64层CTA诊断房颤患者冠状动脉狭窄准确性的临床研究

目的:与CAG对照分析来评价64层螺旋CT冠状动脉成像在房颤患者中诊断有血流动力学意义的冠状动脉狭窄的准确性.方法:58例房颤患者行64层螺旋CT冠状动脉成像,扫描前均未服用倍它乐克.血管图像质量分为好、中等和差.以CAG作为参考标准,分别基于血管节段和患者水平来分析MDCTCA诊断有血流动力学意义的冠状动脉狭窄的敏感性、特异性、阳性预测价值和阴性预测价值.诊断价值的评价首先仅限于图像质量达到诊断要求的血管节段和患者,进一步的分析中将图像质量不能诊断的血管节段和患者均作为阳性来处理.结果:58例患者有645段(96.55%)图像质量为中等以上,诊断有血流动力学意义的敏感性、特异性、阳性预测价值和阴性预测价值分别是86.21%(25/29)、99.35%(612/616)、86.21%(25/29)和99.35%(612/616).将23段图像质量没有达到诊断要求的血管均作为阳性后,CTCA诊断有血流动力学意义的血管狭窄的总体阳性预测价值为48.08%(25/52),特异性为95.77%(612/639).基于患者总体图像质量的分析,58例患者中有47例(81.03%)图像质量为中等W_h,CTCA诊断有血流动力学意义的敏感性、特异性、阳性预测价值和阴性预测价值分别是87.50%(7/8)、97.44%(38/39)、87.50%(7/8)f97.44%(38/39).将11例图像质量没有达到诊断要求的血管均作为阳性后,CTCA诊断有血流动力学意义的血管狭窄的敏感性、特异性、阳性预测价值和阴性预测价值分别是90.00%(9/10)、79.17%(38/48)、47.37%(9/19)和97.44%(38/39).结论:64CTCA在房颤患者中诊断有血流动力学意义的冠状动脉狭窄具有较好的阴性预测价值,但需要进一步提高图像质量来提高诊断血管狭窄的准确性.     

64层螺旋CT肺动脉成像低管电压设置结合个体化对比剂应用的对照研究

Objective To investigate the feasibility of the low tube voltage setting and personalized contrast agent application in 64-row multi-slice spiral CT pulmonary angiography.Methods Ninety patients with high risk of pulmonary artery embolism were sequentially enrolled in the study and divided into 3 groups employing completely randomized design: (1) Regular group included 30 patients using 120 kV and fixed dose of 70 ml contrast agent, (2)Another 30 patients were in 120 kV group, using 120 kV and the contrast amount was determined according to the patient weight (1.0 ml/kg), (3) The remaining 30 patients were included in 100 kV group, using 100 kV and the contrast amount was also determined according to the patient weight(1.0 ml/kg).Administration of contrast agent was completed within 20 seconds for all the patients, followed by 20 ml of saline.The objective and subjective indexes for assessing CT image quality, CT dose index volume (CTDIvol) and effective received dose (ERD) were compared between 120 kV group and 100 kV group; then the contrast media volume, injection rate, objective CT image indexes and subjective indexes for image quality was compared between the 100 kV group and regular group.The variance analysis and post hoc test were employed for the statistical analysis.Results Compared with 120 kV group(3.4± 0.7), the image quality of 100 kV group(5.2±1.8)had higher noise(52.9%), but subjective index for the image quality demonstrated no differences(q=0.272 ,P=0.063)in mediastinum window while CTDIvol and ERD decreased for 34.9%[(9.5±0.0) vs (14.6±0.0) mGy]and 36.8%[(3.8±0.6) vs (2.4± 0.4) mSv].The mean CT values on pulmonary artery of 100 kV group[(269.2±54.7) HU]were 13.4% (31.8/237.4) higher than the 120 kV group[(237.4±62.9) HU], but there was no statistical differences eornpared to normal group(q=0.172,P=0.260).Conclusion Using low kV setting (100 kV) to reduce radiation dose is proved to be effective and feasible in 64-MSCT pulmonary angiography.Personalized contrast agent injection has clinical application value for specific patient group.     

扩散加权成像ADC值评估睾丸生精功能的初步研究

目的评价MR扩散加权成像(DWI)睾丸ADC值对评估生精功能的价值。方法本研究纳入睾丸穿刺活检证实生精功能减低者为病例组A组(n=18),年龄20~40岁,平均(28.1±5.1)岁;以精液检查正常者为对照组,按年龄段设立3个对照组:对照组B(n=18),年龄20~30岁,平均(25.4±3.1)岁;对照组C(n=22),年龄31~40岁,平均(35.4±3.3)岁;对照组D(n=16),年龄41~50岁,平均(43.4±4.3)岁。均采用3.0 T MR机行睾丸常规平扫及DWI序列扫描,DWI扫描采用EPI序列(b值分别取0,900,4000),ADC图自动生成。由同一位医生在影像工作站采用手动选取尽可能大的兴趣区测量双侧睾丸ADC值。采用独立样本t检验,比较病例组与对照组、各对照组之间的ADC值;通过ROC曲线分析,计算诊断睾丸生精减低时的ADC最佳临界值。结果病例组A组睾丸平均ADC值(0.479±0.025)mm~2/s,对照组B为(0.446±0.018)mm~2/s,对照组C为(0.458±0.033)mm~2/s,对照组D为(0.468±0.033)mm~2/s。3个对照组进行组间ADC值的比较均有明显统计学差异(P0.001),表明尽管生精功能还能保持正常范围,但随年龄增长睾丸ADC值逐渐增高。而病例组睾丸平均ADC值明显高于所有对照组(P0.001)。通过ROC分析,本组诊断睾丸生精功能减低时的ADC最佳临界值为0.473 mm~2/s,敏感度及特异度分别是84.1%和73.7%。结论采用MR扩散加权成像(DWI)睾丸ADC值测量能有效对睾丸生精功能进行初步评估。     

