Objective:The ability and value of a modified lung ultrasound scoring to assess the severity of the disease in children with neonatal respiratory distress syndrome（NRDS） were discussed and compared the results with chest X-ray in children with（NRDS）.Methods:In the neonatal ward, 23 children with clinical diagnosis of NRDS（case group） and 30 children without lung disease（normal group） were selected.All children in the case group underwent chest radiography and modified lung ultrasound score.Chest X-ray and ultrasound scores were both performed 40 times in the case group（including re-examination cases）,and 30 ultrasound scores were performed in the control group.The ultrasound scores of the case group and the control group were compared.The correlation between the severity of NRDS and the ultrasonic score of the case group was analyzed.Case group were divided into four groups based on chest X-ray grading.By drawing the receiver operating characteristic（ROC） curve, the diagnostic efficacy of ultrasound scoring was analyzed and the cutoff values between each group were obtained.Results:The ultrasound scores of the case and control groups were（16.3±9.6） and（0.5±0.8） respectively.Pulmonary ultrasonic score in case group was significantly higher than that in control group, the difference was statistically significant（P＜0.05）.The results of the correlation analysis showed a positive correlation between the lung ultrasound score and NRDS severity in the case group（r=0.635,P＜0.01）.ROC curve analysis showed that the cut-off value of ultrasonic score between each group in the case group was 10.5,18.5,25.5,the area under curve was 0.877,0.891,0.92,the corresponding Youden index was 0.688,0.68,0.796,and the sensitivity was 0.813,0.800,0.857,respectively.The specificity was 0.875,0.880,0.939,respectively.Conclusion:The modified lung ultrasound scoring method can quantitatively evaluate the severity of neonatal respiratory distress syndrome, and the higher the score, the more severe the disease.

Background: Prenatal esophageal atresia (EA) diagnosis may improve outcomes by optimizing prenatal and postnatal care. This study evaluated the feasibility of direct antenatal visualization of normal longitudinal esophageal sections using two-dimensional ultrasound between 21 and 23 gestational weeks. Methods: A detailed prenatal anatomic survey was performed, followed by dedicated esophageal imaging. The latter was performed as follows: coronal sections of the thoracic aorta were obtained; the sound beam was then moved ventrally; and strip-shaped high echoes with three or more hyperechoic layers were identified as the esophagus. Images showing the longest esophageal segment were used to measure the esophageal length and angle (between the thoracic aorta and esophagus). Results: Longitudinal esophageal sections were visualized in 94.0% (n = 205/218) of patients. The visualization rates between fetuses in different positions were statistically significant (p < 0.05). Two tubular patterns of longitudinal fetal esophagus sections were observed when collapsed on ultrasound: a tubular structure composed of three hyperechoic layers (40.4%, 88/218); and a tube composed of multilayered hyperechoic structures (59.6%, 130/218). Swallowing actions were observed in 28 cases (12.8%, 28/218). The fetal esophagus was fluid-filled and exhibited an appearance similar to a tram-track sign. The time taken to visualize the longitudinal esophageal section was 21.3 ± 13.1 sec (range 3–60 sec). Conclusions: Direct antenatal visualization of a normal fetal esophagus is feasible, and recommended when suspecting EA on routine fetal ultrasound, to improve diagnostic specificity.

目的 应用经食管超声心动图右心声学造影(cTEE)探讨不同来源右向左分流(RLS)与隐源性脑卒中(CS)的相关性.方法 募集CS患者 180 例及健康志愿者 52 例.两组受检者均接受 cTEE 检查,根据静息状态和 Valsalva 动作时检测到的左心房内微泡位置将 RLS分为卵圆孔未闭型(PFO-RLS)及肺内型(P-RLS),并对 RLS行半定量分级.结果 CS 组 RLS 阳性率为 82.2%,其中单纯 PFO-RLS、单纯 P-RLS 及两者同时存在的阳性率(28.9%、30.0%、23.3%)均明显高于对照组(13.5%、7.7%、9.6%,P<0.05);CS 组与对照组 RLS 总检出率比值比(OR)为 10.4(95%CI:5.2～21.0),PFO-RLS总检出率OR 为 3.6(95%CI:1.8～7.4),P-RLS 总检出率OR 为 5.5(95%CI:2.5～11.9).CS组患者的中量及以上 RLS者检出率亦高于对照组(66.7%vs.9.6%,P<0.001).结论 PFO-RLS和P-RLS在CS病因学中都具有重要意义.cTEE是 RLS诊断、鉴别及分级的直观、有效方法.

