Purpose To investigate risk factors associated with left ventricular diastolic dysfunction (LVDD) of patients with septic shock. Materials and methods Patients with septic shock concomitant with or without LVDD were retrospectively enrolled and divided into the LVDD group ( n = 17) and control without LVDD ( n = 85). The clinical and ultrasound data were analyzed. Results A significant ( P < 0.05) difference existed between the two groups in serum creatinine, APACHE II score, serum glucose, triglyceride, BUN, FT4, LAVI, mitral E, average e’, E/average e’, septal e’, septal e’/septal s’, E/septal e’, lateral s’, lateral e’, and E/lateral e’. LAVI > 37 mL/m 2 , septal e’ < 7 cm/s (OR 11.04, 95% CI 3.38–36.05), septal e’/septal s’ < 0.8 (OR 4.09, 95% CI 1.37–12.25), E/septal e’ > 15 (OR 22.86, 95% CI 6.09–85.79), lateral e’ < 8 cm/s (OR 9.16, 95% CI 2.70–31.07), E/lateral e’ > 13 (OR 52, 95% CI 11.99- 225.55), lateral s’ < 10 (OR 3.36, 95% CI 1.13–9.99), average e’ > 10, E/average e’ > 10 (OR 9.53, 95% CI 2.49–36.46), APACHE II score > 16 (OR 3.33, 95% CI 1.00–11.03), SOFA > 5 (or 3.43, 95% CI 1.11–10.60), BUN > 12 mmol/L (OR 3.37, 95% CI 1.15–9.87), serum creatinine > 146 μmol/L (OR 5.08, 95% CI 1.69–15.23), serum glucose > 8 mmol/L (OR 3.36, 95% CI 1.09–10.40), and triglyceride > 1.8 mmol/L were significant (P < 0.05) risk factors for LVDD. LAVI > 37 ml/m 2 , lateral e’ < 8 cm/s, E/lateral e’ > 13, and SOFA > 5 were significant (P < 0.05) independent risk factors for LVDD. ROC curve analysis demonstrated that the cut-off value and AUC were 37.09 mL/m 2 and 0.85 for LAVI, 8.00 cm/s and 0.89 for lateral e’, 12.86 and 0.82 for E/lateral e’, and 5.00 and 0.69 for SOFA, respectively. Conclusion Left atrial volume index, mitral lateral e’, E/lateral e’, and SOFA score are significant independent risk factors for predicting left ventricular diastolic dysfunction in patients with septic shock.

压力性尿失禁是前列腺癌根治术后常见并发症,主要表现为腹压增加的情况下尿液不自主流出,严重影响患者生活质量,往往病情顽固,经保守治疗疗效多欠佳[1].目前临床上保守治疗方法主要有生物反馈、盆底肌锻炼[2]等,而手术治疗的主要选择有男性尿道中段悬吊术[3]及人工尿道括约肌植入术[4].前者手术失败率较高,多导致尿潴留,开展并不普遍[5];后者费用较高,同样存在异物排斥、感染等并发症[6].我们前期临床研究发现,经皮穿刺电针电刺激阴部神经治疗前列腺癌根治术后顽固性压力性尿失禁疗效满意,但穿刺阴部神经是否精准仅凭术者经验和患者的主观感受.本研究采用神经电生理监控下电针电刺激阴部神经,以提高穿刺精确性,取得满意的临床疗效,现报道如下.

目的 探讨四维盆底超声对初产妇产后盆底功能障碍的诊断价值.方法 选取2018年1月到2019年10月来该院行产后复查的初产妇180例,以临床综合诊断结果作为金标准,同时行四维超声检测产后盆底功能障碍检查,观察后者的诊断灵敏度、特异度及诊断准确度.结果 临床综合检查诊断出产后盆底功能障碍95例(52.8％),四维超声诊断出82例(48.3％).四维盆底超声对初产妇盆底功能障碍诊断的灵敏度为86.3％(82/95)、特异度为94.1％(80/85)、准确度为90.0％(162/180).结论 四维盆底超声对初产妇盆底功能障碍的诊断与临床综合诊断一致性良好,可作为产妇盆底功能障碍的诊断方法.

