肺静脉异常连接X线诊断 (附11例报告)

目的:提高X线对肺静脉异常连接的诊断准确性,为手术治疗提供可靠的依据。材料与方法:回顾性分析了11例肺静脉异常连接的X线胸片和病理生理改变,男3例,女8例,年龄8—34岁。从血液动力学变化分析了“8”字征,镰刀综合征等X线典型征象。结果:11例中完全性肺静脉异常连接4例,部分性7例。按部位分心上型6例;心内型4例;心下型1例。肺静脉异常连接或多或少合并房间隔缺损,法鲁氏三联症,以及右肺和肺动脉发育不全。结论:肺静脉异常连接的X线征象十分复杂而多变,因此,术前的仔细观察和精心判别对于手术治疗是非常重要的。     

肺血管流动参数的CT相关测量研究

目的：探讨活体肺血管分支几何学和流动状态参数的特征。方法：在63例正常人胸部螺旋CT图像上测量20l0套两分支的血管横径，计算Z值和雷诺数，分析并判断不同横径血管内血液的流动状态。结果：Z值与标本数据比较有显著不同；雷诺数随血管横径的增大而增大，但不超过l000。结论：2—4mm的正常肺小血管内雷诺数＜l000，流动为层流。     

64层螺旋CT三联检查在急性胸痛诊断中的应用

目的探讨64层螺旋CT（MSCT）三联检查显示急性胸痛患者肺动脉、胸主动脉和冠状动脉病变的能力及其临床应用价值。方法70例患者进行64层MSCT回顾性心电门控肺动脉、胸主动脉和冠状动脉联合检查。采用多平面重组（MPR）、最大密度投影（MIP）、曲面重组（CPR）及容积再现（VR）多种重组技术显示肺动脉、胸主动脉和冠状动脉，评价成像质量能否满足临床诊断需要。结果平均扫描时间（8．5±1．0）s，总对比剂用量100ml。肺动脉和主动脉增强后CT值均≥200HU者占95．7％（67／70）；冠状动脉显影图像质量优的节段占85．8％（720／839），图像质量良的节段占8．6％（72／839），图像质量差的节段占5．6％（47／839）。共检出冠状动脉狭窄≥50％者20例，肺动脉栓塞2例，主动脉夹层2例。结论64层MSCT三联检查能够在8s左右1次扫描完成肺动脉、胸主动脉和冠状动脉检查，图像质量可以满足临床诊断需要，在急性胸痛病因诊断中具有很高的临床应用价值。     

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.     

Type II pneumocytes modulate surfactant production in response to cigarette smoke constituents: Restoration by vitamins A and E

This study was to evaluate the effects of cigarette smoke constituents upon type II pneumocyte surfactant production in vitro, and how vitamins A and E may alter the response. Freshly isolated type II pneumocytes from Sprague–Dawley rats were incubated 20 h in medium with fetal bovine serum that was or was not treated with cigarette smoke. The number of adherent cells was inversely related to the dose of smoke or benzo(a)pyrene. Despite the decreased number of treated cells, the total amount of surfactant per culture well was unchanged, whereas surfactant production per cell was significantly increased (P < 0.05). Vitamin A concentration was significantly (P < 0.05) lower in the smoke-treated serum compared with untreated serum. When vitamin A or E was added to the cigarette smoke-treated serum, cell adherence and surfactant production returned to control values. In conclusion, cigarette smoke constituents or benzo(a)pyrene alone decreased the number of adherent type II pneumocytes, but did not alter surfactant amounts because of an increased production of surfactant per cell. Type II pneumocytes seem to adjust surfactant production dependent upon the number of type II pneumocytes to produce it and vitamin A or E enhance cell attachment in the presence of the smoke toxins.     

肾移植术后肺部感染的诊治

目的：探讨治疗肾移植术后肺部感染的有效方法。方法：对我院1999年至2002年发生的23例肾移植术后肺部感染病人治疗方法和结果总结，结果：发现强调提高病人机体免疫力水平的治疗方法效果明显。结论：肾移植术后肺部感染的主要病因是机体免疫水平的低下，提高机体免疫水平是治疗移植后肺部感染的最重要手段。     

In vivo comparison of two through-plane MR velocity mapping methods: Fast fourier encoding and phase mapping

Magnetic resonance imaging maps of velocity were acquired with a 1.5-T system in 10 subjects in a plane perpendicular to the main pulmonary artery. Velocity images were successively acquired with a method developed from Fourier-encoding velocity imaging (FEVI) principles with eight gradient steps and one excitation, and with two-point phase-subtraction mapping. Reconstruction in FEVI was implemented by zero-filling interpolation around the eight gradient steps and then around the four central steps. The methods were compared by using estimates of noise in velocity measurements based on the difference between the experimental map and a smooth fitted map. For the same acquisition time, FEVI with four encoding steps was more precise in velocity measurements than phase mapping. Precision was further increased by the use of eight encoding steps, but acquisition time was doubled.     

Temporary vena cava filters in the prevention of pulmonary embolism during total hip arthroplasty

Thromboembolism constitutes one of the most dangerous complications during the immediate postoperative period of prosthetic surgery. Pharmacological prophylaxis and mechanical vascular compression are not always sufficient to protect from this surgical complication. In patients at greatest risk for thromboembolism, often with a positive history for pulmonary embolism, temporary vena cava filters may be used to reduce the incidence of vascular and pulmonary complications. However useful, these filters cannot be routinely used in orthopedic surgery. We present our results with the use of Filcard RFO2 vena cava filters in an open, randomized study of 30 patients. Received: 5 November 2001/Accepted: 30 November 2001     

吸入一氧化氮对心瓣膜置换术后肺动脉高压患者血流动力学的影响

目的：观察吸入一氧化氮（ＮＯ）对心瓣膜置换术后肺动脉高压患者血流动力学的影响。方法：选择９例心瓣膜置换术后伴肺动脉高压的病人，吸入ＮＯ０．００３％，观察三个时象点：吸入ＮＯ前；开始吸入ＮＯ后１５分钟；停止吸入ＮＯ后１５分钟。结果：吸入ＮＯ能显著降低肺动脉压和肺循环阻力指数（Ｐ＜０．０１），停止吸入ＮＯ１５分钟后，肺动脉压和肺循环阻力指数恢复到原有水平。在整个观察过程中，心率、平均动脉压、中心静脉压、肺动脉楔压、体循环阻力指数和心脏指数均无显著变化（Ｐ＞０．０５）。结论：吸入ＮＯ具有选择性肺血管扩张作用，是治疗心瓣膜置换术后肺动脉高压的较理想药物。     

三种结核抗体对肺结核的诊断价值

目的:探讨3种结核抗体试剂盒对肺结核的诊断价值。方法:采用澳大利亚产ICT-TB卡、TB—DOT和国产快速ELISA试剂盒检测220例肺结核,菌阳者60例,菌阴者160例,与48例非结核肺疾病和30例健康人对比观察。结果:220例肺结核血清结核抗体敏感性ICT-TB卡为50.7%、TB-DOT为60.0%、ELISA为68.2%,三者间差异具有显著性(P<0.05)。菌阳组分别为76.7%、80.0%、88.3%,菌阴组50.0%、52.5%、60.6%,菌阳与菌阴者间均有显著差异(P<0.005)。3种结核抗体特异性为98.7%、91.0%、84.6%,差异显著(P<0.025)。结论:抗原纯度较高的ICT-TB卡,TB-DOT特异性较强,但敏感性较低,复合抗原ELISA敏感性较好,但特异性偏低。