实时肝脏超声造影过程中的护理配合

<正>肝脏各种占位的生长均有其血流动力学规律以及供血与灌注的特征[1]。近年来,随着超声造影剂和造影成像技术等方面的不断进步,特别是新型第2代造影剂注射用六氟化硫微泡[2](Sono Vue声诺维)在临床的广泛应用,为肝脏占位性病灶的鉴别诊断提供了新方法。肝脏超声造影的成功与护理工作的密切配合是分不开的,它保证了造影的顺利进行、造影剂的良好显影,对诊断起着重要的作用。我科于2013年1~     

105例乳腺超声造影的护理配合与体会

目的探讨超声造影新技术在诊断乳腺疾病中的发展。方法利用超声造影剂微泡及其匹配成像技术，显示乳腺病灶造影灌注全过程，阐述造影过程中护理方法。结果通过105例乳腺超声造影及良好护理，对乳腺占位性疾病进行定位、定量诊断105例，受检者无1例出现不良反应。结论由于声诺维不同于其它药物，在使用时需要护理人员认真掌握其操作方法及其注意事项，以确保医师成功完成造影检查。     

肝脏超声造影临床应用中的护理配合

<正>超声造影又称对比增强造影,是超声影像诊断学领域的一个新里程碑,尤其是第二代超声微泡造影剂SonoVue(声诺维)2001年投入临床使用以来,超声造影在鉴别肝脏占位性病变性质上已得到了广泛应用,从而提高了超声对肝脏疾病诊断的敏感性和特异性[1]。肝脏超声造影的成功与护理工作的密切配合是分不开的,它保证了造影的顺利进行、造影剂的良好显影,对协助诊断起着重要的作用。我科于     

超声微泡造影剂在甲状腺肿瘤鉴别诊断中的研究

<正>通过使用微泡型增强显像造影剂,来达到组织微观显像的目的的超声造影技术,是目前超声领域最前沿的技术,也是近十年来医学影像界研究的热点,目前在肝脏占位性病变中已经应用较为成熟[1]。微泡型超声造影剂声诺维良好的血池成像特性已经得到了公认,然而在甲状腺疾病中的使用依然处于探索阶段,国内外鲜有报道,现有的报道显示关于其使用方法和价值存在较大的争议[2,3],至今未形成公认的良恶性鉴别诊断标准,亦未有大样本前瞻性研究证实常规超声联     

两种不同静脉穿刺部位对肝肿瘤患者超声造影的护理分析

目的 探讨超声造影中护理要点,以提高超声造影质量.方法 回顾162例肝脏肿瘤患者超声造影检查,按造影静脉留置针选取位置分为肘部静脉组128例和手背静脉组34例,比较两组造影一次性成功率.结果 162例肝肿瘤患者共行220次超声造影检查,其中肘部静脉组造影174次,成功174次,成功率100％,手背静脉组造影46次,成功42次,成功率91.3％.肘部静脉组和手背静脉组超声造影成功率比较差异有统计学意义,肘部静脉组造影成功率高于手背静脉组.结论 正确的注射方式、合适的注射部位及配合科学合理的护理方法能提高超声造影诊断的效果.     

超声造影诊断肝占位性病变39例报告

超声检查是检出肝脏占位性病变使用最广泛的影像学方法,但常规的二维及彩色多普勒超声对肝脏占位性病变的定性诊断存在一定困难.随着新型超声造影剂及超声造影相关专用成像技术的出现与发展,其应用于肝脏占位性病变的检查诊断技术已趋成熟,基于病灶与正常组织微循环的不同,造影时,性质各异的肝占位出现不同的增强方式,从而使对肝脏占位性病变的性质加以鉴别成为可能.本文应用该技术,对39例筛选出的肝占位性病变患者进行实时灰阶超声造影检查,以研究其诊断价值.     