目的 探讨超声引导定位切除临床触诊不清乳腺肿块患者的疗效.方法 选取70临床触诊不清乳腺肿块患者作为研究对象,其中35例术前经X线定位切除为对照组,另35例采用超声引导定位切除为观察组.记录两组手术情况.结果 对照组35例(35病灶)均为良性,观察组共35个病灶,其中直径≤10mm为20个,＞10mm为15个;良性病灶为33个,恶性为2个;纤维腺瘤为10个、乳腺腺病为18个、囊性增生4个、浸润性导管癌3个.观察组平均手术时间为(30.44±5.71)分钟明显短于对照组(46.88±4.72)分钟,P＜0.05.观察组定位费用平均为(159.35±21.64)元,明显少于对照组(517.98±28.87)元,P＜0.05.结论 超声引导定位切除临床触诊不清乳腺肿块可更精准,缩短手术时间,减少治疗费用.

目的:观察经会阴盆底三维超声对评估针灸治疗女性盆底功能障碍疗效的价值.方法:选择32例接受针灸治疗的女性盆底功能障碍患者为观察组,另选择32例同期接受健康体检的健康女性作为参照组,2组均接受经会阴盆底三维超声,对比2组各项超声指标水平变化情况及观察组行针灸治疗前后的盆底功能障碍程度.结果:与参照组比较,观察组治疗前的尿道倾斜角、宫颈与耻骨联合下缘间距离、肛提肌尿道间隙明显更小,尿道旋转角、静息状态下膀胱尿道后角、Valsalva动作下膀胱尿道后角、膀胱颈下降距离、宫颈下降距离及盆膈裂孔面积明显更大,差异均有统计学意义(P＜0.05).观察组治疗前后超声检查各指标及盆底器官脱垂轻度、中度、重度发生率比较,差异有统计学意义(P＜0.05).结论:经针灸治疗女性盆底功能障碍后,采用经会阴盆底三维超声检查可直观反映患者治疗前后盆底器官脱垂程度,清晰描述盆底功能变化情况.

目的 探讨正常人群不同部位肾皮质超声灰阶值的对比差异,为临床评估肾占位性病变提供一种新的办法.方法 同一操作者对34例健康志愿者68枚肾脏进行超声检查,使用GE公司voluson?E8及LOGIQ?E9超声诊断仪,采用动态范围分别为:C3、C6、C9和DR48、DR60、DR72,增益分别为G0、G6和G60、G70、G80,采用不同设置条件组合对肾脏进行检查并规范留图,通过放射科RADinfo阅片系统进行肾皮质灰阶值测量并记录分析.结果 相同的条件下同一深度肾皮质灰阶值差异无统计学意义(P>0.05),不同的检查条件下相同深度肾皮质灰阶值比值差异无统计学意义(P>0.05).结论 正常人群同一深度肾皮质的灰阶值比值差异无统计学意义,为进一步研究用灰价值比值变化评价肾占位性病变打下基础.

目的 探讨四维盆底超声对产后女性盆底障碍与针灸治疗产后女性盆底功能障碍的诊断价值.方法 选择金华市妇幼保健院妇产科2019年1-5月收治的80例产后女性盆底功能障碍患者与同期产后无盆底功能障碍的80例妇女开展前瞻性研究,分别设置为观察组、对照组,对2组妇女进行四维盆底超声检查,比较观察组与对照组的肛提肌裂孔情况.将观察组患者分为2组,各40例,比较2组的四维盆底超声检测指标、盆底肌力评分、阴道最大收缩压.结果 在静息状态、缩肛状态,观察组的肛提肌裂孔前后径、左右径、面积均大于对照组,其肛提肌厚度小于对照组(均P＜0.05).治疗后,观察2组的肛提肌裂孔前后径、左右径、面积均小于观察1组(均P＜0.05),其肛提肌厚度大于观察1组(均P＜0.05).治疗后,观察2组的盆底肌力评分、阴道最大收缩压均高于观察1组(均P＜0.05).结论 四维盆底超声可清晰、直观地显示盆底功能障碍女性患者盆底结构的形态学特点,还可客观评估针灸治疗盆底功能障碍的临床效果,可将四维盆底超声作为盆底功能障碍的辅助诊断手段和疗效评估方法.