Objectives Echocardiographic global myocardial work (GMW) indices recently emerged to non-invasively evaluate left ventricular (LV) myocardial performance with less load-dependence than LV ejection fraction (LVEF) or global longitudinal strain (GLS). Yet, few data exist on the descriptions of LV GMW indices in young people. We therefore aimed to provide normal reference values of LV GMW in a healthy young cohort, and simultaneously to investigate factors associated with non-invasive GMW indices. Materials and methods A total of 155 healthy young people (age 10–24 years, 59% male) underwent transthoracic echocardiography were recruited and further stratified for age groups and divided by gender. Two-dimensional speckle-tracking echocardiography (2D-STE) were performed to determine LV GLS, peak strain dispersion (PSD) and GMW indices, which include global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). LV peak systolic pressure was assumed to be equal to the systolic brachial artery cuff blood pressure. Results Age and gender specific normal ranges for LV GMW indices were presented. On multivariable analysis, GWI and GCW correlated more closely with systolic blood pressure (SBP) than LV GLS, while both GWW and GWE independently correlated with PSD (P < 0.05 for all). There were no associations between any of the GMW indices with age, sex, body mass index, heart rate, left ventricular mass index as well as LV sizes or LVEF. Of noted, LV GMW indices had good intra-observer and inter-observer reproducibility. Conclusion We reported echocardiographic reference ranges for non-invasive LV GMW indices in a large group of healthy young subjects, which are reproducible and reliable, and thus can be further used when assessing subclinical dysfunction in young people with myocardial diseases.

目的 探讨两种二维斑点追踪成像(2D-STI)软件评价健康年轻人左心室整体纵向峰值应变(GLPS)及峰值应变离散度(PSD)的临床价值.方法 收集10～24岁正常年轻人155例,按年龄分为3组:1组40例(10～14岁),2组79例(15～19岁),3组36例(20～24岁);使用2DStrain和AFI软件分别测量左室GLPS和PSD并比较两种方法测量差异,分析PSD的相关性因素.结果 1组GLPS绝对值均大于其他2组(P＜0.05),而PSD值在各组间无统计学差异(P＞0.05).AFI软件获得的PSDAFI大于PSD2Dstrain(P＜0.05),两种软件的GLPS差异无统计学意义(P＞0.05);PSD与GLPS绝对值呈负相关(r=-0.328,P＜0.001);GLPS和PSD测值在观察者内及观察者间重复性良好.结论 两种2D-STI分析软件均可准确、快捷地评价年轻人左室收缩功能和同步性,但应用PSD评估心肌收缩同步性时需注意方法学差异.

目的 系统评价应用肺部超声评分(LUS)评估急性呼吸窘迫综合征(ARDS)严重程度的价值.方法 对中国知网、万方、维普、PubMed、Embase和Cochrane Library数据库进行检索,检索时限均从建库至2021年12月20日.由2位研究者独立筛选文献,采用美国卫生保健质量和研究机构(AHRQ)制定的评价标准对纳入文献进行质量评估,用Egger's检验评估纳入研究偏倚风险.用Stata14.0软件对数据进行Meta分析,探讨重度与轻中度ARDS患者之间的LUS评分是否存在差异.结果 Meta分析结果显示重度ARDS患者LUS评分高于轻中度患者,SMD=1.18(95％CI:0.76,1.61),差异有统计学意义(P＜0.05).经亚组分析和灵敏度分析剔除异质性大的研究后,差异仍具有统计学意义(P＜0.05).结论 应用LUS能有效识别重度ARDS患者,对于ARDS患者,肺部超声检查是一项有价值的影像学检查手段.

