孕晚期胎儿及新生儿肺动脉多普勒频谱正常演变规律探讨

 目的 探讨正常孕晚期胎儿产前和产后肺动脉血流多普勒频谱的变化情况, 为早期发现新生儿疾病提供依据。方法 将265例受检者分为3组, 孕晚期(32～40周)为A组, 生后1 d为B组, 生后28 d为C组, 分别测量各组胎儿及新生儿主肺动脉加速时间(accelerating time, AT)、主肺动脉峰值流速(the main pulmonary artery peak velocity, VMPA)及右肺动脉峰值流速(the right pulmonary artery peak velocity, VRPA), 并进行统计学对比分析。结果 AT值正常孕晚期胎儿(0.059±0.012) s、生后1 d新生儿(0.072±0.010) s及生后28 d新生儿(0.085±0.010) s比较, 差异有统计学意义(P＜0.05);正常孕晚期胎儿、生后1 d新生儿、生后28 d新生儿VMPA及VRPA比较, 差异均有统计学意义(P＜0.05)。但生后1 d新生儿与生后28 d新生儿VMPA及VRPA差异均无统计学意义。结论 AT不随年龄增长, 需警惕病理性肺动脉高压;VMPA及VRPA持续增快, 需警惕病理性肺动脉狭窄及右心容量负荷增重等疾病。
     

正常成人主肺动脉的HRCT测量及其意义

目的：探讨通过正常成人主肺动脉的ＨＲＣＴ测量诊断肺动脉高压与否的可能性。方法：连续测量２００例正常成人主肺动脉直径（外径）并计算其与同一层面降主动脉直径（外径）的比值,另外采用相同方法测量１１例６０～７８岁一组已经ＣＴ与彩色Ｄｏｐｐｌｅｒ证实的ＣＯＰＤ患者主肺动脉直径及与降主动脉直径的比值并与正常组比较。结果：正常成人不同年龄,不同性别主肺动脉直径不同并有随年龄增长而增大的趋势（Ｐ＜０．０５）,但其比值与年龄有关（Ｐ＜０．０５）与性别无关（Ｐ＞０．０５）,其比值与ＣＯＰＤ患者的比值比较存在显著差异（Ｐ＜０．０１）。结论：正常成人不同年龄组主肺动脉与降主动脉的比值可作为判断肺动脉高压与否的简单、敏感的指标     

主肺动脉间隔缺损合并主动脉弓离断及右肺动脉起源异常一例

患儿女 ,3岁。因生后 4个月发现心脏杂音 ,哭闹后轻度发绀入院。入院后体检 :发育差 ,发绀 (+) ,杵状指 ,心率118次 /ｍｉｎ ,律齐 ,杂音不明显 ,肺动脉瓣第 2音亢进。血压 :左上肢 12 0 / 70ｍｍＨｇ(1ｍｍＨｇ =0 .133ｋＰａ) ,右上肢 90 /70ｍｍＨｇ ,左下肢 180 / 110ｍｍＨｇ ,右下肢 140 / 110ｍｍＨｇ。实验室检查及心电图无特殊发现。Ｘ线胸片检查 :双侧肺血增多 ,主动脉结显示不清 ,右肺动脉上移 ,肺动脉段明显凸出 ,心室大 ,以左室为著 ,心胸比例 0 5 5。诊断 :主动脉弓病变或 (和 )心内复合畸形并存 ;右肺动脉上移 ,不除外右肺…     

超声筛查胎儿及新生儿先天性心脏病

目的:探讨超声筛查和诊断胎儿及新生儿先天性心脏病的临床价值.方法:回顾性分析22088例孕13～40周胎儿的超声学资料,包括四腔心、左、右室流出道声像图,以及其新生儿期的超声学资料,分析胎儿期和新生儿期超声检出和诊断先天性心脏病的能力.结果:①共诊断先天性心脏病105例.产前超声诊断胎儿心脏畸形34例,包括:肺动脉闭锁3例、重度肺动脉狭窄1例、心内膜垫缺损7例、大动脉转位2例、法洛四联症2例、永存动脉干1例、单心室1例、右位心1例、无心畸形1例、心脏肿瘤1例、室间隔缺损12例(小于5mm室间隔缺损5例,大于5mm室间隔缺损7例)、房间隔缺损2例.中止妊娠24例,9例分娩后新生儿超声心动图证实,1例失访.②产后7天内心脏听诊、超声心动图共发现71例先天性心脏病,包括:24例室间隔缺损、3例房间隔缺损、17例动脉导管未闭、15例卵圆孔未闭、11例动脉导管未闭和卵圆孔未闭、1例肺动脉闭锁.除去动脉导管未闭和卵圆孔未闭43例,先天性心脏病产前超声检出率为54.8%.③单纯性室间隔缺损是最常见的先天性心脏病,超声诊断室间隔缺损36例,占先天性心脏病58%.产前检出12例,产后检出24例.单纯性室间隔缺损产前超声检出率33.3%.结论:大部分严重先天性心脏病可在产前诊断.常见的先天性心脏病产前常漏诊,单纯性室间隔缺损是发病率最高、产前漏诊最多的先天性心脏病.     