Objective To study the clinical significance of two-dimensional speckle tracking imaging (2D-STI) in the treatment of left ventricular function in patients with sepsis. Methods Totally 81 patients with sepsis who were hospitalized in the Department of Intensive Care Medicine of Zhejiang Provincial People's Hospital from January 2014 to December 2015 were selected as the observation group, while 81 healthy subjects in the same period as the control group. The general data, left ventricular end systolic diameter (LVESd), left ventricular end diastolic diameter (LVEDd), interventricular septum diastolic (IVSD), stroke volume (SV), left ventricular ejection fraction (LVEF), early diastolic peak of mitral orifice (E peak), late diastolic peak of mitral orifice (A peak), E-wave velocity descent time (DT), global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), standard deviation of time to peak systolic longitudinal strain (Tssl-SD), standard deviation of time to peak systolic radial strain (Tssr-SD), standard deviation of time to peak systolic circumferrntial strain (Tssc-SD), maximum difference of Tssl (Tssl-Dif), maximum difference of Tssr (Tssr-Dif), maximum difference of Tssc (Tssc-Dif) of these two groups were compared. The relations between two-dimensional strain parameters and LVEF were analyzed by Spearman correlation. Results LVEF in the observation group [(62 ± 5)% vs. (68 ± 7)%] was significantly lower than that in the control group (t = 5.109, P < 0.001). In the observation group, GLS [(-18.4 ± 3.1)% vs. (-20.3 ± 2.1)%], GRS [(28.3 ± 2.1)% vs. (26.6 ± 4.2)%], GCS [(-23.8 ± 1.2)% vs. (-24.4 ± 2.4)%], Tssl-SD [(45.3 ± 3.2) ms vs. (19.3 ± 1.3) ms], Tssr-SD [(32.1 ± 2.9) ms vs. (21.3 ± 1.8) ms], Tssl-Dif [(103 ± 13) ms vs. (30 ± 25) ms], Tssr-Dif [(281 ± 23) ms vs. (160 ± 11) ms], and Tssc-Dif [(242 ± 12) ms vs. (169 ± 13) ms] were significantly higher than those in the control group (t = 4.828, 4.983, 2.165, 77.772, 31.516, 0.753, 35.843, 27.645; all P < 0.05). Spearman correlation analysis showed that GLS (r = -0.644, P = 0.005), Tssl-SD (r = -3.553, P < 0.001), Tssr-SD (r = -3.715, P < 0.001), Tssl-Dif (r = -2.944, P < 0.001), Tssr-Dif (r = -0.842, P = 0.003) and Tssc-Dif (r = -0.811, P = 0.003) were negatively associated with LVEF, while GCS (r = -0.085, P = 0.513) and GRS (r = -0.054, P = 0.517) were not associated with LVEF. Conclusion The 2D-STI index can objectively evaluate the systolic dysfunction and synchrony of left ventricle, and has important value in the early diagnosis of cardiac conditions in sepsis patients. Key words: Ultrasound cardiogram; Two-dimensional speckle tracking imaging; Left ventricle

Objective To assess the value of contrast-enhanced transrectal ultrasonography (CETRUS) and serum prostate special antigen (PSA) in diagnosis of prostate cancer.Methods One hundred and ninety eight patients with prostate carcinoma confirmed by pathological examination were enrolled in the study.The free prostate specific antigen (f-PSA),total prostate specific antigen (T-PSA),f-PSA to T-PSA ratio (f/T-PSA),PSA density (PSAD) were measured.All patients underwent CETRUS and ultrasound-guided "12+X" biopsy.The time-intensity curves (TIC) was developed;and peak enhancement (PK),time to peak (TP),sharpness and area under the enhancement curve (AUC) were obtained.With pathological examination as gold standard the diagnostic value of CETRUS and PSA was analyzed.Results PSAD in prostate cancer group was higher than that in benign prostate hyperplasia group.CETRUS showed the "rapidly in and out",fast to peak,short acceleration time as characteristic features for prostate cancer.Conclusion CETRUS and PSAD have high diagnostic value for prostate cancer.

