目的 调查分析我国超声报告模板使用现状及超声医师相关需求.方法 以我国不同省市自治区直辖市的各级医院的超声医师为调查对象,采用互联网线上方式对超声报告模板使用现状,高效、规范化超声报告模板的主观需求程度进行调查分析.采用R×C列联表x2检验,比较分析不同级别医院超声医师反馈之间的差异.结果 本调查共收回有效答卷3863份,除香港特别行政区、澳门特别行政区及台湾省之外的全国31个省级行政区均有超声医师响应了此次问卷调查.问卷应答率方面:在地理分布、医院级别、职称类型方面均有一定差异,其中华北地区、三级医院、主治医师应答率最高,分别为30.44％(1176/3863)、53.46％(2065/3863)和41.11％(1588/3863).无超声工作站和有超声工作站但无报告模板者共96份(2.49％,96/3863)答卷,有超声工作站并有报告模板者3767份(97.51％,3767/3863)答卷.在超声报告模板使用高效性方面:43.40％(1635/3767)的超声医师反馈需要用鼠标或键盘操作≥4步才能调出报告模板;93.05％(3505/3767)的超声医师表示,在遇到阳性病例时,"经常需要"或"一般需要"在报告模板的基础上修改较多文字;对于常见病是否都有超声报告模板的调查,"几乎全部常见病都有模板"者仅占37.09％(1397/3767),而常见病的不同严重程度是否有相应的报告模板方面,仅35.07％(1321/3767)的超声医师反馈有.在超声报告模板规范化方面:对于报告模板内容描述是否全面的调查,仅16.11％(607/3767)的超声医师认为所在科室报告模板内容描述"非常全面";以甲状腺结节分级诊断(甲状腺超声影像报告和数据系统)所描述内容为标准,仅22.40％(832/3715)的超声医师反馈每一份甲状腺结节报告均描述全面;针对报告模板术语是否规范的调查,仅13.75％(518/3767)的超声医师认为所在科室报告模板术语使用"非常规范",56.78％(2139/3767)的超声医师反馈所在科室超声报告模板中有"光点""光团"等文字.对高效、规范化超声报告模板的主观需求方面:98.52％(3806/3863)的超声医师反馈需要一套使用高效、内容规范的超声报告模板.不同级别医院超声医师对所有上述几方面调查问题的答复,差异均具有统计学意义(P均＜0.01),三级医院的超声报告模板在高效性及规范程度方面优于其他级别医院.结论 目前我国超声报告模板在使用高效性及规范化程度方面均存在一定的不足,多数超声医师希望有一套使用高效的规范化超声报告模板.

目的:分析总结心肌梗死后心肌夹层患者的临床特征、治疗及预后.方法:利用中文、英文数据库,包括PubMed、Embase、Cochrane图书馆、中国知网、维普网、万方数据库和中国生物数据库,对2020年10月以前中英文文献报道的54例心肌梗死后心肌夹层患者的临床资料进行汇总.对手术治疗患者(n=28)与非手术治疗患者(n=26)、死亡患者(n=16)与生存患者(n=38)之间的临床资料进行比较分析.结果:54例患者中,男性38例(70.4％),38例(70.4％)由超声心动图确诊.手术治疗患者的死亡率低于非手术治疗患者(17.9％vs.42.3％,P=0.049),室间隔穿孔发生率高于非手术治疗患者(53.6％vs.26.9％,P=0.046).死亡患者的左心室下后壁或右心室壁心肌梗死(75.0％vs.39.5％)、心肌夹层伴有室间隔穿孔(62.5％vs.31.6％)、心肌夹层位于左心室心尖以外部位(81.3％vs.52.6％)、非手术治疗的比例(68.8％vs.39.5％)均高于生存患者(P均<0.05).Logistic回归分析显示,非手术治疗是心肌梗死后心肌夹层患者死亡的危险因素(OR=9.144,95％CI:1.574～53.117,P=0.014).结论:心肌梗死后心肌夹层临床罕见,超声心动图是首选诊断方法,手术治疗能降低死亡率.

