目的 分析冠心病心衰患者用曲美他嗪联合琥珀酸美托洛尔治疗的临床效果.方法 用2020年5月-2021年3月院内收治的74例冠心病心衰患者,随机均分两组,各37例.参照组常规治疗,观察组用曲美他嗪联合琥珀酸美托洛尔治疗,比较治疗前后3个月的心功能指标和血压指标.结果 治疗后,参照组的心功能指标和血压指标比观察组略差,有差异(P<0.05).结论 曲美他嗪联合琥珀酸美托洛尔在心功能和血压等方面表现更佳,能提高疗效,可推广.

目的 探究冠心病不稳定型心绞痛(CHD-UA)采用替格瑞洛联合阿司匹林治疗的临床效果.方法 选取2020年5月～2021年5月本院收治的冠心病不稳定型心绞痛(CHD-UA)患者92例,使用随机、双盲法进行分组,每组患者46例,对照组口服阿司匹林治疗,实验组采用替格瑞洛联合阿司匹林治疗,对比两组治疗效果及不良反应.结果 实验组治疗有效率明显高于对照组,且实验组不良反应发生率明显低于对照组(P<0.05).结论 在冠心病不稳定型心绞痛(CHD-UA)治疗中,替格瑞洛联合阿司匹林治疗效果更为显著,建议在临床治疗中推广使用.

肺心病即慢性肺源性心脏病的简称,是指肺组织或肺动脉血管病变所致肺动脉高压引起的心脏病.本病常因呼吸系统感染而诱发,以冬春季多发.肺心病往往预后不良,但是通过积极的治疗,可以提高患者的生存质量.长期系统的药物治疗是关键.但肺心病患者用药要小心5种药物可能带来的风险.

Objective It is to observe the effect and mechanism of Shenfu injection pretreatment combined with intracoronary injection of alprostadil on the prevention of no reflow phenomenon (NRP) after emergency percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods 120 patients with ACS were randomly divided into group A,group B and group C,with 40 cases in each group. Group A was given routine treatment of PCI. Group B was injected with alprostadil on the basis of the group A in PCI surgery (balloon dilation + implantation of stent). On the basis of the group B,group C was given intravenous infusion of Shenfu Injection (1 mL/kg diluted to 100 mL normal saline) before PCI and maintained intravenous drip to 24-hour after operation. The classification of TIMI blood flow,the incidence of NRP and the myocardial perfusion were observed before and after PCI,the levels of inflammatory factors and vascular endothelial markers were measured before,during and after PCI,the incidence of major adverse cardiac events(MACE) during hospitalization was recorded. Results The blood flow classification of TIMI in the group C was significantly higher than that in the group A and B (P<0.05),and that in the group B was significantly higher than the group A (P< 0.05). The incidence of NRP in the group C was significantly lower than that in the group A and B (P<0.05),and that in the group B was significantly lower than the group A (P<0.05). The corrected TIMI frame count (cTFC) and wall motion score index (WMSI),contrast perfusion deficient score index (CSI) of the 3 groups after PCI were significantly improved(all P<0.05),and those in the group C were improved significantly better than the group A and B (all P<0.05),those in the group B was significantly higher than the group A (all P<0.05); the serum levels of hs-CRP,IL-6 and ET-1 during and after PCI in the group C were significantly lower than those in the group A and B (all P<0.05),and group B was significantly lower than the group A (all P<0.05),while serum B showed an opposite trend. The total incidence of MACE in the group C was significantly lower than that in the group A and B (P<0.05),and that in the group B was significantly lower than the group A (P<0.05). Conclusion Shenfu injection pretreatment combined with intracoronary injection of alprostadil can significantly reduce the incidence of NRP in patients with ACS after emergency PCI,it also significantly improved myocardial perfusion and reduced the risk of postoperative MACE,its mechanism may be related to its inhibition of inflammatory response and the protection of vascular endothelial cell function.