Objective To study the determinants of left ventricular diastolic dysfunction (LVDD) and investigate its association with mortality in patients with septic shock. Methods Totally 127 patients with septic shock in Zhejiang Provincial People's Hospital recruited from June 2014 to December 2015 were divided into the LVDD group (49 cases) and control group as patients with normal left ventricular diastolic function (78 cases). General data of the two groups were compared. According to diastolic function underwent trans-thoracic echocardiography examination within 24 h after admission to ICU, LVDD was assessed as the combination early diastolic mitral annulus velocity (E') with the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/E'). The related factors of LVDD in patients with septic shock were analyzed by Pearson simple correlation, and the risk factors associated with mortality in patients with septic shock were evaluated by Logistic regression. Results Compared with the control group, the age [(63 ± 14) years vs. (58 ± 18) years], systolic blood pressure admitted to ICU [ (90 ± 18) mmHg vs. (99 ± 18) mmHg], coronary atherosclerotic heart disease (CHD) (15/49 vs. 12/78), serum creatinine [(188 ± 96)μmol/L vs. (116 ± 92)μmol/L], acute physiology and chronic health evaluation (APACHE) Ⅱ scores [(21 ± 5) vs. (17 ± 6)], plasma brain natriuretic peptide (BNP) [(178 ± 84) ng / L vs. (355 ± 128) ng / L], left ventricular end systolic diameter (LVESD) [(34 ± 8) mm vs. (31 ± 5) mm], interventricular septal thickness (IVST) [(10.1 ± 1.9) mm vs. (9.4 ± 1.4) mm], left ventricular posterior wall thickness (PWT) [(10.2 ± 1.5) mm vs. (9.6 ± 1.2) mm], mitral annular systolic velocity peak (S') [(9.0 ± 3.0) cm/s vs. (11.4 ± 3.6) cm/s], E' [(7.3 ± 2.3) cm/s vs. (12.3 ± 3.6)cm/s] and E/E' [(11.6 ± 4.0) vs. (6.8 ± 2.6)] in the LVDD group were significantly different (all P<0.05). Correlation analysis showed that E/E' had a positive correlation with age, hypertension, CHD, plasma BNP and APACHE Ⅱ score (r=0.302, 0.289, 0.277, 0.418, 0.290; all P < 0.05). However, the systolic blood pressure admitted to ICU and left ventricular eject fraction (LVEF) had negative correlations with those parameters (r=-0.239, -0.284; all P<0.05). Logistic regression analysis found that age [OR=1.040, 95%CI (1.020, 1.071)], blood lactic acid [OR=1.492, 95%CI (1.176, 1.732)], plasma BNP [OR=2.051, 95%CI (1.232, 2.964)], E/E' [OR=1.362, 95%CI (1.122, 1.534)] and APACHE Ⅱ score [OR=2.370, 95%CI (1.131, 3.674)] were the independent risk factors associated with mortality in patients with septic shock (all P < 0.05). Conclusions Age, systolic blood pressure admitted to ICU, hypertension, CHD, plasma BNP, APACHE Ⅱ score and LVEF were significantly related to LVDD. However, age, blood lactic acid, plasma BNP, E/E' and APACHE Ⅱ score were the independent risk factors associated with mortality in patients with septic shock.

目的 探讨经直肠超声弹性成像(TRTE)应用于前列腺癌的诊断价值.方法 选择前列腺病变患者70例,分别进行经直肠前列腺超声(TRUS)检查TRTE检查及前列腺穿刺活检.比较TRUS与TRTE两种方法前列腺癌检出情况及诊断效能(包括特异度、准确度及灵敏度).结果 70例患者穿刺共检出前列腺癌43例(61.43%);TRTE法检测前列腺癌率(54.29%)明显高于TRUS法(均37.14%,P<0.05);TRTE法特异度、准确度及灵敏度均高于TRUS法(P<0.05).结论 TRTE用于前列腺癌诊断具有良好的特异度、准确度及灵敏度.

Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Objective To compared the value of contrast-enhanced ultrasound(CEUS)with contrast-en-hanced CT(CECT)in the diagnosis of renal tumor.Methods The CEUS and CECT features of 55 cases of renal tumor confirmed by operation and pathology were retrospectively analyzed,evaluate the value of CEUS and CECT in&nbsp;the diagnosis of renal tumor.Results Of the 55 cases,21 cases showed benign lesions,and 34 cases malignant lesions.The sensitivity,specificity,positive predictive value,and negative predictive value of the CEUS were 90. 6%,78.3%,85.3%,and 85.7%,respectively;and the sensitivity,specificity,positive predictive value,and negative predictive value of the CECT were 87.5%,73.9%,82.3%,81.0%.There was no significant difference in the results between two methods(P >0.05).Conclusion CEUS can get the same effect as the CECT.The suit-able method is selected according to the characteristics of the inspection technology.

