目的 应用实时三维超声心动图评价缺血性心肌病(ICM)所致慢性心力衰竭患者左室收缩同步性,并分析收缩不同步性指数(SDI)与左室射血分数(LVEF)的相关性.方法 选择缺血性心肌病引起心力衰竭患者53例为ICM组,体检健康者50例为对照组.应用实时三维超声心动图测量其左室舒张末容积(EDV)、收缩末容积(ESV)和LVEF,16节段(除外心尖帽)收缩达最小容积时间的标准差并以R-R间期校正后百分数作为左室SDI.结果 与对照组比较,ICM组EDV增高,LVEF降低,左室SDI增高,差异均有统计学意义(P＜0.01).ICM组SDI与LVEF呈高度负相关(r=-0.72,P=0.000),对照组SDI与LVEF呈低度负相关(r=-0.31,P=0.020).结论 ICM心力衰竭患者相较对照组左室内存在明显收缩不同步,且SDI与左室收缩功能存在负相关.

Objective To investigate the application of echocardiography in the diagnosis of neonatal ductus arteriosus aneurysm (DAA).Methods A total of 27 neonates with DAA were detected by echocardiography.Echocardiographic features in these cases were explored and outcome of these neonates were followed up.Results There were four crucial features in DAA detected by echocardiography:① A vessel bump was shown on the left side of the origination of left pulmonary artery(LPA) in the high parasternal short-axis view.②A horizontal shunt jet from the bump to the origination of LPA was shown when interrogate the top of the bump.③The bump joined the descending arota when interrogate it down and back orientately.A ‘V' shaped sign was shown when the aortic arch appeared on the right side and the bump on the left side.④A slow red flow signal was found in bump when the scale of color Doppler was cut down.The follow-up echocardiography showed spontaneous closure of the DAA when 3 months of age except one case lost.There were no abnormality in the figure and function in heart.Conclusions Echocardiography can be a valuable method for the diagnosis of neonatal ductus arteriosus aneurysm.Neonate with DAA have a good outcome.

目的 探讨心下型完全性肺静脉异位引流(ITAPVD)的超声和CTA的特征性表现.方法 10例心下型TAPVD患者首诊均行经胸超声心动图检查,其中7例又行CT血管造影检查(CTA),并与手术结果进行对照分析.结果 10例心下型TAPVD均经手术证实.超声心动图首诊准确率为70％ (7/10),误漏诊率为30％ (3/10),7例CTA诊断准确率为100％.心下型TAPVD的超声和CTA的特征性表现是:共同肺静脉内径较其他类型TAPVD的细小；剑下主动脉横断面可见三条血管的横断面,即连接共同肺静脉的垂直静脉位于主动脉前方、下腔静脉左后方；肝内门静脉扩张迂曲；CDFI显示垂直静脉与下腔静脉血流方向相反,5例垂直静脉与之连接的部位狭窄,出现流速增快成湍流.结论 掌握心下型TAPVD的特征性超声表现,经胸超声心动图仍是诊断ITAPVD的首选方法,结合CTA检查可提高诊断准确率,避免误漏诊.

Aim To investigate the feasibility and the clinical value of strain-blood pressure index(SBPI) in assessing the elasticity of brachial artery and anterior tibial artery in patients with end-stage renal disease(ESRD). Methods 39 patients with ESRD and 46 healthy volunteers were involved.39 patients with ESRD belonged to the case group,and 46 healthy volunteers belonged to the control group.Maximum of circumferential strain(CSmax) of brachial artery and anterior tibial artery were acquired through strain and strain rate imaging(Xstrain).Local blood pressure which included local systolic blood pressure(LSBP) and local diastolic blood pressure(LDBP) of brachial artery and anterior tibial artery were measured at the same time.SBPI were calculated.Parameters were compared between the case group and the control group. Results SBPI of anterior tibial artery in case group(4.01%±0.59%) was less than that in control group(5.71%±0.55%,P<0.01).While SBPI of brachial artery in case group and control group were 3.82%±0.39% and 3.95%±0.46% respectively.There was no significant difference between case group and control group(P>0.05). Conclusion SBPI might be a new index that could evaluate the elasticity of medium-sized arteries in patients with ESRD.

