目的:比较肺部超声是否和床旁胸部X线检查具有老年社区获得性肺炎(CAP)同样的诊断效力;比较肺部分区逐肋探查法和改良BLUE方案两种肺部超声探查方法在诊断老年CAP时是否具有同样的诊断效力.方法:2018年12月-2020年11月期间在北京中医药大学东直门医院急诊科就诊、符合65岁及以上社区来源疑似CAP临床特点的患者入选本研究,分别进行床旁胸部X线检查、床旁肺部超声检查和胸部CT检查.以胸部CT为金标准,统计床旁胸部X线和肺部超声诊断的阳性和阴性例数.结果:基于多种征象联合诊断老年CAP,肺部超声敏感度低于床旁胸部X线检查(78.3％vs.85.0％),特异度高于床旁胸部X线检查(91.3％vs.71.7％),而整体诊断准确率高于床旁胸部X线检查(84.0％vs.79.2％);基于多种征象联合诊断老年CAP,肺部分区逐肋探查法其敏感度、特异度、诊断准确率(78.3％、91.3％、84.0％)均高于改良BLUE方案(61.7％、89.1％、73.6％).结论:肺部超声可作为相当于床旁胸部X线的一种有效诊断老年CAP的检查方法,达到急诊科医生早期、快速、准确诊断老年CAP的目的;改良BLUE方案不能够替代逐肋探查的超声检查方法诊断老年CAP.

目的 探讨炙甘草汤加减方对伴有冠心病的心律失常患者心肌收缩功能的影响.方法 将65例伴冠心病的心律失常患者根据其心电图及平板试验病变导联分为A、B、C 3组,A组为Ⅱ、Ⅲ、aVF的ST-T改变(n=21),B组为Ⅰ和AVL的ST-T改变(n=24),C组为V1～V6的ST-T改变(n=20).在应用炙甘草汤加减方治疗前后,采用超声心动图及速度向量成像技术(VVI)对各组患者进行心脏射血分数及四腔心切面6个节段心肌应变分析.结果 与治疗前比较,3组患者治疗后的左心室射血分数(LVEF)未见明显改变(P>0.05).A组患者治疗前后在室间隔的基底段比较差异有统计学意义(P<0.05),其余节段心肌纵向应变的结果比较差异无统计学意义(P>0.05);B组患者的心肌6个节段在治疗前后的纵向应变比较,差异均无统计学意义(P>0.05);C组患者治疗前后除室间隔的心尖段比较差异有统计学意义(P<0.05),其余5个节段治疗前后比较差异无统计学意义(P>0.05).结论 炙甘草汤加减方对缺血节段心肌的心肌收缩功能有明显的改善作用,VVI应用于微观及节段性评估心肌功能较传统心功能检查具有明显的优势.

目的 探讨在椎动脉超声检查中的震荡样频谱,以期为头颈部血管等疾病提供提示.方法 回顾性分析自2018年5月至2019年5月间于我院进行颈部超声检查并提示椎动脉呈震荡样频谱的患者121例,记录其应用彩色多普勒超声进行颈内动脉、椎动脉、锁骨下动脉的二维、彩色以及频谱多普勒超声的检查结果 进行分析.结果 其中,81例峰值流速减低,40例峰值流速正常;82例为收缩期震荡,39例为舒张期震荡;在收缩期震荡的患者中,有60例为锁骨下动脉狭窄;体位性6例;椎动脉起始段重度狭窄或闭塞6例;先天性椎动脉细窄10例;舒张期震荡患者中,椎动脉远段中重度狭窄的28例,主动脉瓣关闭不全的8例,健康人群3例.结论 椎动脉的震荡样频谱可以较为便捷、安全的初步判断患者的头颈部血管情况.

Objective To investigate the feasibility of ultrasonography in the detection of postoperative hematoma and edema in the clearance of anterior cervical surgery and to explore the potential related causes of postoperative complications.Methods This study enrolled 24 patients with 2-segment hybrid surgery.All patients underwent ultrasonography at 24 hours before the surgery, 1-day and 5-day post operation, respectively.Postoperative hematoma was screened, and Image J was used to evaluate a specified rectangular area of local soft tissue at the surgical incision plane.The area of local edema was calculated and the results were statistically analyzed in combination with the postoperative complications score.Results 24 patients underwent ultrasonography at the appointed time, and no postoperative hematoma occurred.The area of edema at 1-day and 5-day post operation were (1.73±0.64) cm2, (0.67±0.58) cm2, respectively.Compared with 1-day post operation, the score of low tone, hoarseness, dysphagia, and feeling of neck swelling were significantly decreased (P＜0.05) in the 5-day post operation.Conclusions Postoperative complications were influenced by various factors during the perioperative period, and ultrasonography could be an effective way to identify hematoma and edema in the early stage after the surgery.

Objective To analyze clinical characteristics of abdominal obese patients with different types of traditional Chinese medicine(TCM) constitution.Methods Sixty male patients with abdominal obesity from March 2016 to October 2016 in Dongzhimen Hospital,Beijing University of Chinese Medicine were enrolled.According to the type of TCM constitution,the patients were divided into phlegm-dampness group and non-phlegm-dampness group,with 30 cases in each group.Sermn biochemical and insulin resistance indexes were tested.The common carotid iutima-media thickness (IMT),echo and number of arterial plaques were detected by color Doppler ultrasound.Results Levels of fasting insulin,triacylglycerol,insulin resistance index and carotid IMT in phlegmdampness group were significantly higher than those in non-phlegm-dampness group[(10.7 ± 0.5) μg/L vs (10.0 ± 0.4) μg/L,(3.4 ±0.4) mmol/L vs (2.7 ±0.5) mmol/L,(1.63 ±0.11) vs (1.37 ±0.98),(1.09 ±0.12)mm vs (0.94 ±0.10)mm] (P ＜0.05).The low echo rate in phlegm-dampness group was significantly higher than that in non-phlegm-dampness group[68.8％ (11/16) vs 18.2％ (2/11)] (P ＜ 0.05).Conclusion Patients with phlegmdampness abdominal obesity have higher common carotid IMT and higher susceptibility to type 2 diabetes and cardiovascular diseases compared to non-phlegm-dampness abdominal obese patients.