超声造影技术在肝脏良恶性占位病变诊断中的临床应用分析

目的探讨应用超声造影技术在鉴别诊断肝脏良恶性占位病变中的发挥的价值。方法运用超声造影技术对辽宁省抚顺市中心医院41例肝脏良恶性占位病变进行鉴别诊断,分析不同肝脏良恶性占位病变超声造影增强特点。结果良性病变共12例,肝恶性肿瘤共29例,肝脏恶性占位病变增强开始时间(12.31±2.38)s、峰值时间(22.67±4.31)s、减退时间(36.83±8.64)s、持续时间(136.57±51.23)s均提前于肝脏良性占位病变增强开始时间(19.54±4.33)、峰值时间(38.41±9.12)s、减退时间(65.21±58.33)s、持续时间(292.31±75.20)s,且差异显著(P<0.05)。结论实时超声造影能显示肿瘤内微小血管的血流灌注情况,对肝脏良恶性占位病变的鉴别诊断具有重要的参考价值。     

超声造影在肝脏良恶性肿瘤鉴别诊断中的应用

目的：探讨超声造影在肝脏实性结节良恶性鉴别诊断中的应用。方法：2009年4～7月使用美国飞利普IU22彩色多普勒诊断仪，造影检查，根据病灶回声变化过程，即刻分别做出超声诊断。结果：本组30例未发生与灰阶超声造影（CEUS）相关的不良反应或并发症。结论：超声造影检查在肝脏占位性病变的诊断方面已经显示出了其独特的优势。随着造影技术的不断发展和人们对肝脏占位性病理特点、超声造影、影像特点认识不断提高，超声造影将会在早期诊断肝脏占位性病变方面发挥更大作用。     

应用六氟化硫微泡超声造影剂诊断肝血管瘤

<正>我院采用六氟化硫微泡(声诺维)超声造影剂与实时超声造影匹配成像技术(CnTI)对肝血管瘤进行诊断,取得较好效果,现报告如下。1资料与方法 1.1一般资料:2008年1月至2013年12月对我院疑患肝血管瘤35例患者采用六氟化硫微泡超声造影剂与CnTI进行观察。35例中,男性15例,女性20例,年龄21⁷5岁,平均(54±12)岁。1.2仪器与方法:先采用意大利ML90彩色多普勒超声仪、CA431E宽频凸阵探头和具有CnTI,先观察肝血管瘤的大小、形态、内部回声、边缘状况及     

脂质微泡造影剂的制备

目的 考察以大豆磷脂及胆固醇作为膜材料,用薄膜-水化法制备脂质微泡的最佳工艺条件,并通过对脂质微泡粒径分布的考察筛选最佳处方工艺.方法 以大豆磷脂、胆固醇为成膜材料,六氟化硫(SF6)气体为核心物质,采用薄膜-水化法制备脂质微泡;以D0.9为指标,D0.9越小,说明符合要求的微泡越多;采用控制变量法考察不同投料比、超声功率与时间、PEG分子量对微泡粒径分布的影响.结果 通过对粒径分布的测定及比较,确定了制备六氟化硫脂质微泡的最佳工艺,并考察了在该工艺条件下制备出微泡的其他理化性质.结论 所制备的六氟化硫脂质微泡的形态规则、大小均匀、Zeta电位、包封气体量及半衰期均符合要求.     

Ultrasound microbubble contrast and current clinical applications

Ultrasound imaging is widely used worldwide principally because it is cheap, easily available and contains no exposure to ionizing radiation. The advent of microbubble ultrasound contrast has further increased the diagnostic sensitivity and specificity of this technique thus widening its clinical applications. The third generation of ultrasound contrast agents consist of sulphur hexafluoride microbubbles encased in a phospholipid shell. This review will elaborate on the pharmacology, safety profile and method of action of these agents. We also aim to discuss the ever expanding uses for contrast enhanced ultrasound in a number of clinical specialities which include the liver, kidney, prostate, sentinel node detection, vascular tree and endovascular stent surveillance. We will also discuss some of the recent patents regarding the future uses of ultrasound microbubble contrast and recent technological advances in clinical applications.     

