目的 探讨不同浓度对比剂进行CTA检查对冠状动脉的增强效果的影响.方法 选取冠状动脉CT造影检查的患者846例,其中应用碘克沙醇(组)454例(碘浓度320 mg I/ml),应用碘佛醇(组)32例(碘浓度350 mg I/ml)进行造影检查,比较两组的基线情况、图像质量主观评分及客观增强效果.结果 846例行冠状动脉CTA检查的患者中,两组一般资料比较,性别、年龄及心率差异无统计学意义(P＞0.05),碘克沙醇组体重小于碘佛醇组(P＜0.05).两组图像质量主观评分及主动脉窦及冠状动脉前降支增强效果比较差异无统计学意义(P＞0.05).结论 使用低浓度等渗对比剂能获得与高浓度对比剂一样高质量的图像,同时可明显降低碘用量.

Objective:To explore the therapeutic effect and the acute complications of Cheatham Platinum stenting (CPs) for treatment of coarctation of the aorta (CoA).Methods:Totally 87 patients who underwent treatment of CPs for native or recurrent CoA in Beijing Anzhen Hospital Capital Medical University from June 2014 to December 2018 were enrolled. Of 87 patients, 54 were males, 33 were females, aged 21 (18, 25) years old. The clinical data of patients with acute complications were collected and retrospectively analyzed.Results:Of 87 patients, 86 cases were successfully implanted with stents. After stent implantation, the proximal and distal arterial systolic pressure difference decreased significantly from 55 (45, 60) mmHg to 0 (0, 5) mmHg, the difference was statistically significant ( Z=-8.118, P<0.001), of which 80 cases met the success index of CPs treatment.A total of 7 cases had acute complications, including aortic injury in 1 case, instrumental and technical complications in 2 cases, peripheral vascular complications in 3 cases, and paradoxical hypertension complication in 1 case. Compared with patients without acute complications, patients with acute complications had a higher rate of surgical failure [42.9%(3/7) vs. 5.0%(4/80), P=0.010]. Conclusion:CPs is safe and effective in the treatment of CoA, acute complications are related to the success or failure of the operation, which should be fully recognized and effectively prevented so that the treatment can achieve a better outcome.

目的 探讨将介入治疗术后封堵器腰部直径的胸部平片测量作为房间隔缺损大小参考标准的价值.方法 研究37例房间隔缺损(ASD)后下缘短缺(＜3mm)并成功实施介入封堵手术的中老年房间隔缺损患者,均于术后第二日复查胸部平片及CT.胸部X线检查拍摄后前位(PA)、左侧位(LL)及左前斜位(LAO)胸片,在LL及LAO胸片上测量封堵器的腰部直径(CR-PODll,CR-PODlao),并评断出显示封堵器双盘平行的较佳投照体位.CT检查采用冠状动脉扫描模式,将患者冠状动脉CTA资料进行三维容积重建,在收缩期时相及舒张期时相分别测量横断面直径a(CT-PODsa,CT-PODda)与矢状面直径b(CT-PODsb,CT-PODdb).将上述测量数据进行配对t检验及相关性分析,并拟合回归方程.结果 胸部平片CR-PODll与CR-PODlao测量值之差为1.61 mm,有显著性差异(t=7.88,P＜0.05);对二者胸片呈现双盘平行的占比行Fisher精确检验,无显著性差别(t=0.642,P=0.321).CT-PODsa分别与CT-PODsb及CT-PODda测量结果相比,差值分别为-0.02mm及-0.10mm,均无显著性差异(t=-0.11,P=0.91;t=-0.73,P=0.47).CR-PODll及CR-PODlao分别与CT-PODda相比,平均差值分别为3.23 mm及1.62 mm,均有显著性差异(t=12.57,P＜0.001;t=6.62,P＜0.001);且二者与CT-PODda均有极强且接近的相关性(R=0.95,P＜0.001),其回归方程分别为YCR-PODll=1.04X+ 1.7及YCR-PODlao=0.97X+2.5.结论 房间隔缺损介入治疗术后封堵器腰部直径的X测量与CTA测量有极好的相关性,差别微小,可以在临床研究中作为估测缺损大小的参考标准.

目的 :评价经导管封堵二尖瓣置换术后瓣周漏的安全性及有效性.方法 :回顾分析2016年11月至2019年3月在我院经导管封堵的二尖瓣瓣周漏病例,共入选12例患者,9例男性,年龄(58.8±8.9)岁.结果:介入治疗距离初次手术时间平均6.5(0.4～28.0)年,介入成功率为83.3％.术后1个月,与术前比较,完成介入治疗的10例患者NYHA心功能分级由Ⅲ级降为Ⅱ级(P=0.001),瓣周漏反流程度由平均2.4级降为0.5级(P=0.000),N末端B型利钠肽原(NT-proBNP)由平均1725 mmol/L降至847 mmol/L(P=0.000),左心室舒张末期内径由(57±7)mm降为(51±6)mm(P=0.001),左心房前后径由(60±11)mm降为(53±10)mm(P=0.001),左心室射血分数改变差异无统计学意义(P=0.965).1例患者试封堵后出现瓣膜功能障碍而放弃封堵,1例溶血伴肾功能不全,转外科手术治疗,1例肱动脉假性动脉瘤,给予局部注射凝血酶后痊愈.术后随访1.0～28.0个月.全组患者无死亡,未出现其他严重并发症.结论:二尖瓣瓣周漏介入治疗总体成功率及近中期效果良好,对具备适应证和手术高危的患者可作为替代手术的治疗选择,长期疗效有待进一步随访.