目的 探讨左室松弛时间常数(Tau)简易测算法评价左室舒张功能的价值.方法 常规测量149例二尖瓣反流患者的左心内径、射血分数(EF)、二尖瓣口舒张早期血流速度与二尖瓣环舒张早期组织速度比值(E/e')、左房容积指数(LAVI);测量二尖瓣反流连续多普勒频谱下降支血流速度为1、3 m/s之间的时间间隔(t1-t3),用Tau简易测算公式Tau=1.2(t1-t3)计算Tau.结果 ①149例患者中左室舒张功能障碍组82例、左室舒张功能正常组67例,两组间一般资料无统计学差异.左室舒张功能障碍组Tau值[(72.1±17.7) ms]高于正常组[(45.7±15.3) ms],差异有统计学意义(P＜0.01).②将149例患者Tau值与左室舒张功能超声经典参数进行Pearson相关分析,Tau与LAVI、E/e'呈正相关,与EF、e '呈负相关(P＜0.05).ROC曲线分析显示Tau诊断左室舒张功能障碍的受试者工作特征(ROC)曲线下面积为0.904 (95％CI:0.847～0.961),最佳截断值为56.4(灵敏度92.7％,特异度82.1％).结论 Tau简易测算法所测算的Tau与左室舒张功能的超声经典参数具有良好相关性,具有进一步深入研究的价值.

目的 分析甲状腺嗜酸细胞肿瘤的超声图像特征,提高对良、恶性甲状腺嗜酸细胞肿瘤的诊断和鉴别诊断水平.方法 回顾性分析13例甲状腺嗜酸细胞肿瘤患者的超声图像及临床病理特征.结果 13例甲状腺嗜酸细胞肿瘤(HCN)患者共计14个结节,其中嗜酸细胞腺瘤(HCA)10例,嗜酸细胞癌(HCC)3例.HCN结节大多具有良性病变的超声特征.HCC与甲状腺乳头状癌(PTC)比较,结节的大小、形态、边界、纵横比、周边晕征、有无钙化、血流等差异均具有统计学意义(P＜0.05);而成分、回声、被膜连续性差异无统计学意义(P＞0.05).结论 甲状腺Hürthle细胞肿瘤具有特定的超声特征,FNA可诊断嗜酸细胞肿瘤,但不能判断有无血管和包膜侵犯;手术后组织学病理是明确良、恶性病变的金标准.

目的 调查分析我国超声医师对制定中国颈部血管超声若干问题专家共识的必要性.方法 以中国不同省市自治区的各级医院超声医师或相关专业医师为调查对象,采用微信手机端问卷方式对颈部血管超声若干问题是否需要制定专家共识进行调查分析.问题涉及颈动脉斑块的诊断与鉴别诊断(Q1～Q3)、易损斑块的评价与新技术展望(Q4、Q5)、颈动脉狭窄诊断标准及注意事项(Q6～Q8)、颈动脉发育异常或走行异常(Q9～Q11)4个方面的11个问题.问题回答设计包括亟需共识问答(A1)、一般需要共识回答(A2),和已有答案,不需要共识回答(A3).不同级别医院问题回答结果的差异比较采用R×C列联表χ2检验,血管超声问题与其他因素的相关性分析采用Kendall's tau-b分类变量.结果 收回有效问卷3658份,涉及全国34个省市自治区等各级医院的医师.问卷响应率在地理分布、医院级别、职称类型等均有一定差异,其中华东区、三级甲等医院、主治医师响应率最高,分别为43.41％(1588/3658)、45.90％(1679/3658)和41.53％(1519/3658).Q1～Q11问题有必要"共识"答复的累积响应率分别为81.00％(2963/3658)、91.94％(3363/3658)、85.24％(3118/3658)、96.61％(3534/3658)、87.64％(3206/3658)、92.62％(3388/3658)、86.80％(3175/3658)、90.08％(3295/3658)、84.53％(3092/3658)、95.02％(3476/3658)和89.99％(3292/3658).问题Q1、Q2、Q3、Q5和Q8与地理分布呈负相关(r值分别为-0.032、-0.032、-0.030、-0.031和-0.030,均P<0.05);而Q3、Q7和Q9与医师职业呈负相关(r值分别为-0.030、-0.033和-0.040,均P<0.05);Q3、Q8和Q9、Q10与医院级别呈负相关(r值分别为-0.039、-0.042和-0.053、-0.035,均P<0.05);Q1、Q4、Q6、Q7、Q8和Q10与医师职称呈负相关(r值分别为-0.079、-0.032、-0.035、-0.030、-0.030和-0.052,均P<0.05).结论 颈部动脉超声若干问题均需要"专家共识"."专家共识"的紧迫性与地理分布、医院级别、医师职称级别相关;"专家共识"有利于消除不同级别超声医师之间的认知差异性,统一标准,规范报告,实现质量控制.