Advances in ultrasound-targeted microbubble-mediated gene therapy for liver fibrosis

Hepatic fibrosis develops as a wound-healing scar in response to acute and chronic liver inflammation and can lead to cirrhosis in patients with chronic hepatitis B and C. The condition arises due to increased synthesis and reduced degradation of extracellular matrix (ECM) and is a common pathological sequela of chronic liver disease. Excessive deposition of ECM in the liver causes liver dysfunction, ascites, and eventually upper gastrointestinal bleeding as well as a series of complications. However, fibrosis can be reversed before developing into cirrhosis and has thus been the subject of extensive researches particularly at the gene level. Currently, therapeutic genes are imported into the damaged liver to delay or prevent the development of liver fibrosis by regulating the expression of exogenous genes. One technique of gene delivery uses ultrasound targeting of microbubbles combined with therapeutic genes where the time and intensity of the ultrasound can control the release process. Ultrasound irradiation of microbubbles in the vicinity of cells changes the permeability of the cell membrane by its cavitation effect and enhances gene transfection. In this paper, recent progress in the field is reviewed with emphasis on the following aspects: the types of ultrasound microbubbles, the construction of an ultrasound-mediated gene delivery system, the mechanism of ultrasound microbubble–mediated gene transfer and the application of ultrasound microbubbles in the treatment of liver fibrosis.     

超声造影对脂肪肝背景下肝内局灶性病变的鉴别诊断价值

目的：探讨超声造影对脂肪肝背景下肝内局灶性病变的鉴别诊断价值。方法对我院2008—2011年常规体检中发现的70例脂肪肝背景下肝内局灶性病变患者进行二维超声、彩色多普勒超声、超声造影检查,并对诊断结果进行比较。结果超声造影检查诊断为血管瘤41例,非均匀性脂肪肝10例,肝局灶性结节增生（FNH）6例,炎性假瘤6例,自发性血肿2例（误诊1例）,腺瘤2例,炎性病灶1例,脂肪肝合并恶性肿瘤（MT）1例,片状高回声性质待定1例。超声造影对于脂肪肝背景下肝内局灶性病变诊断准确率为97.1％（68/70）,高于二维超声结合彩色多普勒超声的52.9％（37/70）,血管瘤29例,非均匀性脂肪肝7例,FNH 1例,差异有统计学意义（ P 〈0.01）。结论超声造影对于脂肪肝背景下肝内局灶性病变具有鉴别诊断价值,对于缺少特异性表现的部分患者需采用穿刺活检明确诊断。     

含蔗糖白蛋白包膜微泡超声造影剂制备研究

目的　研制一种新型的直径在数微米范围内的含蔗糖白蛋白微泡超声造影剂。方法　以全氟化碳及少量氧气为微泡中的气体介质,用超声空化方法进行微泡制备。研究了蔗糖对白蛋白包膜微泡半衰期、微泡尺寸保持及热稳定性的影响,测定了含40%蔗糖白蛋白包膜微泡的谐波特性等。结果　常温下( 20℃) ,在一定范围内,随着糖的加入及浓度的增加,白蛋白微泡的稳定性不断加强;当糖质量浓度达到40% ,微泡半衰期可延长至50d以上,96%微泡尺寸分布在2 - 5 μm ,常温下保存一月后微泡之间无明显合并现象,同时比未含蔗糖微泡耐热性明显加强,4℃下将制得的微泡保存半年,未观测到微泡数量及尺寸有明显变化,制备出的微泡有较强的非线性特征,在2次谐波上的反射幅度远高于背景散射源及对比金属板。结论　含40%蔗糖的以全氟化碳及少量氧气为气体介质的白蛋白包膜微泡可以成为一种性能优良的超声造影剂。     