Impotence is lingering and difficultly treated. The therapeutic effects are not so satisfacto-ry. In recent years,more and more male patients are troubled with this disease. On the basis of the kidney the-ory,Prof. Li Haisong points that blood stagnation is the essential pathogenesis of impotence,kidney deficiency is the ultimate pathological tendency and liver stagnation is the pathological characters. Prof. Li has the u-nique experiences in the treatment of the disease,including 1. Preferring to complex formula with the combi-nation of tonification and purgation;2. Resolving stasis and promoting circulations in the whole process of treatment;3. Consolidating the root and cultivating the primary,strengthening the pathogenic qi;4. Smoothing the liver qi to remove stasis.

Objective To observe the echocardiographic presentation of the Senile Degenerative Heart Valvular Disease (SDHVD). Methods Patients aged over 60 years old and treated in our hospital from March 2014 to October 2015 were examined by echocardiography. 89 cases were selected from the diagnosed SDHVD patients for echocardiogram analysis. Results The SDHVD mainly happened on the left heart system, and usually were presented in aortic valve. Conclusion Echocardiogram had the characteristics of convenience, quickness and no injury in detecting SDHVD.

Objective:To investigate the role of ultrasound in the assessment of gastric motility and the therapeutic effect of electroacupuncture on gastric motility in patients with critically ill gastrointestinal dysfunction.Method:60 patients with gastrointestinal dysfunction in ICU and emergency ICU wards of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2016 to October 2017 were randomly divided into group of 30 cases treated with electroacupuncture and another group of 30 cases treated with conventional treatment.Ultrasound gastric motility examination (GET,ACF,ACA and MI),APACHE Ⅱ score,gastrointestinal dysfunction score,24-hour gastric residual andintra-abdominal pressure was performed on day 0,day 3 and day 7 of treatment.Result:On the 7th day,The electroacupuncture group showed a significant improvement in the gastric emptying time and antral contraction frequency compared with the conventional treatment group,while there was no significant difference in the antral contraction amplitude and motility index between the two groups.Compared with the conventional treatment group,the electroacupuncture group could significantly reduce the gastric residual volume in 24 hours and the intra-abdominal pressure,in the meantime,improve the APACHE-Ⅱ score on the 7th day.There was no significant difference in the score of gastrointestinal dysfunction between the two groups.Conclusion:Electroacupuncture is able to improve gastric motility in critically ill patients.Ultrasound can be employed as a real-time,bedside,noninvasive,economical,safe and objective auxiliary examination to evaluate the therapeutic effect of acupuncture on gastric motility dysfunction.

Objective:To evaluate the diagnostic value of 18G and 16G needle biopsy of breast lesions.Methods: Onr hundred and fifteen patients with breast lesions those were excised through surgery. Each lesion was under ultrasound-guided needle biopsy(US-CNB) with 18G and 16G, then underwent surgical resection of mass and pathological histology. Histological findings of US-CNB and the surgical specimens were analyzed for sensitivities, false negative rates, and underestimate rates.Results: Among 84 cases of breast cancer proved by surgical pathology, the sensitivity, specificity, false negative rate of 18G and 16G biopsy diagnosis were followed by 95.2% and 97.6%, 89.6% and 94.3%, 4.8% and 2.4%. Paired chi-square test showed no significant difference between the two methods.Conclusion: 18G and 16G needle biopsy has no significant difference in the diagnosis of breast lesions.

Objective and significance: Based on the opportunity of hospital PACS installation and implementation, make full use of the Hospital case characteristics and advantages of Chinese medicine clinics, through a combination of syndrome differentiation and treatment requirements for medical imaging and information intelligent processing, to abandon the traditional macroscopic observation and imaging diagnosis of the subjective judgment of objective. The use of computer technology, the image pixel analysis, calculation, processing, obtains the related data, provide more objective information for medical imaging diagnosis and establishing related differences in disease classification teaching module, to fill the domestic in the University of traditional Chinese medicine medical imaging teaching and research evaluation system gaps, for the clinical, research and teaching work provides more reliable tools.

政党情况下,子宫内膜覆盖于子宫体腔面,如因某种因素,使子宫内膜在身体其他部位生长,即可成为子宫内膜异位症.

临床实习的中医药院校学生中,较为普遍地存在着一个问题,就是对西医知识的掌握与临床工作的要求存在一定差距,尤其是在内容较为庞杂的西医诊断知识方面,就更加明显.超声诊断学是现代医学诊断学的一个重要学科.近年来,超声已发展成为和CT、核磁一样对临床具有重要作用的基本诊断技术,在临床上广泛应用于内、外、妇、儿、骨等多个学科.但我们在超声医学的教学工作中,深深感到学生们对这门学科的兴趣、理解、学习和掌握差强人意.

患者男,18岁,北京人.自觉右上臂肿物来诊.查体:右上臂内侧中部有一肿物,无触痛,质较硬,边界尚清,位置较深,活动度差.B超检查:右上臂肌层内可探到2.2cm×2.0cm×1.4cm的混合性包块,与周围组织分界尚清楚,形态尚规则,其内壁欠光滑,包块中心部可见不规则液性暗区0.6cm×0.5cm×0.4cm,液性暗区内可见中等回声光条居于其中,后方声影不明显(图1).