Doppler ultrasound waveform analysis is routinely used for diagnosis and evaluation of arterial stenosis in patients suffering from peripheral artery disease (PAD).1,2 It was previously demonstrated that there is significant heterogeneity of descriptions of Doppler waveforms by French vascular residents.3 However, this heterogeneity was significantly reduced when using a four-item Doppler classification.3,4 The aim of the present study was to assess the heterogeneity of Doppler waveform descriptions among Chinese ultrasound specialists and the impact of a four-item Doppler classification. During a national Annual Ultrasound Congress in Beijing (May 5–6, 2019) ultrasound specialist attendees were invited to complete an online questionnaire developed by Scissons.5 The questionnaire presented 30 Doppler waveforms (15 pulsed ultrasound waveforms (PW) and 15 continuous ultrasound waveforms (CW)).3 Attendees were invited to describe 30 Doppler waveforms as they would in their usual clinical practice (first round) and then using a four-item classification (triphasic, biphasic, monophasic, and others) (second round). This study was validated by the ethical committee of Rennes (France) and registered on clinicaltrials.gov (NCT03827512). The Wilcoxon signed-rank test was used to compare the heterogeneity of descriptions between the first and the second round. Comparisons of correct answers (in percent) were compared using the chi-squared test. Statistical analyses were made using R software (Vienna, Austria, http:// www.R-project.org). A two-tailed p-value < 0.05 was considered as statistically significant. A total of 209 participants from 23 provinces in China (Figure 1A) were included in the study: 128 in the first round, 178 in the second; 97 participated in both rounds. The median number of years working in vascular ultrasound was 7 [4–7] years. There were 198 medical doctors and 11 sonographers. Among the 209 participants, 10, 59 and 140 worked in a primary hospital, secondary hospital, and tertiary hospital, respectively. In the first round, among 128 participants, the average number of terms used to describe the 30 Doppler waveforms was 51.2 ± 10.5. Among the 97 participants who participated in both the first and second rounds, the average number of different descriptions was 40.1 ± 8.0 for the interpretation without classification compared to 3.4 ± 0.8 (p < 0.05, Figure 1B) with the suggested four-item classification. An average of 76% (range 9–100%) of Doppler waveforms were correctly identified by the 97 participants who participated in both rounds. There was no statistical difference between the average identification rate of PW and CW (p > 0.05). Scissons has previously reported that the description of Doppler waveforms is an issue in the USA.5 Our previous work conducted in France also found that there was a large heterogeneity in the description of Doppler waveforms.3 There are several possible explanations. First, there is no international consensus defining the different Doppler waveform profiles, despite the fact that Doppler waveform analysis is recommended in the diagnosis of PAD.6 Second, as shown by Nicolaides and Yao,7 the same word can be used for the description of different Doppler waveforms. This contributes to maintain the confusion in ultrasound practice. In the present study, the percentage of correct answers (76%) was similar to the one previously reported by Scissons (74%), suggesting a similar level of vascular ultrasound knowledge between our participants and American sonographers.5 The number of correct answers is slightly lower than the one reported among French residents, but the number of participants was low (n = 19).3 A high variability of arterial Doppler waveform descriptions exists in China