1临床资料患者,女,58岁,因间断发热（体温最高38℃）,干咳1周入我院呼吸内科。查体:体温:37.7℃,脉搏:70次/分,呼吸:20次/分,血压:120/80 mmHg.胸廓对称,右下肺呼吸运动减弱,语音震颤消失,右下

彩色多普勒成像技术(Color Doppler flow imagine,CDI)是目前临床常用的无创性诊断方法,它在二维显像的基础上,获取血流频谱,进行血流动力学研究.我们利用CDI检测了正常人15例(30眼)及CACG患者25例(36眼)手术前后眼动脉(ophthalmic artery ,OA)、视网膜中央动脉(central retinal artery,CRA)和睫状后短动脉(short posterior ciliary artery,SPCA)的血流参数,探讨原发性闭角型青光眼视神经损害与眼底血流动力学改变的相关关系.

目的:探讨二维超声、彩色多普勒超声及能量多普勒超声在乳腺良、恶性肿块鉴别诊断中的作用,提高超声检查对乳腺良、恶性肿块的诊断符合率。方法:观察98例乳腺肿块的超声改变,与其病理诊断结果进行对照分析。结果:超声检查可以确定乳腺肿块发生的部位、肿块的大小、乳腺肿块的声像图特点及肿块的血流分布特征、丰富程度、血流动力学参数值。结论:彩色多普勒超声及能量多普勒超声与肿块的二维超声征象相结合可提高乳腺肿块的超声诊断准确率。

目的:观察肝脏肿瘤的超声造影灌注过程及回声变化规律与增强CT三个时期的强化特征,探讨超声造影对肝脏肿瘤的诊断价值。方法:对30例肝脏实质性占位性病变患者进行动态灰阶超声造影检查,其中的26例进行了增强CT检查。研究分析30例病例在超声造影与增强CT不同时相的增强情况的各自不同的典型图像。结果:超声造影显示原发性肝癌中85.7%(18/21)的肿块增强早于肝实质,门脉相和延迟相则多呈低回声;与增强CT显示85%(17/20)的肿瘤动脉期高密度,门脉期多呈低密度相一致。肝转移癌中88.9%(8/9)在动脉期呈环状增强或均匀增强,而肝实质期回声显著低于肝组织和增强CT83.3%(5/6)的肿瘤动脉期高密度的表现基本一致。肝脏恶性肿瘤在超声造影与增强CT不同时相的增强情况比较,差异无统计学意义(P>0.05)。结论:超声造影与增强CT对肝脏肿瘤的诊断和鉴别诊断均有较高的临床应用价值。

Objective To explore the changes of the Ultrasonic cardiography(UCG) before and after transcather closure of secundum atrial septal defect(ASD).Methods The apparatus of UCG was used to measure right ventricular and diastolic diameter(RVED),the rate of tricuspiol annulus motion(Rt),the ratio of early and late diastolic peak myocardial motional velocity(EM/EA),pulmonary artery systolic pressure(PASP).Results The UCG showed that RVED and SPAP decreased(P0.05) after transcatheter closure,at the same time,TR and EM/EA increased.Conclusion The right ventricular function improved noticeably after transcatheter closure.

Objective To evaluate the application of acoustic densitometry(AD) in patients with normal renal function but abnormal biopsy. Method 50 patients whose renal function were normal but biopsy results were abnormal were selected ,the control group was composed of 22 healthy subjects(44 kindeys). All subjects were divided into three groups: less than 40 years(40y),40~59 years (40~59y) and more than or equal to 60 years(≥60y). AD technology was applied to measure the intergrated backscatter(IBS)and the normalized value of IBS(IBS%) of renal cortex and medulla of different groups. Results ①Cortex and medullar IBS% of patients with normal renal function but abnormal biopsy in three age groups were significantly higher than those of contrasts. ②Among patients with normal renal function but abnormal biopsy, cortex and medullar IBS% in 40y group were significantly lower in comparison with both 40~59y and ≥60y,but no statistical difference was found between 40~59 and ≥60. Conclusion Cortex and medullar IBS%of patients with normal renal function but abnormal biopsy had been different from those of contrasts. With acoustic densitometry, we can differentiate such patients early, and effective treatment can be enduced early. In addtion, it is necessary for physicians to consider the effects of aging factor because age was related closely to IBS%.

Objective To evaluate the value of Echocardiographic in transcatheter occlusion of atrial septal defect (ASD).Methods 32 patients with ASD were chosen according to the indication of ASD occlusion by transthoracic echocardiography (TTE) and/or transesophageal echocardiography.All the patients underwent attempted transcatheter closure with the guide of X-ray.The real time echocardiography had been used to guide occlusion of ASD.Follow-up evaluation was performed with echocardiography at 24 hours and 1,3,6,12,24 months after wards.Results The occlusion of ASD was successful in 31 ASD patients(96.88%).Of these cases,26(83.87%)displayed an immediate complete closure on color Doppler while only 5(16.13%) showed trace of small residual shunt,which had gone till the sixth month of the follow-up.One patient had to quit the occlusion because the residual organization of ASD was too thin and soft to uphold the septal occluder.All the cases had no other complications.Conclusion Echocardiography can be used to choose the case of ASD occlusion,guide occlusion of ASD and evaluate curative effect.

Objective To study the effects of sodium profile hemodialysis on left ventricular function with acoustic quantification technique. Method 30 patients were divided into 2 groups by random: conventional hemodialysis(CHD) group(n=15) and profile hemodialysis(PHD)group(n=15).All the patients' left ventricular function were measured before and after there months. Results The indices of left ventricular systolic function EF?PER were improved siginificantly after three months of PHD,whereas in CHD group,there were no obvious changes in left ventricular function. There were no siginificant distinction between two groups before and after three months. Conclusion A long time PHD can improve patients' left ventricular function quickly.