高海拔地区64层CT正常肺动脉管径的测量

64层CT因其可以在一次屏气时间内获得高分辨率的肺动脉及其分支的图像,并可通过工作站后处理进行冠状、矢状位重建,进行多方位观察,应用于肺动脉及其分支的测量更为方便和准确.建立高海拔地区(海拔高度为2260～3700 m)肺动脉管径正常标准,可以更好地判断高原病和肺动脉形态改变的疾病,为临床提供更加丰富的诊断信息.并和崔立明等研究的武汉地区相关资料进行了比较.     

主肺动脉窗的X线诊断(附5例报告)

本文报告主肺动脉窗5例。主要X线表现是:肺血明显增多,心脏明显增大,呈二尖瓣型,主动脉结正常,肺动脉段明显突出并延长。双心室及左心房增大,以左心室增大为主;心导管检查对其诊断具有重要价值。在讨论中,重点指出本病与动脉导管未闭和室间隔缺损的鉴别。     

主-肺动脉间隔缺损的外科治疗(附2例报告)

报告2例主-肺动脉间隔缺损,均经手术治愈。1例合并动脉导管未闭和原发性血小板减少症,另1例合并心力衰竭。2例均经主动脉切口采用补片4定点加连续缝合法修复。指出该病术前诊断必须依靠主动脉造影,并强调了经主动脉切口用补片4定点修复连续缝合法修复的优点。     

彩色多普勒超声心动图诊断主-肺动脉窗1例

1病例报告 患者,男,4岁,因活动后胸闷、气短,曾于当地医院就诊,临床诊断为室间隔缺损、肺动脉高压。闪家长要求手术来我院就诊。查体,患儿心前区异常隆起,哭闹及活动后无口唇发绀。     

超声心动图诊断胎儿肺动脉吊带1例

1 病例简介 女,28岁,G2P0,孕24周,产前超声系统筛查:胎儿心脏位置正常,心房正位,心室右袢,房室连接一致,心胸比例未见明显失调,心轴未见明显异常;四腔心切面、三血管及三血管气管切面均显示,肺动脉分叉切面显示左肺动脉起源于右肺动脉后方呈半环形,跨过右主支气管,于气管后方向左侧走行入左肺,左肺动脉血流速度 82 ...     

Early onset of retrograde flow in the main pulmonary artery is a characteristic of pulmonary arterial hypertension

Purpose:

To evaluate if early onset of retrograde flow in the main pulmonary artery is a characteristic of pulmonary arterial hypertension (PAH).

Materials and Methods:

Fifty‐five patients with suspected pulmonary hypertension (PH) underwent right‐sided heart catheterization and retrospectively ECG‐gated MR phase‐contrast velocity quantification in the main pulmonary artery. Pulmonary hypertension was defined by a mean pulmonary artery pressure being larger than 25 mmHg. The onset time of the retrograde flow relative to the cardiac cycle duration (Relative Onset Time = ROT) was compared with mean pulmonary artery pressure.

Results:

By the catheterization, 38 patients were identified as having PAH. The ROT for these PAH patients was significantly different from those found in the 17 non‐PH subjects (0.14 ± 0.06 versus 0.37 ± 0.06, P < 0.001). The mean pulmonary artery pressure was related to the ROT (r² = 0.62, P < 0.001) and could be estimated from the ROT with a standard deviation of 11.7 mmHg. With a cutoff value of 0.25, the ROT distinguished PAH patients from non‐PH subjects.

Conclusion:

Early onset of retrograde flow in the main pulmonary artery is a characteristic of pulmonary arterial hypertension and is visible by standard MR phase‐contrast velocity quantification. J. Magn. Reson. Imaging 2011;33:1362–1368. © 2011 Wiley‐Liss, Inc.     