1病例报告<br>　　患者男，29岁，因反复发热伴心慌、憋气10 d 入院，入院时即出现胸闷、憋气、精神差，伴心率增快、血压下降，给予多巴胺静脉泵入症状缓解不明显。胸部 CT 提示心包囊性占位（图1～3），考虑囊肿可能性大。血常规：白细胞19.99×109／L，其他各项指标基本正常。经胸超声心动图（transthoracic ech-ocardiography，TTE）提示心包囊肿，心包大量积液，心功能不全（射血分数45％），考虑心包填塞。遂急诊手术。

目的 探讨临床路径(clinical pathway,CP)在先天性心脏病介入封堵术中的应用效果.方法 2006年6月-2012年6月期间成功行先天性心脏病封堵术的患者,包括:动脉导管未闭(PDA)、房间隔缺损(ASD)和室间隔缺损(VSD);分CP组和非CP组.对两组的平均住院日、住院总费用、并发症发生率、患者满意度及病案质量进行对比分析.结果 599名患者(男203/女396)成功接受先天性心脏病封堵术,CP组408例(PDA126例、ASD 166例、VSD116例),非CP组191例(PDA52例、ASD83例、VSD56例).CP组各病种平均住院日均明显缩短(P＜0.05);PDA和ASD患者住院总费用明显下降(P＜0.05),但VSD总费用无明显降低(P=0.518).两组整体并发症率无差异(P=0.897),CP组甲级病案率及患者满意度明显提高(P＜0.001).结论 临床路径是改善先天性心脏病介入封堵术医疗管理质量的有效方法.

<正>病例资料患者,女,10岁。出生后发现心脏杂音,易感冒,轻度发绀,哭闹后加重。体检:发育差,心率125次/分,律齐,胸骨左缘第2、3肋间可闻及吹风样收缩期杂音,肺动脉第2音亢进。心电图:右心室肥厚,心房扩大。胸片示两肺血多,肺动脉段凸出,右心室增大,心胸比率0.55。超声心动图:先天性心脏病,右心室双出口、室间隔缺损、房间隔缺损、永存左上腔静脉。右心导管检查:先天性心脏病右室双出口、室间隔缺损(主动脉瓣下)、肺动脉狭窄;主动脉根部造影:冠状动脉左

新生儿缺血缺氧性脑病(hypoxic-ischamic encephalopathy,HIE)是造成新生儿中枢神经系统发育障碍和新生儿死亡的一种较常见的疾病.早期诊断和具有针对性的治疗直接关系到HIE患儿的生存和预后.磁共振质子波谱(hydrogen-1 magnetic resonance spectroscopy, 1H-MRS)是目前唯一能够无创性地检测活体内代谢产物改变的方法,在探讨病理机制,指导临床诊断、治疗和判断预后等方面可弥补CT和MRI的不足[1].

肠梗阻是临床上成人常见的一种急腹症,病情急、重,其中机械性单纯性小肠梗阻所占比例很大[1].因为该病不但可以引起肠管局部解剖和正常功能的改变,还可引起全身一系列生理性紊乱,严重者危及患者生命[2].因此早期诊断就显得尤为重要.

患者女,21岁,于2年前无明显诱因突然咯血,并有右侧胸痛,此后偶有咳嗽、痰中带血,为红色血丝.于1年前出现活动时气喘、胸闷,休息后缓解,并再次出现右侧胸部疼痛,逐渐加重,活动渐少.1个月前症状加重,休息时亦有胸闷,偶有头晕、晕厥、痰中带血.体检:双肺呼吸音低,坐位呼吸,伴双下肢水肿。

Objective:To study the clinical application of CT angiography(CTA) subtraction technique in carotid artery and vertebrobasilar artery.Methods: MSCTA was performed on 43 patients.The primitive images were transferred to work station,and subtraction imaging and 3D image processing were performed.Visualization of the carotid artery and vertebrobasilar artery were reviewed and scored by 2 observers.The data were analyzed using the SPSS11.0.Results: The vessel reconstruction image with subtracted technique was significantly more excellent than that without subtracted technique.Compared with conventional CTA,subtracted images had advantages in displaying the integrity of vessels,the range of carotid artery and vertebrobasilar arteries.However,calcified plaque can't display well in subtracted images,which should be diagnosed by plain scan and non-subtracted images.Conclusion: CTA subtraction technique can distinctly display the whole course and the complicated anatomical relationship of carotid and vertebrobasilar arteries,and is beneficial for clinical diagnosis combining plain scan image and non-subtracted image.

Objective:To investigate the valuation of B Super-sonic,Color Doppler and CT diagnosis of ARC.Methods: To analyze the B Super-sonic,Color Doppler and CT manifestation of twenty-two ARC having been testified by pathology,the ability to the finding,location-determining and nature-determining of ARC can be compared.Results: (1)Both B Super-sonic,Color Doppler and CT could find the tumor.(2)CT had apparent priority to B Super-sonic,Color Doppler in determining the location and nature.Twenty-one patients had explicit diagnosis before operation.Conclusion: CT has important valuation in the diagnosis of finding,location-determining and nature-determining,and is the major method of finding,location-determining and nature-determining of ARC.

急性肠套叠是2岁以下小儿常见的一种急腹症,诊断治疗不及时、不正确会导致肠坏死、肠穿孔及腹膜炎等严重并发症,有时甚至危及患儿生命.多数学者[1-3]认为发病时间在24 h之内、一般状态良好、没有腹膜炎及肠坏死征象时,最佳治疗方法为空气灌肠复位法.但是如果空气灌肠整复失败,患儿就需要进行外科手术治疗.所以,提高空气灌肠整复的成功率极为重要.