目的 探讨病态窦房结综合征(SSS)患者分别在右心室流出道间隔部(RVOT)和右心室心尖部(RVA)植入永久性心室起搏导线前后各项心功能指标是否存在差异,比较各项指标的敏感性.方法 选取SSS患者60 例,随机分为RVOT 组和RVA组,均植入DDD永久性起搏器.所有患者术前及术后1、3、6 个月进行心电图检查,测量QRS 时限;超声心动图测量左心室舒张末期内径(LVEDD)、左心室射血分数(EF)、左右室射血前期时间延迟(PETd);实时三维超声心动图(RT-3DE)分别检测左心室16、12 节段达到最小收缩容积时间的标准偏差(Tmsv16-SD、Tmsv12-SD)及心率校正后的Tmsv16-SD/R-R、Tmsv12-SD/R-R 和左心室16 节段达到最小收缩容积时间的最大差值(Tmsv16-Dif)、心率校正后的Tmsv16-Dif/R-R 和左右心室间机械延迟(IVMD);检测血NT-proBNP.结果 与术前比较,RVOT组术后1、3、6个月QRS 及IVMD 均显著升高(P＜0.01);RVA组术后1、3、6 个月QRS、IVMD、Tmsv16-SD、Tmsv12-SD、Tmsv16-SD/R-R、Tmsv12-SD/R-R、Tmsv16-dif、Tmsv16-dif/R-R 均显著升高(P＜0.01),术后3、6 个月PETD 亦显著升高(P＜0.01).与ROVT 组比较,术后1、3、6 个月时RVA 组IVMD、Tmsv16-SD、Tmsv12-SD、Tmsv16-SD/R-R、Tmsv12-SD/R-R Tmsv16-dif、Tmsv16-dif/R-R均明显升高(P＜0.05 或0.01).结论 DDD 起搏后,无论是RVA 起搏还是RVOT起搏,均影响了心室运动的同步性;RVOT起搏对心室收缩同步性影响较RVA 小.实时三维超声心动图评价DDD 起搏术后患者心室运动的同步性优于传统的检测方法.

Objective To evaluate the left ventricular remodelling index(LVRI) and systolic dyssynchrony by real-time three-dimentional echocardiography(RT-3DE)in the patients with heart failure(HF).Methods 80 patients with heart failure(HF) for different causes and 32 normal subjects were collected.Patients with HF were divided into three groups according to the severity of heart failure(group A,group B and group C,respectively).Data of 80 patients with HF were acquired by RT-3DE.The left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV) and the left ventricular end-diastolic mass(LVM) were measured and the LVRI were calculated.Parameters for evaluating systolic dissychrony included the average time to maximum systolic amplitude of all segments(average 3D-TS),the time to minimum systolic volume of 16-segmental standard deviation as a ratio of R-R interval(Tmsv16-sd /RR,SDI),the time to minimal systolic volume of 16-segmental maximal difference(Tmsv16-Dif).All the parameters were compared between groups,then the correlation analysis between LVRI and all the dyssynchrony parameters in each group were finished respectively.Results Compared with the normal group,all the parameters increased in different HF groups,especially in group B and group C.Analysis showed that LVRI had positive correlations with dyssynchrony parameters in all the HF groups.In group C,the correlation coefficients between LVRI and average 3D-TS,SDI were 0.76,0.82,respectively.Conclution Left ventricular remodeling and dyssynchrony occurred in HF patients.There was well correlation between LVRI and dyssynchrony parameters in the patients with HF.To some extent,the LVRI could evaluate the severity of LV systolic dyssynchrony.