目的 探讨术前左心室整体纵向应变(LVGLS)对接受主动脉瓣置换术(AVR)的主动脉瓣狭窄患者的生存及临床事件的预测价值.方法 检索利用LVGLS评价接受AVR患者预后的原始研究,由两位研究者独立筛选文献,运用RevMan 5.3进行Meta分析.结果 最终纳入13篇文献,共3 263例患者.Meta分析显示:①LVGLS每恶化1％,患者在置换术后全因死亡的风险增加7％,HR95％CI:1.07(1.04,1.10),P＜0.05.②LVGLS较差的患者全因死亡的风险增高,LVGLS截断值为-12.9％至-15％,HR 95％CI:1.81(1.43,2.28),P＜0.05.③随访期内存活患者的LVGLS值负值较大,即较好的心功能,MD 95％CI:-1.83(-2.61,-1.04),P＜0.05.④术后出现临床事件的患者LVGLS负值较小,即较差的心功能,MD 95％CI:2.38(1.31,3.46),P＜0.05.结论 术前LVGLS是接受AVR的主动脉瓣狭窄患者临床事件发生及中远期存活的预测因子,值得临床应用参考.

目的:探讨运用二维超声(2D)与剪切波弹性成像(shear wave elastography,SWE)的特征与乳腺结节基底细胞角蛋白(CK5/6)和抑癌基因(P63)表达之间的相关性.方法:收集2018-09～2021-03南方医科大学深圳医院74例乳腺结节患者,乳腺病灶均经手术切除或穿刺活检获取组织病理学,全部病灶采用二维超声和剪切波弹性成像,观察病灶的超声特征,检测乳腺结节最大弹性模量值(maximum modulus of elasticity Emax),ROC曲线评估Emax诊断效能,观察CUS(常规超声)及UE(超声弹性成像)对乳腺良、恶性诊断的准确率;28例乳腺癌患者采用免疫组织化学法检测肿瘤相关生物学指标CK5/6,P63阳性表达率,分析超声特征与CK5/6,P63阳性表达率相关性.结果:乳腺74例受试患者88个乳腺病灶,良性病灶62.5％(55/88),恶性病灶37.5％(33/88),剪切波弹性模量Emax最佳截断值为116.2 kPa时,诊断为乳腺结节良、恶性的AUC为70.4％,灵敏度为75％,特异度为61％,以组织病理检查为金标准,以Emax≥116.2 kPa诊断恶性乳腺结节,准确率为92％.结论:剪切波弹性成像及超声征象与CK5/6,P63阳性表达具有相关性,可无创性预测乳腺结节的良恶性.

目的 观察子痫前期胎儿脐动脉血流参数(收缩期峰值和舒张末期流速之比S/D、阻力指数RI、搏动指数PI)的Z值在中晚孕期的变化趋势,探讨其临床应用的意义与价值.方法 回顾性比较分析子痫前期胎儿(120例)和正常妊娠胎儿(1 287例)不同孕期脐动脉血流参数(S/D、RI、PI)及其Z值的差异,并绘制受试者工作特征曲线(ROC).结果 子痫前期胎儿脐动脉血流参数(S/D、RI、PI)Z值随孕周及病情严重程度的增加呈增高趋势,且对比正常对照组朝正向偏离度进行性加大,以晚孕期明显.脐动脉血流参数Z值的曲线下面积(AUC)大于原始参数,预测子痫前期效能更好.结论 通过Z值定量分析晚孕期子痫前期胎儿脐动脉血流参数的变化趋势,有助于监测宫内胎儿血流动力学情况.

目的 探讨孕11～13+6周第四脑室增宽胎儿后脑部超声特征.方法 对180例正常胎儿、7例诊断为Dandy-Walker综合症(DWS)胎儿和3例因第四脑室扩张而被诊断为Blake's pouch囊肿(BPC)胎儿的孕11～13+6周经腹超声图像进行分析和测量.在颅脑正中矢状切面上比较其脑干、第四脑室、后颅窝池等结构的形态特征,测量脑干前后径(BS)、第四脑室宽度(FV)、脑干后缘至枕骨之间的距离(BSOB).结果 180例胎儿的后脑部可见脑干、第四脑室、后颅窝池低回声结构清晰显示,位于几乎平行的四条高回声线之间;DWS胎儿及BPC胎儿第四脑室和后颅窝池之间的分界线显示不清,第四脑室呈囊状扩张,明显增宽,但增宽程度两者无明显差异.正常胎儿BS、FV及BSOB均随头臀长的增加呈线性增加.两组异常胎儿FV均大于正常值第95百分位数,且部分胎儿BS变小,部分胎儿BSOB增大.结论 孕11～13+6周DWS及BPC胎儿后颅窝结构较正常胎儿发生改变,FV值显著增大,可以作为孕11～13+6周筛查DWS及BPC的指标.