OBJECTIVE:To evaluate the prognostic value of combination of plasma brain natriuretic peptide(BNP) with the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity(E/E') in the patients with septic shock.METHODS:From June 2012 to December 2013 , 127 patients with septic shock were consecutively recruited and underwent trans-thoracic echocardiography examination within 6 h after admission to Intensive Care Unit(ICU), Zhejiang Provincial People's Hospital. Plasma BNP concentration was measured using ELISA method. All Clinical, laboratory, and survival data were prospectively collected.RESULTS:Of 127 patients enrolled, mean values for age were(59.9±17.3) years and APACHE Ⅱ score(16.8±5.8), respectively. 95 patients(74.8%) took mechanical ventilation. 28- , 60-day mortality rate was 36.3% and 42.3%, respectively. Univariate Cox regression analysis showed that age, coronary artery disease, serum creatinine and lactate, plasma BNP, left ventricular ejection fraction(LVEF), E/E' and APACHE Ⅱ score were significantly(P≤0.05) associated with 60-day mortality. Multivariate analysis revealed that serum lactate, plasma BNP(χ(2)=9.4, P=0.002) , E/E'(χ(2)=4.89, P=0.02) and APACHE Ⅱ score(χ(2)=10.6, P=0.001) remained independent predictors for 60-day mortality. ROC curve analysis showed that the optimal plasma BNP and E/E' cutoff values identified were 338.8 pg/ml and 10.8, and the areas under ROC curve were 0.89(sensitivity: 83.7%; specificity: 81.4%)and 0.83(sensitivity: 76.7%; specificity: 72.9%)for 60-day mortality, respectively. In addition to plasma BNP and clinical predictors, the E/E' could provide in independent and incremental prognostic value of 60-day mortality(χ(2)=59.3 vs 47.8, P<0.001).CONCLUSION:Plasma BNP and E/E' are independent predictors for 60-day mortality, and combination of plasma BNP and E/E' could improve risk stratification in patients with septic shock.

目的 评价超声双重造影(DCUS)与增强MRI在直肠癌术前局部分期中的应用价值.方法 76例直肠癌患者术前经直肠腔内灌注胃肠超声造影剂和静脉注射微泡造影剂行DCUS及MRI增强扫描,将分期结果与术后病理对照.结果 术前DCUS与增强MRI对T分期的准确性分别为82.9％、78.9％,对N分期的准确性分别为71.1％、78.9％,差异均无统计学意义.其中DCUS对T1、T2、T3、T4分期的准确性分别为84.6％、63.6％、86.8％、85.7％;增强MRI对T1、T2、T3、T4分期的准确性分别为53.8％、45.5％、92.1％、92.8％.两种检查方法局部分期一致性较好,T分期和N分期Kappa值分别为0.842、0.629(P＜0.01).结论 DCUS作为一种新的增强影像学方法,对直肠癌局部分期与增强MRI无统计学差异,两种方法T分期具有高度一致性,N分期具有中度一致性.

以往外科治疗肾结石多采用开放性手术,损伤较大.近年来开展的微创治疗方法-经皮肾镜取石、腹腔镜外科手术及体外冲击波碎石等,使越来越多的患者避免了开放性手术.

慢性充血性心力衰竭是临床治疗的一大难题,可导致患者劳动能力丧失,具有较高的死亡率.尽管药物治疗不断更新和发展,但仍有不少患者疗效不佳,而且此部分心力衰竭患者常合并房室、室间和室内传导障碍而导致心脏活动失同步,影响了心脏的收缩力.心脏再同步治疗(CRT)的成功应用[1],显示出了对药物疗效不佳的心脏活动失同步心力衰竭患者的良好应用前景.本研究应用实时三维组织同步显像技术(tissue synchronization imaging,TSI)评价心脏运动的同步性,探讨其对CRT术前患者筛选及术后参数优化的临床应用价值,现报道如下.

目的探讨门静脉高压性脾肿大患者脾内动脉的血流动力学改变。方法应用多普勒超声检测肝硬化门静脉高压所致的脾肿大患者脾门区动脉、中央区动脉、周围区动脉的血流速度和阻力指数,并与对照组相比较。结果门静脉高压性脾肿大组脾内各级动脉的血流速度与阻力指数明显高于正常对照组(<0.05)。结论门静脉高压性脾肿大脾内动脉血流速度增快、阻力增大;脾肿大本身成了促进门静脉压力升高的致病因素之一。

Objective: To study the ultrasonographic feature in advanced-stage gallbladder carcinoma and estimate its value. Methods: To analyze the ultrasonographic image in 39 cases of advanced-stage gallbladder carcinoma which were confirmed by surgery and pathology. Results: The ultrasonography of advanced-stage gallbladder carcinoma could be divided into fungation, thick-wall, solid and mixed-pattern. The hepatic metastasis, hepatic invasion, regional lymph node enlargement, stones in gallbladder, dilated bile duct etc were displayed simultaneously. Conclusion: Diagnosing advanced-stage gallbladder carcinoma accurately and estimating the metastatic foci are very important to surgical operation.

感染性心内膜炎引起心脏瓣膜损害及瓣膜赘生物已有较多报道,但由心内膜炎导致右室流出道赘生物的报道不多.本文报告我院2例先天性室间隔缺损(VSD)合并感染性心内膜炎(IE)病例.