肠套叠的平片评价:左侧卧位水平投照的作用

目的评价左侧卧位水平投照在回结肠肠套叠影像诊断中的增量价值。材料与方法本回顾性研究已获伦理委员会批准,免除病人知情同意。2002年2月24日—2007     

静滴清开灵致小儿腹泻的临床分析

清开灵注射液是在传统中药安宫牛黄丸配方基础上研制的一种纯中药复方制剂，由板兰根、金银花、栀子、水牛角、珍珠母、黄芩苷、胆酸、猪去氧胆酸等8种药物组成(其中前6种均为安宫牛黄丸配方的成份)。具有清热解毒，化痰通络，醒神开窍等功效。在临床上常用于热病神昏，中风偏瘫，神志不清，急性上呼吸道感染、肺炎、急慢性肝炎、脑血管意外及肝昏迷等，近来还不断报道有其它新用途。随     

64层螺旋CT肺动脉成像低管电压设置结合个体化对比剂应用的对照研究

Objective To investigate the feasibility of the low tube voltage setting and personalized contrast agent application in 64-row multi-slice spiral CT pulmonary angiography.Methods Ninety patients with high risk of pulmonary artery embolism were sequentially enrolled in the study and divided into 3 groups employing completely randomized design: (1) Regular group included 30 patients using 120 kV and fixed dose of 70 ml contrast agent, (2)Another 30 patients were in 120 kV group, using 120 kV and the contrast amount was determined according to the patient weight (1.0 ml/kg), (3) The remaining 30 patients were included in 100 kV group, using 100 kV and the contrast amount was also determined according to the patient weight(1.0 ml/kg).Administration of contrast agent was completed within 20 seconds for all the patients, followed by 20 ml of saline.The objective and subjective indexes for assessing CT image quality, CT dose index volume (CTDIvol) and effective received dose (ERD) were compared between 120 kV group and 100 kV group; then the contrast media volume, injection rate, objective CT image indexes and subjective indexes for image quality was compared between the 100 kV group and regular group.The variance analysis and post hoc test were employed for the statistical analysis.Results Compared with 120 kV group(3.4± 0.7), the image quality of 100 kV group(5.2±1.8)had higher noise(52.9%), but subjective index for the image quality demonstrated no differences(q=0.272 ,P=0.063)in mediastinum window while CTDIvol and ERD decreased for 34.9%[(9.5±0.0) vs (14.6±0.0) mGy]and 36.8%[(3.8±0.6) vs (2.4± 0.4) mSv].The mean CT values on pulmonary artery of 100 kV group[(269.2±54.7) HU]were 13.4% (31.8/237.4) higher than the 120 kV group[(237.4±62.9) HU], but there was no statistical differences eornpared to normal group(q=0.172,P=0.260).Conclusion Using low kV setting (100 kV) to reduce radiation dose is proved to be effective and feasible in 64-MSCT pulmonary angiography.Personalized contrast agent injection has clinical application value for specific patient group.     

鼻咽癌颅神经周围浸润与扩散的MRI诊断

目的 探讨鼻咽癌沿颅神经周围浸润与扩散的MRI征象.资料与方法 回顾性分析经病理活检证实的15例鼻咽癌患者颅神经周围扩散的MRI表现.结果 15例鼻咽癌均显示沿着三叉神经分支浸润扩散,其中2例沿着面神经浸润扩散.6例(2例双侧)Meckel腔浸润;7例沿着三叉神经眼支(V1)扩散;10例沿上颌神经(V2)浸润,表现为圆孔扩大,上颌神经增粗;13例翼腭窝扩大,肿块占据;3例眶下神经增粗,异常强化;3例沿着下颌神经浸润,表现为卵圆孔扩大,下颌神经(V3)增粗.结论 鼻咽癌可以沿着三叉神经、面神经浸润扩散,MRI是显示扩散的重要检查方法.     

急诊科护患沟通技巧探究

护理工作是医院工作中的重要环节,急诊科是与患者接触最密切,最易引起纠纷投诉的部门.现代社会人们的自我保护意识、法律维权意识不断增强,护理纠纷日益增多.因此,建立良好的护患关系,减少护理纠纷是护理工作中的重要内容.