妊娠高血压、糖尿病和其他可能导致母体和胎儿血液循环异常的妊娠并发症均可导致不良妊娠结局.多普勒超声可通过测量母体及胎儿重要血管血流动力学参数评估宫内胎儿情况,及时为临床诊断和治疗提供依据.本文对血管多普勒超声预测不良妊娠结局临床应用进展进行综述.

目的 研究孕11～13+6周胎儿超声脑部特征,探讨脑干宽度(BS)、脑干后缘到枕骨距离(BSOB)、两者比值(BS/BSOB)在开放性脊柱裂(OSB)胎儿的诊断中哪个更有价值.方法 采用经腹超声于孕11～13+6周对180例正常胎儿和27例确诊为OSB的胎儿进行检查,在颅脑正中矢状切面检查脑干、第四脑室、后颅窝池、间脑及中脑的形态结构,测量BS、BSOB,计算BS/BSOB数值,比较分析其与胎儿头臀长(CRL)关系,其中OSB胎儿CRL由超声胎龄(由早孕期超声推算而来)校正.结果 180例正常胎儿的后脑部的脑干、第四脑室、后颅窝池均清晰显示,可见接近平行四条高回声线,间脑和中脑呈现"8"字形态;27例OSB胎儿中可见上述后脑结构的异常,BS下移增宽,BSOB变窄,BS/BSOB显著增大.但校正CRL后,BS增宽幅度明显变小,BSOB变窄幅度变大,BS/BSOB则基本不受CRL变化影响.结论 因OSB胎儿多合并脊柱长度异常,相较于观察BS与CRL关系容易出现漏误诊,BSOB及BS/BSOB这两个指标对于OSB的诊断更有价值.

目前肺部超声已应用于多种肺部疾病的临床诊断,尤其在肺间质综合征、气胸、肺实变、胸腔积液、肺栓塞等疾病诊断中均有较高的敏感性及特异性.近年来肺部超声与心血管超声的联合应用,实现了床旁超声对多种常见危重症疾病的快速排除及诊断,为抢救患者赢得了宝贵的时间.本文就肺部超声的临床应用及进展进行综述.

由于传统的检查报告智能生成系统,存在提取语音信号特征不佳的情况,导致系统运行所耗时长过长,基于此,设计基于语音识别技术的复杂超声检查报告智能生成系统.硬件部分:设计复杂超声检查报告智能生成系统的高通滤波器;软件设计:提取语音信号特征,构建复杂超声检查报告生成模型,实现智能化生成检查报告中影像与诊断.实验结果表明:研究的系统在生成报告的速度上更具优势,平均生成时长提升61.371μs,能够更好地完成相关检查工作并智能生成影像与诊断结论.

目的:探究在浅表器官疾病诊断中运用超声新技术的临床应用价值.方法:选取280例在2018年1月～ 2019年10月本院收治的浅表器官疾病患者,所有患者均实施超声新诊断,综合分析超声新技术诊断结果情况.结果:超声诊断的准确率由超声成像的扫查范围、穿透深浅及清晰程度决定.按照超声成像的扫查范围、穿透深浅及清晰程度评分:超声诊断结果的优良率为91.43％.结论:在浅表器官疾病诊断中运用超声新技术,具有较高的诊断优良率.在临床应用中可以有效结合声学方面的新技术和超声诊断新技术,加深穿透的厚度,加大扫查的范围,提高超声成像的清晰度.

目的 应用超声射频信号血管内中膜分析(QIMT)技术和血管硬度定量分析(QAS)技术检测糖尿病患者颈动脉血管结构及弹性功能,探讨体质量指数(BMI)与其颈动脉血管损害的相关性.方法 前瞻性选取我院糖尿病患者和性别、体质量与之相匹配的健康志愿者各90例(糖尿病组和对照组),根据体质量指数(BMI)将两组分别分成3个亚组即正常体质量亚组、超重亚组及肥胖亚组,每个亚组各30例.采用QIMT、QAS技术测量各组颈动脉内-中膜厚度(IMT)、颈动脉僵硬度指数(β)、脉搏波传播速度(PWV)及顺应性系数(CC),比较各组上述参数差异,并将颈动脉弹性参数与糖尿病史及BMI进行相关性分析.结果 与对照组比较,糖尿病组颈动脉IMT、PWV及β值均明显增高,CC明显降低,差异均有统计学意义(均P<0.05).随着BMI的增加,糖尿病组和对照组IMT、PWV、β均逐渐增高,CC逐渐下降(均P<0.05).多变量分析显示,糖尿病史和BMI均与IMT和PWV独立相关(均P<0.05);与糖尿病史危险因素比较,BMI的增加对IMT和PWV的影响更大(标准化β=0.643、0.534,均P<0.001).结论 糖尿病和BMI均能独立引起糖尿病患者颈动脉血管结构和弹性功能损害,且BMI的增加较糖尿病对颈动脉血管结构及弹性功能的损害作用更大.