CT肺动脉栓塞指数与右心功能及动脉血气分析指标的相关性研究

目的：通过CT肺动脉栓塞指数(PAOI)与右心功能参数及动脉血气分析指标的相关性研究,探讨 CT PAOI 评价肺栓塞(PE)病情严重程度的价值。方法整理本院进行CT肺动脉造影(CTPA)检查并确诊的70例 PE患者的 CT PAOI、右心功能参数及动脉血气分析指标,使用Spearman等级相关系数评价PAOI和右心室/左心室最大短轴直径比(RVd/LVd)、主肺动脉直径(MPAd)、上腔静脉直径(SVCd)、动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、血氧饱和度(SaO2)、肺泡-动脉氧分压差(P(A-a)O2)之间的相关性。结果 PAOI与PaO2呈负相关,相关系数为-0.442;PAOI与RVd/LVd、WPAd、SVCd及P(A-a)O2呈正相关,相关系数介于0.163~0.675之间;PAOI与 SaO2不相关。结论 CT PAOI可以用来评估PE的严重程度,但与患者临床病情严重程度不完全一致。     

Quantification of regional pulmonary blood flow using ASL-FAIRER.

Pulsed arterial spin labeling (ASL) techniques have been theoretically and experimentally validated for cerebral blood flow (CBF) quantification. In this study ASL-FAIRER was used to measure regional pulmonary blood flow (rPBF) in seven healthy subjects. Two general ASL strategies were investigated: 1) a single-subtraction approach using one tag-control pair acquisition at an inversion time (TI) matched to the RR-interval, and 2) a multiple-subtraction approach using tag-control pairs acquired at various TIs. The mean rPBF averaged 1.70 +/- 0.38 ml/min/ml when measured with the multiple-subtraction approach, and was approximately 2% less when measured with the single-subtraction method (1.66 +/- 0.24 ml/min/ml). Assuming an average lung density of 0.33 g/ml, this translates into a regional perfusion of approximately 5.5 ml/g/min, which is comparable to other measures of pulmonary perfusion. As with other ASL applications, a key problem with quantitative interpretation of the results is the physical gap between the tagging region and imaged slice. Because of the high pulsatility of PBF, ASL acquisition and data analysis differ significantly between the lung and the brain. The advantages and drawbacks of the single- vs. multiple-subtraction approaches are considered within a theoretical framework tailored to PBF.     

Correction of phase offset errors in main pulmonary artery flow quantification

PURPOSE: To investigate whether an existing method for correction of phase offset errors in phase-contrast velocity quantification is applicable for assessment of main pulmonary artery flow with an MR scanner equipped with a high-power gradient system. MATERIALS AND METHODS: The correction method consists of fitting a surface through the time average of stationary pixels of velocity-encoded phase images, and subtracting this surface from the velocity images. Pixels are regarded as stationary if their time standard deviation falls into the lowest percentile. Flow was measured in the main pulmonary artery of 15 subjects. Each measurement was repeated on a stationary phantom. The phase offset error in the phantom was used as a reference. Correction was applied with varying polynomial surface orders (0-5) and stationarity percentiles (5-50%). The optimal surface order and stationarity percentile were determined by comparing the fitted surface with the phantom. RESULTS: Using a first-order surface and a (noncritical) 25% percentile, the correction method significantly reduced the phase offset error from 1.1 to 0.35 cm/second (RMS), which is equivalent to a reduction from 11% to 3.3% of mean volume flow. Phase error correction strongly affected stroke volume (range -11 to 26%). CONCLUSION: The method significantly reduces phase offset errors in pulmonary artery flow.     

Estimation of pulse wave velocity in main pulmonary artery with phase contrast MRI: preliminary investigation

PURPOSE: To assess the feasibility and reproducibility of a noninvasive MRI method to measure pulse wave velocity (PWV) in the main pulmonary artery (MPA). MATERIALS AND METHODS: A total of 17 subjects without history of pulmonary diseases (38.2 +/- 18.4 years) participated in this study. Series of MR velocity maps of the MPA were acquired at 2 cm above the pulmonary valves using a two-dimensional phase-contrast sequence. Effective temporal resolution was 11 msec after interleaving two dynamic series with different values of electrocardiograph (ECG) trigger delay. PWV was derived as the rate of MPA flow variations per unit change in MPA cross-sectional area, during early systole. Seven healthy subjects underwent three repetitive examinations to investigate intrascan and interscan reproducibility. RESULTS: Flow vs. area was highly linear in the MPA during early systole, with Pearson's coefficients ranging from 0.982 to 0.999, rendering derivation of PWV with little difficulty. Average value of PWV in MPA was 1.96 +/- 0.27 m/second, in good agreement with literature values measured using invasive means. The percentage intra- and interscan differences were 5.46% and -10.86%, respectively. CONCLUSION: Phase-contrast MRI to noninvasively measure PWV in the MPA is feasible with good reproducibility.     