目的 本研究旨在探讨应用超声造影三维成像对脑梗死患者颈动脉低回声斑块内新生血管进行定量评价的临床意义.方法 61例存在颈动脉低回声斑块患者根据是否存在脑梗死分为两组:脑梗死组27例,34例无脑梗死患者作为对照组,对低回声斑块行超声造影三维成像,并对三维图像按照统一的标准进行处理,计算并记录斑块的体积和斑块内新生血管的条数,计算血管指数,所有参数进行两组间的对比分析. 结果脑梗死组颈动脉低回声斑块的血管指数明显高于对照组,差异有统计学意义(P＜0.05).而两组间的斑块体积、最大厚度、横截面积狭窄率差异无统计学意义(P＞0.05).结论 超声造影三维成像不仅能显示颈动脉低回声斑块内的新生血管的空间立体分布,还可以通过血管指数对斑块内新生血管进行定量评价,这为进一步研究斑块内微血管灌注提供了一个新方法.

目的 使用血流向/量图(vector flow mapping,VFM)技术分析正常儿童左心室的血流动力学特点.方法 采集60例正常儿童心尖左室长轴切面左心室的彩色多普勒动态图像,同时应用脉冲多普勒采集主动脉瓣口及二尖瓣口频谱,用VFM软件进行脱机分析.结果 VFM分析显示,舒张期左室层流南左室流人道指向心尖部,射血期左室层流由心尖部指向左室流出道;左心室主要存在2处涡流,左室前部涡流和二尖瓣后叶下涡流,舒张期这2个涡流的发展是非对称性的,前部涡流大于后部涡流.结论 VFM分析可精确显示心腔内血流动力学变化,VFM技术是一种评价心脏血流动力学特点的新方法.

目的 观察并比较舒芬太尼和瑞芬太尼分别复合丙泊酚静脉麻醉对腹腔镜胆囊切除术后患者的恢复情况和并发症的影响.方法 120例择期行腹腔镜胆囊切除术患者随机分为观察组和对照组各60例,麻醉诱导药物均为味达唑仑+芬太尼+丙泊酚+维库溴铵,麻醉维持观察组应用舒芬太厄+丙泊酚,对照组应用瑞芬太尼+丙泊酚.观察并记录两组的手术时间、自主呼吸恢复时间、睁眼时间、拔管时间,并观察两组术后疼痛、术中知晓和苏醒期躁动的发生情况.结果 观察组的自主呼吸恢复时间、睁眼时间和拔管时间均长于对照组,差异具有统计学意义(t=5.49,4.62,4.83,P<0.05).观察组术后疼痛、术中知晓和苏醒期躁动发生率低于对照组,差异具有统计学意义(X<'2>=9.38,6.55,15.44,P<0.05).结论 舒芬太尼复合丙泊酚静脉麻醉应用于腹腔镜胆囊切除术麻醉效果满意,术后恢复较瑞芬太尼慢,但能有效降低术后并发症的发生.

目的 应用实时三维超声心动图技术(RT-3DE)评价心脏再同步化治疗(CRT)心衰的疗效.方法 选取15例经RT-3DE评价为左室收缩不同步接受CRT的心衰患者,分别于术后1周内,3个月时给予经胸实时三维超声心动图检查,应用Qlab定量分析软件,获取并分析左室整体功能参数,以及不同步指数,即心率校正后的16节段收缩达最小容积标准差(Tmsv16-sd/RR/),对上述三维参数进行定量分析比较.结果 术后1周内左室整体功能参数较术前无明显改善(P>0.05),而左室不同步指数Tmsv16-sd/RR较术前明显降低,差别有统计学意义(P<0.001).3个月时左室整体功能参数及左室不同步指数均较术前有明显改善(P<0.01), 但左室不同步指数Tmsv16-sd/RR术后3个月与术后1周内相比差别无统计学意义(P>0.05).结论 CRT可降低左室不同步指数,从而改善左室功能,不同步指数Tmsv16-sd/RR能够较早且敏感地预示该变化.