目的 分析心脏磁共振(CMR)成像技术和超声心动图对肥厚性心肌病(HCM)的诊断,探讨两种方法诊断HCM的价值.方法 53例HCM患者均进行3.0 T CMR和超声心动图检查.CMR检查包括常规成像、灌注及延迟强化,测量心肌厚度,评价心肌延迟强化特点.超声心动图测量左室壁各节段心肌厚度,评价左室流出道梗阻程度.比较CMR和超声心动图评价心肌厚度及纤维化能力的差异.结果 肥厚性心肌病CMR和超声心动图测量心肌各节段厚度除侧壁外,两种方法测量其余室壁心肌厚度值的差异无统计学意义.CMR表现为延迟强化39例,7例局限性强化,5例弥漫性强化,2例透壁性强化,异常强化灶分布在游离壁和室间隔交界区、室间隔.超声心动图显示44例患者有左室流出道梗阻.结论 心脏超声在测量心脏除侧壁外其余节段厚度时不劣于CMR,而测量侧壁时存在一定误差,易高估侧壁厚度.CMR可用于心肌纤维化的定量检测.超声心动图可以实时显示二尖瓣收缩期前向运动,评价左室流出道梗阻程度优于CMR.

目的:研究超声造影在腹部实质脏器外伤治疗中的应用效果.方法:选取在2018年1月～2019年10份来某院就诊的60例患者为研究对象,设为观察组和对照组,每组30例.对照组行保守治疗,观察组实施超声造影引导注射治疗.结果:观察组的患者治疗总有效率90.00％与对照组83.33％相比差异性显著(P<0.05).结论:超声造影应用在腹部实质脏器外伤治疗中,提高了临床上的治疗总有效率,能够及时治疗患者的疾病,之后对患者的预后情况进行反馈,临床恢复效果良好.超声造影能够准确到血管灌注的区域,并且操作比较简单,值得在临床中应用.

目的 探讨中孕期三血管气管切面正常胎儿食管声像表现及影响显示的因素.资料与方法 前瞻性纳入420例20～26周胎儿,运用四腔心头侧偏斜法筛查中孕期胎儿心脏,观察左心房后方、胸主动脉右前方的食管回声,并在探头自四腔心切面向头侧偏斜至三血管气管切面过程中追踪食管的延续性.观察三血管气管切面上食管的位置及回声特点.若四腔心切面胎儿食管显示不清则在三血管气管切面观察食管回声,对初步确定为食管回声的结构旋转探头显示其纵切面,纵切面为多层状、条带状高回声即为食管回声.比较不同胎位三血管气管切面食管显示率以及不同显示程度孕妇腹壁脂肪厚度的差异.结果 三血管气管切面胎儿食管的显示率为96.9％(407/420),高于四腔心切面食管显示率(95.0％,399/420),差异有统计学意义(P<0.05).三血管气管切面食管回声39.1％(159/407)表现为随降主动脉搏动的点状高回声,60.9％(248/407)表现为3～4层短线样高回声.不同胎位三血管气管切面食管显示率差异无统计学意义(P>0.05);无法显示胎儿食管组孕妇腹壁脂肪平均厚度明显大于可显示组,差异有统计学意义(P<0.05).结论 三血管气管切面可显示胸段食管的横切面,且显示率较高;胎位对其影响有限,但孕妇肥胖会影响其显示.

左右心室收缩功能的评估对心血管疾病患者的管理和预后有着重要的作用.斑点追踪超声心动图是一种新兴的评估心室功能的技术,与传统参数相比更加准确和敏感,可用于检测亚临床心室收缩功能不全,并且可以提供额外的预后价值.本文对斑点追踪超声心动图在右心疾病中的应用进展进行综述.