Proximal pulmonary artery blood flow characteristics in healthy subjects measured in an upright posture using MRI: the effects of exercise and age

PURPOSE: To use MRI to quantify blood flow conditions in the proximal pulmonary arteries of healthy children and adults at rest and during exercise in an upright posture. MATERIALS AND METHODS: Cine phase-contrast MRI was used to calculate mean flow and reverse flow index (RFI) in the main (MPA), right (RPA), and left (LPA) pulmonary arteries in healthy children and adults in an open-MRI magnet equipped with an upright MRI-compatible ergometer. RESULTS: From rest to exercise (150% resting heart rate), blood flow (liters/minute/m2) increased in the RPA (1.4+/-0.3 vs. 2.5+/-0.4; P<0.001), LPA (1.1+/-0.3 vs. 2.2+/-0.6; P<0.001), and MPA (2.7+/-0.5 vs. 4.9+/-0.5; P<0.001). RFI decreased in the LPA (0.040+/-0.030 vs. 0.017+/-0.018; P<0.02) and MPA (0.025+/-0.024 vs. 0.008+/-0.007; P<0.03). Adults experienced greater retrograde flow in the MPA than the children (0.042+/-0.029 vs. 0.014+/-0.012; P<0.02). CONCLUSION: It appears that at both rest and during exercise, in children and adults alike, RPA/LPA mean blood flow distribution is predominantly determined by distal vascular resistance, while retrograde flow is affected by proximal pulmonary bifurcation geometry.     

脐血流检测与胎心监护联合应用预测围生儿结局

目的:探讨多普勒脐动脉血流速度检测、无负荷试验(NST)联合应用预测围生儿结局的临床价值.方法:将158例NST监测异常的孕妇分为2组,即高危妊娠组(妊娠合并症组)和正常妊娠组,进行多普勒脐动脉血流阻力(S/D)测定.结果:高危妊娠组围生儿预后不良发生率明显高于正常妊娠组.距最后一次检测时间2 d内分娩的孕妇围生儿,预后不良发生率明显低于3～7 d分娩的孕妇(P＜0.05).结论:NST异常、脐动脉血流阻力S/D值正常者,无需过早干预妊娠,可动态观察.NST异常且S/D值异常者,宜尽早终止妊娠.     

异位妊娠时子宫及输卵管动脉血液循环特征及诊断价值

目的明确异位妊娠（ectopic pregnancy,EP）时子宫及输卵管动脉血流动力学特点,评估其诊断价值。方法选择98例经阴道超声检查诊断为输卵管妊娠并经手术全部证实的患者,测量子宫动脉及输卵管动脉阻力指数及搏动指数。结果子宫动脉及输卵管动脉阻力指数及搏动指数不随孕龄改变;异位妊娠侧血流量明显增加,与对侧相比较有明显差异,与孕龄无明显相关性。结论与子宫动脉主干血流指标相比,异位妊娠时患侧输卵管动脉参数指标变化更为明显,而且患侧供血较对侧明显增加。     

彩色多普勒超声监测胎儿脐动脉血流的临床意义

目的:通过监测晚期妊娠胎儿脐动脉血流异常,指导临床分娩。方法:采用彩色多普勒超声监测了1 226例晚期妊娠胎儿的脐动脉血流,定量分析收缩期血流速度最大值(S)与舒张期血流速度最低值(D)的比值(S/D)和阻力指数(resist-ance index,RI)。结果:1 226例孕妇中,脐动脉血流异常95例,其中脐带异常38例,胎儿宫内生长迟缓(intrauterine growthretardation,IUGR)20例,羊水少27例,妊娠高血压综合征(pregnancy-induced hypertension syndrome,PIH)10例;IUGR时S/D比值最高,为6.47±0.45;PIH时,RI值最高,为1.01±0.65。结论:脐动脉血流异常发生在临床症状出现之前,所以脐动脉血流的监测对临床的诊治有重要指导意义。