目的 本研究旨在探讨应用和应变率成像(Xstrain)以及射频动脉僵硬度分析技术(QAS)评价2型糖尿病患者颈总动脉应变与弹性相关性的临床价值.方法 随机选取2型糖尿病患者52例,全部应用Xstrain和QAS技术对颈总动脉进行检查.获得颈总动脉的最大圆周应变和应变率、顺应性系数(CC)、僵硬度系数(β),并对以上参数进行相关分析.结果 2型糖尿病患者颈总动脉最大圆周应变及应变率均与顺应性系数呈明显正相关,而与僵硬度系数呈明显负相关.结论 2型糖尿病患者颈总动脉应变与弹性存在明显相关,最大圆周应变和应变率可作为反映动脉机械运动特性的新指标.

Objective To assess left ventricular segmental function in patients with coronary heart disease(CHD)before and after percutaneous coronary intervention(PCI)using volume-time curves(VTCs)and Bulls Eye images from real-time three-dimentional echocardiography(RT-3DE).Methods Thirty-two patients with CHD confirmed by coronary angiography were undergone RT-3DE before and 1 week after PCI,respectively.The 17-segmental VTCs and Bulls Eye images from RT-3DE were obtained and analyzed by the on-line Qlab software.Parameters including the numbers of dyskinetic segments,regional diastolic volume(rEDV),regional systolic volume(rESV),regional ejection fractions(rEF)and the ejection fractions of regional stroke volume to global diastolic volume(rgEF)were compared.Thirty normal subjects were selected as control group.Results Compared with control group,the CHD group before PCI showed more dyskinetic segments(5.2±1.8),and the parameters of regional heart function reached high significant difference(P<0.01).By contrast with CHD group before PCI,the numbers of dyskinetic segments reduced and the parameters of regional heart function impmved after PCI(P<0.05).Conclusions Seventeen-segmental volume-time curves(VTCs)and Bull's Eye images from RT-3DE can assess the effective changes of regional heart function resulted from PCI qualitatively and quantitatively,which providing another useful modality for evaluating the effection of PCI in CHD patients.

Objective To investigate the clinical value and the feasibility of strain-blood pressure index(SBPI) in assessing the elasticity of brachial artery and anterior tibial artery in patients with type 2 diabetes mellitus. Methods Forty-six type 2 diabetic patients and 50 healthy volunteers were involved. Maxmum of circumferential strain (CSmax) of brachial artery and anterior tibial artery were acquired through strain and strain rate imaging(Xstrain). Local systolic blood pressure(LSBP) and local diastolic blood pressure(LDBP) of brachial artery and anterior tibial artery were measured at the same time. SBPI,tibial-brachial index (TBI), and ankle-brachial index(ABI) were calculated, SBPI = CSmax/[(LSBP-LDBP) /LDBP]×100%,TBI = SBPI of anterior tibial artery/SBPI of brachial artery, ABI = LSBP of anterior tibial artery/LSBP of brachial artery. Parameters were compared between the case group and the control group. Results SBPI of anterior tibial artery and TBI had significant difference between the case group and the control group( P < 0.05), while SBPI of brachial and ABI had no significant difference( P >0. 05).Conclusions SBPI might be a new index for evaluating the elasticity of medium-sized arteries in patients with type 2 diabetes, and different changes caused by type 2 diabetes between brachial artery and anterior tibial artery could be reflected by TBI.