目的 联合应用射血分数(EF)和心排血指数(CI)评价心血管外科心力衰竭(HF)患者的心脏功能,分析EF、CI与美国心脏病学会/美国心脏学会(ACC/AHA)提出的HF分期的相关性,评估心血管外科患者的心脏功能,指导治疗.方法 2016年3月至2017年3月选取正常对照组15例为A组,健康成年人;哈尔滨市第一医院心内四病房收治的HF患者30例为B组,其中B1组15例EF<50％,B2组15例EF≥50％,分别应用心脏超声和心脏磁共振的方法测量A组、B组所有入选人员的EF、每搏输出量(SV),记录即时心率.记录所有入选人员的身高、体重,计算CI.比较A组EF与CI的相关性.对于B组HF患者,按照AHA/ACC提出的HF分期标准进行分期,分别比较B组患者的EF与CI、EF与HF分期、CI与HF分期的相关性.结果 A组患者的EF与CI无固定关系;B1组患者的EF越低,CI越低,P<0.05;B2组患者的CI降低,EF与CI无明显关系;B组患者根据AHA/ACC提出的HF分期进行分期,C期、D期患者分期越高,CI越低,P<0.05.结论 健康人的心脏EF与CI无固定关系;EF<50％的HF患者EF与CI成正相关;EF≥50％的HF患者CI降低,但是无固定关系;根据AHA/ACC提出的HF分期,分期越高,CI越低.

Objective:To explore the effect of partial body weight support training (PBWST) on the cardiac function,neuroendocrine function,and vascular endothelial function in patients with early heart failure.Methods:A total of 98 patients with early heart failure who were admitted in our hospital were included in the study and randomized into the observation group and the control group.The patients in the control group were given routine drugs and rehabilitation.On this basis,the patients in the observation group were given PBWST.The patients in both groups were treated for 3 months.The changes of cardiac function,neuroendocrine function,and vascular endothelial function indicators before and after rehabilitation in the two groups were detected.Results:LVESD and ESV after training in the two groups were significantly reduced (P<0.05).LVESD and ESV after training in the observation group were significantly lower than those in the control group (P<0.05).SV,CI,LVEF,and FS after training in the observation group were significantly elevated when compared with that before treatment (P<0.05).LVEF and FS after training in the observation group were significantly higher than those in the control group (P<0.05).LVEF after treatment in the control group was significantly elevated (P<0.05).PRA,Ang Ⅱ,ET,and ALD levels after treatment in the observation group were significantly reduced (P<0.05),while NO was significantly elevated (P<0.05),and the improvement of the above indicators was significantly superior to that in the control group (P<0.05).Conclusions:PBWST can improve the cardiac function in patients with early heart failure,inhibit the excessive activation of neuroendocrine system,and protect the vascular endothelial function in order to enhance the clinical efficacy.

目的 探讨中孕期及晚孕早期规范化产前超声标准切面在各级医院推广的临床应用价值.方法 2014年7月至2016年6月哈尔滨市红十字中心医院超声科医生对选定的哈尔滨市9家医院超声医生不定期来本院超声科进修学习产前超声筛查技术.将培训前后的胎儿畸形检出情况进行对照分析.结果 ①推广规范化胎儿筛查标准切面图后,各医院筛查人数增加,较推广前增加比率35.8％～121.7％[(125-92)/92～(1459-658)/658]不等;②推广标准切面图后筛查出的畸形种类明显增多,且涵盖的内容更全面.结论 选定的9家医院应用规范化超声标准切面进行胎儿筛查,减少了漏诊,降低了出生缺陷率及围产儿死亡率,具有重要的临床价值和意义.

采用回顾性分析法选择2014年10月-2016年9月期间我院收诊的90例稳定型心绞痛患者,随机分观察组与对照组各45例,观察组患者均行曲美他嗪20 mg 3次/d与倍他乐克25 mg 2次/d药物治疗方法;对照组患者实施倍他乐克25 mg 2次/d、伯基与长效型硝酸脂类治疗方法,10周设置为1个疗程.对两组患者治疗前后心绞痛发作状况、运动耐受优化状况、心电图变化状况进行观察分析.1个疗程后,观察组与对照组患者心绞痛发作次数均有不同程度降低,血压、心率、运动耐受与心电图都有所变化,治疗后观察组患者变化程度显著优于对照组,差异有统计学意义(P<0.05).曲美他嗪与倍他乐克联合治疗稳定型心绞痛能使患者临床症状显著改善,毒副作用较低,安全性较高,具有推广与应用价值.

目的：研究分析妇产科出血疾病使用超声诊断的效果。方法超声诊断能够对阴道切面以及子宫附件进行检查，使用该方法来对妇产科出血患者进行诊断，此次共有65例患者接受研究，对他们的诊断效果进行探讨分析。结果 B超显示子宫占位患者共34例，肌壁间肌瘤和黏膜下肌瘤16例，宫颈肌瘤8例，1例玻璃样变，子宫肌瘤7例，有2例是误诊，诊断准确率是94．1％；对患者的各类流产症状的诊断中，有先兆流产8例，难免流产5例，不全流产5例、完全流产2例，准确率是95．2％，宫外孕诊断准确率是83．3％，出血诊断准确率100％。相比手术验证，超声诊断准确率高，为93．8％。结论妇产科出血患者接受超声诊断，临床中的重复性比较强，准确性比较高，对患者进行诊断后提供有效地治疗措施非常有帮助，是临床妇产科检查的首要选择。