Objective To evaluate the clinical value of atrial filling fraction(AFF) in detecting left vertricular relaxation function of patients with hypertension. Methods AFF, peak rapid filling rate(PRFR) of 40 patients with hypertension and 40 normal people were measured by acoustic quantification(AQ) technique, and EV/AV of mitral valve were also calculated. Results AFF of patients were higher than normal(P0.001), while PRFR and EV/AV of patients were lower than normal(P0.001～P0.005). Moreover, AFF of the whole subjects have negative correlations with PRFR and EV/AV respectively(r=-0.51, r=-0.61). Conclusion AFF can objectively show changes of left ventricular relaxation function in patients with hypertension, it is useful in identification of abnormality of left ventricular relaxation function.

目的:应用声学定量(AQ)和彩色室壁运动(CK)技术结合动态观察急性心肌梗塞(AMI)溶栓后心功能和室壁运动变化,探讨AQ和CK技术对溶栓后心脏功能的应用价值.方法:AMI患者溶栓组13例,未溶栓组10例,测量不同治疗时间两组左室舒张末期容积(EDV)、左室收缩末期容积(ESV)、射血分数(EF)、峰值射血率(PER)、峰值快速充盈率(PRFR)及室壁运动幅度.结果:在同一治疗时间溶栓组的各项指标均比未溶栓组明显提高(P＜0.005);溶栓组比未溶栓组恢复较早,第3天就出现显著变化(P＜0.05).结论:AQ和CK技术可以定量评价溶栓后心功能变化,而且准确、迅速,有较好的临床价值.

目的:评价老年黄斑变性(AMD)眼的血流动力学改变. 方法:应用彩色超声多普勒诊断仪,分别检测AMD患者40例(40只眼)、正常人30例(40只眼)的视网膜中央动脉(CRA)、睫状后动脉(PCA)的血流速度及阻力指数(RI).结果:AMD患者CRA和PCA的血流速度较正常对照组明显减小(P<0.01);RI较对照组明显增加(P<0.01).结论:AMD患者存在眼血流动力学异常,脉络膜血管床血液灌注减少,提示血管缺陷可能是AMD发病的一个重要因素.

目的进一步研究加味补阳还五汤对改善肺循环,降低肺动脉压,提高免疫力,从而使右室功能得以改善的作用.方法在西药治疗的基础上,口服加味补阳还五汤治疗20例老年急性发作期的慢性肺心病患者1个月,观察其治疗前后外周血T淋巴细胞亚群及右室功能的变化,并与20例单纯使用西药治疗的老年患者进行对照.结果治疗后老年肺心病患者的外周血T淋巴细胞亚群和右室功能明显改善(P＜0.01或P＜0.001),且加味补阳还五汤组优于单纯西药治疗组(P＜0.05或P＜0.001).结论加味补阳还五汤能够良好的调节老年慢性肺心病患者的免疫功能,改善右心室功能.

以往,仅用超声检查鉴别诊断乳腺占位性病变的良恶性十分困难.随着具有高频探头的超声诊断仪的问世,尤其以二维图像为基础的多普勒超声(Imagedirected Doppler Ultrasoud,IDU)及彩色多普勒血流显像(Color Dopple Flowing Imaging,CDFI)应用于临床检查后,明显提高了超声诊断乳腺肿块性质的准确率.我们采用IDU和CDFI两种方法对两组病人分别检测乳腺病灶内的血流分布情况,并对二者在鉴别诊断乳腺肿块良、恶性方面的作用进行讨论.

目的:探索心脏瓣膜闭锁(CVA)二维超声心动图(2DE)图像特征及规律性.方法:145例CVA年龄1～26(平均9.3)岁.其中三尖瓣闭锁(TA)93例,室间隔缺损伴肺动脉闭锁(PAVSD)28例,二尖瓣闭锁(MA)17例,室间隔完整的肺动脉瓣闭锁(PAIVS)7例.所有患者均有心血管造影对照,78例经手术证实.结果:2DE对129例作出正确诊断.CVA的共同图像特征表现为闭锁的瓣膜呈一条光带状回声无开放运动.房室瓣闭锁还具有三大特征表现:1.均有房间隔回声中断;2.闭锁瓣膜的下方心室发育不良;3.闭锁瓣膜的对侧心房、心室内径显著增大.在CVA中发病率由多到少依次为TA 64.2%、PAVSD 19.3%、MA 11.7%和PAIVS 4.8%.结论:CVA的2DE图像特征及规律性明显.2DE对CVA中的TA、PAVSD和PAIVS具有特异性诊断价值.

目的探讨老年高血压病患者(EH)血浆内皮素(ET)与左室重量和功能的关系.方法采用放射免疫分析法和多普勒超声心动图技术检测86例EH患者和57例健康对照者血浆ET的浓度及室间隔(IVST)、左室后壁厚度(PWT)、左室心肌重量指数(LVMI)以及左室流入道E峰和A峰比值(E/A)、E峰加速面积(EAA).结果 EH组ET、IVST、PWT、LVMI显著高于对照组(P值均＜0.01),E/A、EAA显著低于对照组(P＜0.01);EH组ET与IVST、LPWT、LVMI之间均存在着显著正相关(P值均＜0.01),ET与E/A、EAA之间均存在着显著负相关(P值均＜0.01).结论 ET可能是引起EH患者左室肥厚及舒张功能不全的原因之一.