Objective To investigate the clinical value of contrast-enhanced three-dimensional ultrasound in assessing neovascularization within carotid soft plaques. Methods Thirty-six cases with 42 soft plaques were examined with contrast-enhanced two dimensional ultrasound and contrast-enhanced three dimensional ultrasound. Soft plaques were divided into four grades according to distribution and shape of contrast media:grade Ⅰ (there was no enhancement in plaque) , grade Ⅱ (plaque was enhanced with sparse spots pattern or enhanced in small range locally), grade Ⅲ (plaque was enhanced with sparse spots and short-line pattern ),grade Ⅳ (plaque was enhanced with line and grid pattern). Results The results of contrast-enhanced two-dimensional ultrasound were as followed: 4.8% grade Ⅰ , 35.7% grade Ⅱ , 52.4% grade Ⅲ and 7.1% grade Ⅳ. The results of contrast-enhanced three-dimensional ultrasound were as followed:9.5% grade Ⅱ , 47.6% grade Ⅲ and 42.9% grade Ⅳ. Conclusions Spatial distribution of neovascularization within carotid soft plaques could be reflected comprehensively by contrast-enhanced three dimensional ultrasound, and it might be a new mothod to investigate spatial structure and microvascular perfusion of soft plaques furtherly.

目的 探讨应用应变-血压指数(SBPI)评价健康成年人颈总动脉弹性的临床价值及可行性.方法 随机选取健康成年人208例,均应用应变和应变率成像、射频动脉僵硬度分析技术对颈总动脉进行检查.通过应变和应变率成像获得颈总动脉的最大圆周应变,同时测量被检者肱动脉血压,通过射频动脉僵硬度分析技术获得颈总动脉的顺应性系数(CC)、僵硬度系数(β)以及局部血压.计算颈总动脉的SBPI,并将SBPI分别与CC、β进行相关性分析;后将被检查者按照不同年龄分组,进行各组间的对比分析.结果 颈总动脉的SBPI与CC呈显著正相关,而与β呈显著负相关(均P＜0.01).20～29、30～39和40～49岁组的SBPI、β、CC的差异均有统计学意义(均P＜0.01);但50～59岁的β和CC参数与40～49岁组之间的差异无统计学意义(P＞0.05),而其SBPI与40～49岁组之间的差异有统计学意义(P＜0.01).20～24、25～29、30～34、35～39、40～44、45～49、50～54和55～59岁组中,β和CC两项参数在相邻两组间差异均无统计学意义(均P＞0.05),而SBPI在相邻两组间差异则有统计学意义(P＜0.01).结论 SBPI可作为评价颈总动脉弹性的新指标,并且较β和CC更精确、敏感.

Objective To assess the relationship between the enhanced intensity of carotid plaque and risk of cerebral infarction using contrast-enhanced ultrasonography(CEUS). Methods Eighty one patients with cerebral infarction and 95 patients without cerebral infarction were enrolled in this study. All the patients were performed using CEUS. The characteristics of plaque enhancement was categorized: grade Ⅰ , non-enhancement;grade Ⅱ , the arterial wall vasa vasorum enhancement; grade Ⅲ. the arterial wall vasa vasorum and plaque shoulder enhancement; grade Ⅳ , extensive and internal plaque enhancement. The data between the two groups was compared and analysed. Results Plaque enhancement presented with grade Ⅰ in 7 cases of 81 patients and 26 cases of 95 controls,grade Ⅱ in 14 and 37,grade Ⅲ in 26 and 17,grade Ⅳ in 34 and 15. The percentage of stroke in grade Ⅰ was 21.2% (7/33),grade Ⅱ was 27.5%(14/51), grade Ⅲ was 60.5% (26/43) and grade Ⅳ was 69.4% (34/49). The percentage of stroke in grade Ⅲ was significantly higher than that in grade Ⅰ and Ⅱ ( P = 0. 001, P = 0. 001 ), and there was no significant difference between grade Ⅲ and Ⅳ ( P = 0.370). The sensitivity and specificity for grade of plaque enhancement (AUC = 0. 721, cutoff value > grade Ⅱ ) were 74. 1 % and 66. 3% respectively. Conclusions The grade of enhancement of carotid plaques in CEUS is a valid indicator to anticipate cerebral infarction. The higher the grade of enhancement of carotid plaques,the higher the risk of cerebral infarction.