Contrast-enhanced ultrasound for liver imaging: recent advances

Contrast-enhanced ultrasonography (CEUS), providing relevant informations not available with non-enhanced ultrasonography, greatly impacted the practice of liver imaging. The characterization of focal liver lesions (FLLs), is obtained in a rapid, accurate and safe way and is considered the main hepatic indication; however CEUS offers other established or emergent relevant applications. Metastases detection and assessment of response to locoregional tumor treatment are accepted applications with specific indications. Needle guidance in case of poorly or non visible target lesions at conventional ultrasound is also accepted. The early assessment of response to systemic treatment, and in particular to antiangiogenic ones, by quantification software is an emergent application. The manageability of CEUS determined also its use in the operating theatre, improving the accuracy of intraoperatory US with a significant impact on final surgical strategy. In cirrhotic patients, the role of CEUS was proven highly accurate and sensitive in the characterization of portal vein thrombosis, by identification of contrast arterial enhancement inside the thrombus, that occurs only in case of neoplastic origin. In recent years microbubbles taken up by Kupffer cells, thus possessing a "postvascular" phase, were registered as ultrasound contrast agent in Japan (Sonazoid). During the post-vascular phase tumoral tissue tend to appear as a contrast defect image due to the lack of Kupffer cells, strongly contributing to tumor staging beside characterization. Newly developed techniques, such as fusion imaging or real-time three dimensional US, in addition to other applications of CEUS, in terms of post-transplantation or cholecystitis-related complications, have been recently proposed and will be discussed.     

Low-intensity focused ultrasound mediated localized drug delivery for liver tumors in rabbits

Objective: To explore the antitumor effects of low-intensity focused ultrasound (LIFU) mediated localized drug delivery of adriamycin-microbubble-PLGA nanoparticle complexes on rabbits VX2 liver tumor.

Methods: ADM-NMCs were prepared by covalent linking of ADM-PLGA nanoparticles (ADM-NPs) to the shell of the microbubbles. A fixed water bag filled with microbubbles was subjected to LIFU and non-focused ultrasound respectively, and the ultrasound images of which were recorded before and after ultrasonication. A total of 54 VX2 liver tumor-burdened rabbits were divided into six groups randomly, including control, ADM-NPs combined with LIFU, microbubbles combined with LIFU, ADM-NPs and microbubbles combined with LIFU, ADM-NMCs combined with LIFU and ADM-NMCs combined with Non-FUS. The tumor volume and volume inhibition rate (VIR) of tumor progression were calculated and compared. Apoptotic cells were labeled by terminal deoxyuridine nick end. Proliferating cell nuclear antigen was detected by immunohistochemistry. The median survival time of the animals were recorded and compared.

Results: ADM-NMCs were successfully prepared with an average diameter of 1721?nm. The highest VIR and apoptotic index (AI) were found in the group of ADM-NMCs combined with LIFU while the lowest proliferating index (PI) was simultaneously observed in this group. The median survival time of the rabbits in the ADM-NMCs combined with LIFU group was the longest (71days) among all groups.

Conclusions: ADM-NMCs combined with LIFU could inhibit the rabbits VX2 liver tumor progress by delaying the tumor proliferation and accelerating apoptosis, which presents a novel process for liver tumor targeting chemotherapy.     

高分子聚合物PLGE超声微泡的制备与体外显影研究

目的：应用新型高分子聚合材料聚乳酸/羟基乙酸/聚乙二醇嵌段共聚物（PLGE）制备超声微泡并观察其体外显影效果。方法：采用复乳法（W/O/W）制备超声微泡,使用光镜和扫描电镜观察形态、测定微泡的粒径分布,通过体外溶液超声显影实验观察显影效果。结果：采用该法制备的超声微泡呈球形,粒径分布均匀,平均粒径1.75μm,体外显影效果好。结论：以PLGE为外壳材料,采用复乳法制备的微泡可以作为超声造影剂,为下一步载药研究提供基础。     