Objective To study the different diagnosis and comparison of outcome between fetus omphalocele and fetus gastroschisis by ultrasonograghy.Methods Retrospective analyse the clinical data of thirty-four pregnant woman cases of fetus omphalocele and fetus gastroschisis which were diagnosed from January,2009 to July,2011 in Harbin Red Cross Center Hospital.Results The thirty-four fetus diagnosed omphalocele and gastroschisis showed different ultrasonic characteristics and outcomes.① There are fifteen cases of omphalocele and nineteen cases of gastroschisis.Average ages of pregnant women diagnosed omphalocele and gastroschisis are respectively 28.64 and 23.06 years old,and their average gravidity times are 1.8 and 2.2.Incidences of omphalocele and gastroschisis are respectively 0.0297% and 0.0376%.② Multiple malformations are respectively ten cases(66.7%,10/15) and two cases chromosome of fetus omphalocele is abnormal(13.3%,2/15) in fetus omphalocele.Different from omphalocele,there are no multiple malformation and chromosome abnormality in cases of gastroschisis.③ The initial diagnosis for omphalocele and gastroschisis are respectively in thirteenth and eighteenth week gestation.Conclusions The incidence of fetus gastroschisis has been increasing in the recent years.It is important to distinguish the fetus omphalocele and the fetus gastroschisis by ultrasound screening because the prognosis of the latter is much better than the former.

目的 探讨产前超声在胎儿前腹壁异常中的诊断价值.方法 回顾性分析经产前胎儿系统超声检查的43 971例次中证实为胎儿前腹壁异常的超声表现,进一步研究胎儿系统超声检查对前腹壁异常诊断的准确率.结果 43 971例次中前腹壁异常36例,其中腹裂20例,脐膨出12例,体蒂异常3例,泄殖腔外翻1例,超声确诊34例,误诊2例.胎儿系统超声检查诊断胎儿前腹壁异常的准确率为94.4%.结论 产前胎儿系统超声检查,对胎儿前腹壁异常有较高的诊断准确率,并能显示伴随的其它畸形,有较重要的临床意义.

Objective Comparative analysis of the ultrasonic appearance and the pathological findings of the breast infiltra- ting ductal carcinomas(IDC).Try to investigate the relationship between the ultrasonic features and the expression levels of Id2mRNA and Id3mRNA.Methods The real-time fluorescent quantitative RT-PCR(FQ-RT-PCR)was used to detect the expression levels of Id2mRNA and Id3mRNA in 36 IDC.The results were compared with the ultrasonic features of IDC.Re- sults The expression of Id2mRNA was higher in normal tissues than that in carcinoma tissue(P0.05)and was lower in WHOⅢgrade than that in WHOⅠgrade(P0.05),Id3mRNA inversely(P0.01,P0.05,respectively).Id2mRNA has no statistically significant with the ultrasonic appearance(P0.05).Id3mRNA was high expression in spiculate margin and peripheral duct extension(P0.01).Conclusion Uhrasonographie morphologic manifestations are closely related to pathology in IDC.The expression level of Id3mRNA can be assessed according to ultrasonic features of IDC(spiculate mar- gin and disorder structure in duct)in certain degree.

[Purpose] To explore the value of two-dimension ultrasound(2D),color doppler flow imaging(CDFI),pulse wave doppler(PW) and three-dimension color power angiography(3D-CPA) in differentiating malignant from benign thyroid nodules.[Methods] The ultrasonography features including 2D,CDFI,PW and 3D-CPA finding in 89 cases with thyroid nodules were analyzed and compared with pathological results.[Results] There were significant difference between malignant and benign thyroid nodules in boundary,appearance,calcification,acoustic halo,blood grading,PSV and RI.3D-CPA combined with CDFI could clearly show the blood feature of thyroid nodules.[Conclusion] Combination of 2D,CDFI,PW and 3D-CPA images can improve the diagnostic accuracy for thyroid nodules.