Objective To investigate the correlation between intima-media thickness(IMT)and elasticity of carotid in patients with type 2 diabetes accompanied hyperlipidemia by quantitative intima-media thickness(QIMT)and quantitative arterial stiffness(QAS)technique.Methods Fifty-six patients with type 2 diabetes accompanied hyperlipidemia were involved into the study as case group.Forty-eight healthy volunteers were supplied as normal control group in the same period.IMT,compliance coefficient(CC),distensibility coefficient(DC)and stiffness index(β)of carotid were acquired through QIMT and QAS.Case group was divided into case group 1(IMT＜0.9mm)and case group 2(IMT≥0.9 mm),and analysis was performed furtherly.Results β,triglyceride(TG),lowdensity lipoprotein(LDL),cholesterol(Ch),glycosylated hemoglobin(GHb)and IMT had significant differences in case group 1,case group 2 and control group(P＜0.05),control group＜case group 1＜case group 2.DC and CC had significant differences in case group 1,case group 2 and control group(P＜0.05),control group＞case group 1＞case group 2.There was significant positive correlation between β and age,GHb,LDL and IMT of carotid respectively(r=0.811,r:0.764,r=0.732,r:0.729,respectively,P=0.000).Conchmions IMT of carotid could be measured accurately by QIMT.Structure imaging and functional imaging of carotid might be combined organically through QIMT and QAS.Depth study about early change of carotid in structure and function could be performed with these two techniques.

目的 本研究旨在探讨应用应变和应变率成像结合冷加压试验评价2型糖尿病患者肱动脉径向应变及应变率储备的可行性及其临床价值.方法 随机选取 49 例 2 型糖尿病患者作为病例组,58例健康志愿者作为对照组.全部进行应变和应变率成像及冷加压试验,获得冷加压试验前后肱动脉的最大径向应变和应变率,计算径向应变和应变率储备.对病例组和对照组的径向应变和应变率储备进行对比分析.结果 49 例 2 型糖尿病患者肱动脉的径向应变和应变率储备均低于健康对照组,两组比较差异有统计学意义(P<0.05).结论 应变和应变率成像结合冷加压试验可以获得肱动脉的径向应变和应变率储备,径向应变和应变率储备可作为评价2型糖尿病患者早期动脉壁机械运动特性改变的新指标,同时可以反映肱动脉内皮功能.

Objective To investigate the feasibility and the clinical value of strain and strain rate imaging combined with cold pressor test(CPT)in assessing reserve of strain and strain rate of brachial artery in normal adults.Methods One hundred and eight normal adults were involved.Maximum of radial strain(RSmax),and maximum of radial strain rate(RSRmax)of brachial artery were measured,which were supplied by automatic analysis software.The datas after CPT were compared with those before CPT,and reserve of strain and strain rate were calculated.Results There were significant differences between the RSmax and RSRmax of brachial artery before CPT and those after CPT(P<0.05).Normal reference range of reserve of strain was(25.26±6.35)%,and normal reference range of reserve of strain rate was(30.06±7.57)%.Conclusions The RSmax and the RSRmax of brachial artery could be evaluated quantitatively by it in normal adults.Reserve of strain and strain rate could be gained under CPT.

Objective To study the change of early carotid elasticity in perimenopausal women treated by hormone replacement therapy using e-tracking technique. Methods A total of 82 perimenopausal women with lower level of estradiol were randomly divided into two groups:41 cases in the treatment group and 41cases in the control group. Postmenopausal women in the treatment group were treated with Climnen. Before and 6 months after estrogen therapy,e-tracking technique was used to evaluate the carotid elastic modulus,such as the stiffness parameters (β), pressure-strain elastic modulus ( Ep), arterial compliances (AC), pulse wave conducting velocity (PWVβ) and augment index(AI). Results Compared with the normal group,datas of Ep,β,PWVβ and AI were significantly lower in treated group, while AC was obviously higher ( P ＜0.01). Conclusions E-tracking technique is a quick, simple and high accurate evaluating method for the change of carotid elasticity in perimenopausal women.