Ultrasound targeted microbubble destruction for drug and gene delivery

Background: Gas-filled microbubbles have been used as ultrasound contrast agents for some decades. More recently, such microbubbles have evolved as experimental tools for organ- and tissue-specific drug and gene delivery. When sonified with ultrasound near their resonance frequency, microbubbles oscillate. With higher ultrasound energies, oscillation amplitudes increase, leading to microbubble destruction. This phenomenon can be used to deliver a substance into a target organ, if microbubbles are co-administered loaded with drugs or gene therapy vectors before i.v. injection. Objective: This review focuses on different experimental applications of microbubbles as tools for drug and gene delivery. Different organ systems and different classes of bioactive substances that have been used in previous studies will be discussed. Methods: All the available literature was reviewed to highlight the potential of this non-invasive, organ-specific delivery system. Conclusion: Ultrasound targeted microbubble destruction has been used in various organ systems and in tumours to successfully deliver drugs, proteins, gene therapy vectors and gene silencing constructs. Many proof of principle studies have demonstrated its potential as a non-invasive delivery tool. However, too few large animal studies and studies with therapeutic aims have been performed to see a clinical application of this technique in the near future. Nevertheless, there is great hope that preclinical large animal studies will confirm the successful results already obtained in small animals.     

肿瘤新生血管靶向超声造影剂的实验研究

目的制备分别携带VEGF和CD34抗体以及同时携带2种抗体的靶向超声造影剂,并对其体外寻靶能力及免疫活性进行鉴定。方法采用吸附法制造3种靶向超声造影剂,每种靶向超声造影剂又根据微泡与抗体的配比比例及pH值具体各分为6组,共18组(实验组)。使用荧光免疫法,在体外鉴定每个实验组的寻靶能力及免疫活性。同时,设普通造影剂对照组、二抗代替一抗对照组。在电镜下计算靶向超声造影剂的结合率,并进行比较。结果电镜及光镜下观察,靶向超声造影剂为圆形,大小及分布较均匀,无任何聚集现象。荧光显微镜下观察,MBV实验组、MBC实验组、MBB实验组与靶向超声微泡结合的内皮细胞胞浆表达为绿色,而未与靶向超声微泡结合的内皮细胞及其他实验组、普通造影剂对照组与二抗代替一抗对照组均未表达。电镜下观察,靶向超声微泡组部分内皮细胞与靶向微泡结合,MBV实验组的结合率为3.475 5%±0.139 2%,MBC实验组的结合率为3.544 4%±0.214 5%,MBB实验组的结合率为3.682%±0.124 6%,各组比较差异无统计学意义(P>0.05),而其他实验组及对照组未见与微泡结合的内皮细胞。结论自制的3种靶向超声造影剂在体外有寻靶能力及免疫活性,可用于动物肿瘤模型新生血管的体内特异性靶向显影的实验研究。     

Micro- and nanobubbles: A versatile non-viral platform for gene delivery

Micro- and nanobubbles provide a promising non-viral strategy for ultrasound mediated gene delivery. Microbubbles are spherical gas-filled structures with a mean diameter of 1–8 μm, characterised by their core–shell composition and their ability to circulate in the bloodstream following intravenous injection. They undergo volumetric oscillations or acoustic cavitation when insonified by ultrasound and, most importantly, they are able to resonate at diagnostic frequencies. It is due to this behaviour that microbubbles are currently being used as ultrasound contrast agents, but their use in therapeutics is still under investigation. For example, microbubbles could play a role in enhancing gene delivery to cells: when combined with clinical ultrasound exposure, microbubbles are able to favour gene entry into cells by cavitation. Two different delivery strategies have been used to date: DNA can be co-administered with the microbubbles (i.e. the contrast agent) or ‘loaded’ in purposed-built bubble systems – indeed a number of different technological approaches have been proposed to associate genes within microbubble structures. Nanobubbles, bubbles with sizes in the nanometre order of magnitude, have also been developed with the aim of obtaining more efficient gene delivery systems. Their small sizes allow the possibility of extravasation from blood vessels into the surrounding tissues and ultrasound-targeted site-specific release with minimal invasiveness. In contrast, microbubbles, due to their larger sizes, are unable to extravasate, thus and their targeting capacity is limited to specific antigens present within the vascular lumen. This review provides an overview of the use of microbubbles as gene delivery systems, with a specific focus on recent research into the development of nanosystems. In particular, ultrasound delivery mechanisms, formulation parameters, gene-loading approaches and the advantages of nanometric systems will be described.