Objective:To evaluate retrobulbar blood circulatory changes in diabetic patients with ultrasonography.Methods:Thirty patients without diabetic retinopathy and thirty healthy subjects were evaluated for retrobulbar blood flow parameters in terms of the ophthalmic(OA),short posterior ciliary(PCA),central retinal arteries(CRA),and the central retinal vein(CRV) using Ultrasonography and reevaluated the aforesaid terms after 2 weeks of intensive insulin therapy.Results:This study showed that the end-diastolic velocity(EDV) of OA,CRA were lower in diabetic patients than those in control subjects,the resistent index(RI) significantly higher than control subjects.The maxlmum velocity(Vmax) and minimum velocity(Vmin) of CRV were higher in patients without diabetic retinopathy than control subjects.The RI and plasma levels of glucose,triglyeride,total cholesterol and HbA1c showed significant decreased after the therapy.Conclusion:Ultrasonography is a useful method for early detection of the retrobulbar circulation hemodynamics change in diabetic patients.

Objective To investigate the relationship between the ultrasonic appearance of the breast infiltrating ductal carcino- mas(IDC)and the expression level of Id3mRNA.Methods The real-time fluorescent quantitative RT-PCR(RT-PCR)was used to detect the expression levels of Id3mRNA in 36 IDC.The results were compared with the ultrasonic features of IDC.Results The expres- sion of Id3mRNA was lower in normal tissues than that in carcinoma tissue(P0.01).Id3mRNA had high expression in tissue with ul- trasonic appearance of spiculate margin and peripheral duct extension(P0.01 ).Conclusion Ultrasonic appearance is closely related to pathology in IDC.The expression level of Id3mRNA can be assessed according to ultrasonic features of IDC in a certain extent.

Objective:To predict the clinical utility for bladder outlet obstruction (BOO) using ultrasound-estimated bladder weight (UEBW) and to reveal the correlation of UEBW with urodynamics tests. Methods:A total of 70 men with lower urinary symptoms were divided into BOO group, non-BOO group and control group. UEBW of the subgroups was compared with age, maximum flow rate, postvoid residual urine, and international prostatic symptoms scores (IPSS). Results:UEBW of Boo greup was statistical significance compared to non-Boo group and controegroup (P0.001). In a simple regression analysis, there was a statistically significant correlation between UEBW and postvoid residual urine (r=0.49;P0.001). It revealed a diagnostic accuracy of 87.1% (61/70) for bladder outlet obstruction with 11.4%(5/44) and 14.3% (3/21) false-positive and false-negative rates, respectively. Conclusion:UEBW may be used to predict BOO noninvasively and it has an extensive clinical utility.

Objective To investigate the value of blood flow volume and velocity of vertebral basilar system with ultrasound in the diagnosis of vertebrobasilar insufficiency(VBI).Methods One hundred and seven patients were divided into three types and underwent ultrasonography.The blood flow volume and velocity of vertebral artery(VA) and basilar artery(BA) were compared.Results VA systolic flow velocity,BA systolic flow velocity in severely damped patients was significantly lower than that of moderately damped patient(P0.05).However,VA systolic flow velocity,BA systolic flow velocity had no significant differences in moderately damped patients and patients with normal blood flow(P0.05).Conclusion Blood flow volume is valuable in the diagnosis of VBI and can judge the level of VBI,It can be considered as criterion in diagnosing VBI with ultrasound.

患者女,18个月,因腹痛腹胀10d来我院就诊.入院前行超声检查:于右下腹部测及一大小约10.0 cm.×5.9 cm×6.9cm的团状低回声,边界清晰,形态不规则,呈分叶状,内部回声不均匀,可见肿块中之肿块及簇状钙化样强回声,其内测及数条管状无回声区,迂曲走行(图1),彩色多普勒血流显像显示其内血流信号充盈.超声诊断:腹腔实质性占位性病变(结合病史,考虑神经母细胞瘤可能性大).

患者女,47岁,右小腿肿物2年,疼痛3个月.超声所见:右小腿前外侧肌层内探及一大小约为0.7 cm×2.1 cm稍低回声团,边界清晰,内回声欠均匀,其深方可见紧密相邻的宽度约为0.1 cm弧形低回声带,其回声强度与两端相连的管状低回声一致,管状低回声宽度一致约为0.3 cm,内回声较均匀,呈"手表状"(图1).

患者女,55岁.无意间发现左小腿包块就诊,包块处皮肤无异常,质韧,有压痛,超声检查所见:左小腿内侧软组织内可见多个团块状回声,近椭圆形,最大者约2.7 cm×1.0 cm,距皮下0.2 cm,边界尚清晰,内部回声不均匀,低回声中心可见钙化样强回声,后方伴有声影,团块边缘为强回声光带(图1).CDFI:团块周围及其内未见明显血流信号.结论:左小腿内侧软组织病变(多发性,考虑良性可能性大).病理诊断:血管平滑肌脂肪瘤.