的结果进行比较。结果缺血组粥样硬化的检出率缺血组为94．0％，对照组为7．5％，血管内膜增厚检出率缺血组为60．2％，对照组5．0％；血管狭窄检出率缺血组为16．4％，对照组为1．9％，动脉粥样硬化斑检出率缺血组为40．3％，对照组为0．6％。结论颈动脉超声检查能确定颈动脉粥样硬化的性质、稳定性、动脉狭窄的程度，为预防缺血性脑血管疾病提供客观依据。     

缺血性脑血管病患者的颈动脉粥样硬化临床研究

目的分析国人颈动脉粥样硬化（CAS）斑块发病特征及与缺血性脑血管病的相关性。方法以2006年6月至2009年6月在安徽铜陵有色职工总医院神经内科住院的164例急性缺血性脑血管病患者为研究对象,应用超声诊断仪检测双侧颈动脉,评价粥样硬化斑块的发病部位、形态、大小与数目,采用非条件多元逻辑回归分析颈动脉粥样硬化的危险因素及与缺血性脑血管病的关系。结果85.9%（141/164）患者存在不同程度颈动脉粥样硬化。颈动脉粥样硬化病变特点以斑块多见（134/164,81.7%）,中重度狭窄发生率较低（26/164,15.8%）;颈动脉斑块以颈总动脉分叉处最多见（69/134,51.4%）。斑块发生率及颅外段颈动脉狭窄程度与脑血管病危险因素有明显相关性。结论缺血性脑血管疾病患者颈动脉粥样硬化病变可能以斑块居多,颈动脉粥样硬化与缺血性脑血管病有关。     

颈动脉粥样硬化与冠心病相关性研究探讨

目的研究探讨颈动脉粥样硬化（CAS）与冠心病（CHD）的相关性。方法102例患者分为冠心病组（62例）,对照组（40例）。冠心病依据冠脉造影诊断;颈动脉粥样硬化用多普勒超声诊断仪检测。结果对照组颈动脉超声未见狭窄,5例（12．5％）发现颈动脉粥样斑块,收缩期颈内动脉血流速（IC）／颈总动脉血流速（CC）〈0．8。冠心病组颈动脉超声1例（1．6％）,左颈总动脉完全闭塞,其余未见狭窄;53例（85．5％）发现颈动脉粥样斑块,收缩期颈内动脉血流速（IC）／颈总动脉血流速（CC）〉0．8,与对照组比较均有显著差异。但多普勒检测两组收缩期血流峰值速度（PFVS）无显著差异。结论颈动脉粥样硬化与冠心病密切相关,动脉粥样硬化是心脑血管疾病的病理基础间接反映冠状动脉硬化情况。颈动脉和冠状动脉病变具有相同的致病因素,颈动脉粥样硬化与冠状动脉狭窄之间呈线性正相关,有症状的颈动脉狭窄更是被列为冠心病等危症。     

缺血性脑卒中患者颈动脉颅外段CT血管造影与彩超检测比较

缺血性脑血管病在脑血管病中占56．6％～80％，且以颈动脉系统为常见。颈动脉粥样硬化造成管腔狭窄引起血流减少或自身破裂后脱落组织导致远端动脉闭塞，因此，越来越多的学者关注颈动脉颅外段粥样硬化的情况。近年来，多层螺旋CT及其后处理技术得到飞快的发展，CT血管造影（CTA）成像可以观察缺血性脑卒中患者颅内外血管的改变。作者运用多层螺旋CT对30例缺血性脑血管病患者进行颈CTA检查，同时作颈动脉彩色多普勒检测，现将结果分析如下。     

脑梗死与颈动脉超声的关系

脑血管病是基层医院的常见病、多发病,缺血性脑血管病更常见。在众多的缺血性脑血管病的危险因素中,颅外段颈动脉粥样硬化占有相当大的比例,针对颈动脉粥样硬化的各种药物、颈动脉狭窄的介入及手术治疗已成为预防该病的重要措施。行颈动脉超声检测动脉的硬化程度,可为临床预防脑梗死提供参考。我院2004年8月-2005年8月对收治的58例脑梗死患者进行颈动脉超声检测,选择同期20例健康者作对照,探讨颈动脉粥样硬化与脑梗死的关系。     

急性脑梗死患者的颈动脉超声及头部MRI的特征分析

[目的]探讨颈动脉粥样硬化及颅内外动脉狭窄与脑梗死的关系,为脑梗死的防治提供客观依据.[方法]对220例急性脑梗死患者行颈动脉超声及头部磁共振(MRI)检查,分析颈动脉粥样硬化斑块及颅内外动脉狭窄与脑梗死的关系.[结果]220例患者中145例(65.9%)检出有颈动脉粥样硬化斑块,梗死侧斑块的发生率为66.8%;38例(17.3%)发现有颈动脉中重度狭窄,28例(73.7%)在梗死灶同侧;48例(21.8%)有颅内动脉狭窄,32例(66.7%)梗死灶在狭窄动脉的供血区域.梗死侧颈动脉粥样硬化斑块的发生率及颅外颅内动脉的狭窄率明显高于非梗死侧.[结论]颈动脉粥样硬化斑块及颅外颅内动脉狭窄与脑梗死密切相关.高龄、高血压、糖尿病、高胆固醇及甘油三酯及吸烟是颈动脉粥样硬化斑块形成的危险因素.     

高频彩超提高脑梗塞颈动脉异常的检出率

目的 利用１０ＭＨｚ高频彩超研究及梗塞患的颈动脉粥样硬化发生率及病变程度,以及药物治疗的前后对比观察。方法 观察１０６例脑梗塞患和５０例非脑梗塞对照组的颅外颈动脉粥样硬化程度,并对比１２例脑梗塞患颈动脉病灶中药治疗前后声像图的改变。结果 脑梗塞组内膜至中层增厚的发生率为８６．８％,对照组１８％（Ｐ〈０．０１）,颈动脉粥样斑块的脑梗塞组发生率为７７．３％,对照组１８％（Ｐ〈０．０１）,脑梗塞组     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.