儿童直立调节试验对不明原因晕厥的诊断价值

目的:探讨直立倾斜试验对儿童不明原因晕厥的诊断价值,为临床诊断提供科学依据。方法:对208例不明原因晕厥的儿童给予进行直立倾料试验检查,持续进行心电监护监测,记录其血压、心率变化,分析试验结果。结果:145例(69.71%)出现阳性的血管迷走神经反应,73例(50.34%)为血管抑制型反应;19例(13.10%)呈心脏抑制型反应;53例(36.55%)为混合型反应型,并且诱发因子多为持久站立。结论:不明原因晕厥患者在直立倾斜试验中以血管迷走反应为主,持久站立是血管迷走神经性晕厥的主要诱因。     

产前经腹灰阶联合彩色血流超声多参数对胎盘植入性疾病的诊断效能研究

摘要 目的：探究产前经腹灰阶联合彩色血流超声多参数对胎盘植入性疾病的诊断效能。方法：2019年11月-2021年12月于我院收治的产前超声诊断为前置胎盘的孕妇共计62例,其中44例超声诊断合并了胎盘植入的孕妇。所有孕妇产前均进行经腹灰阶检查、经腹彩色超声检查和二者联合检查胎盘植入性疾病,通过分析胎盘植入性疾病筛查结果,评价产前超声经腹灰阶联合彩色血流超声多参数对胎盘植入性疾病的筛查效能。结果：（1）通过灰阶超声诊断检出胎盘植入的灵敏度为73.42 %,特异度为86.54 %;（2）通过彩色超声诊断检出胎盘植入的灵敏度为76.89%,特异度为89.07 %;（3）经腹灰阶联合彩色血流超声多参数诊断检出胎盘植入的灵敏度为87.79 %,特异度为90.36 %;（4）经腹灰阶检查、经腹彩色超声检查和二者联合检查对胎盘植入性疾病筛查阳性率分别为56.45 %、62.90 %和67.74 %,二者联合检查对产前胎盘植入性疾病筛查阳性率显著高于经腹灰阶检查和经腹彩色超声检查（P<0.05）。（5）二者联合检查的敏感度为72.26 %,特异度为90.54 %,阳性比为95.55 %,诊断比值比为78.89 %。结论：产前经腹灰阶联合彩色血流超声多参数对胎盘植入性疾病的诊断有较高的灵敏度和特异度,值得临床推广应用。     

老年H型高血压合并急性缺血性脑卒中患者血清omentin-1、Irisin水平与病情及预后的关系研究

目的:探讨老年H型高血压合并急性缺血性脑卒中患者血清网膜素-1(omentin-1)、鸢尾素(Irisin)水平与病情及预后的关系。方法:选择2017年6月-2019年9月我院收治的老年H型高血压合并急性缺血性脑卒中患者92例,记作合并脑卒中组,根据美国国立卫生研究院卒中量表(NIHSS)评分将患者分为轻症组28例(NIHSS评分≤4分)、中症组39例(5分≤NIHSS评分≤20分)和重症组25例(NIHSS评分>20分),根据改良Rankin量表(mRS)评分将患者分为预后不良组28例(mRS评分>2分)和预后良好组64例(mRS评分≤2分)。另选择同期我院收治的单纯老年H型高血压患者90例作为单纯H型高血压组,分析合并脑卒中组患者血清omentin-1、Irisin水平及omentin-1、Irisin与NIHSS评分、mRS评分的相关性,并应用ROC曲线分析血清omentin-1、Irisin水平对患者预后的预测价值。结果:合并脑卒中组血清omentin-1、Irisin水平显著低于单纯H型高血压组(P<0.05),随脑卒中神经缺损严重程度的升高,H型高血压合并急性缺血性脑卒中患者血清omentin-1、Irisin水平逐渐降低(P<0.05),预后不良组血清omentin-1、Irisin水平显著低于预后良好组(P<0.05)。老年H型高血压合并急性缺血性脑卒中患者血清omentin-1、Irisin水平与NIHSS评分及mRS评分均呈负相关(P<0.05)。omentin-1最佳临界值为105.36 ng/ml,敏感度为78.23%,特异度为83.44%;Irisin最佳临界值为90.77 ng/L,敏感度为71.00%,特异度为61.43%。结论:老年H型高血压合并急性缺血性脑卒中患者血清omentin-1、Irisin水平异常降低,其水平与神经缺损程度和预后呈负相关,血清omentin-1、Irisin对老年H型高血压发生急性缺血性脑卒中的预后评估具有一定价值。     

单气囊小肠镜与胶囊内镜对不明原因消化道出血的诊断价值

目的:探讨单气囊小肠镜(SBE)与胶囊内镜(CE)对不明原因消化道出血(OGffi)患者的诊断价值。方法:将在我院治疗的100例OGIB患者按照诊断方式的不同分为SBE组和CE组各50例。对两组的病灶检出率病因诊断率以及安全性进行比较。结果SBE组病因诊断率为78.0%;CE组病因诊断率为60.0%,两组病因诊断率比较差异无统计学意义(P0.05)。SBE组病灶检出率为80.0%(40/50),CE组病灶检出率为86.0%(43/50),两组病灶检出率比较差异无统计学意义(P0.05)。SBE组患者检查较顺利,CE组胶囊滞留率为4.0%。所有患者检查后均未出现不良反应及并发症。结论:息肉及粘膜糜烂渍疡病变的OGIB患者在SBE与CE检查方法中较为常见,CE病灶检出率与SBE相当,两种检查方法均较可靠,CE检查更为方便。     

心脏手术中经食道彩超的应用价值

经食道超声心动图(TEE)与经胸超声心动图(TTE)结合已广泛应用于心血管疾病的诊断,随着TEE技术的不断发展,其应用范围逐步拓宽。近年来,TEE开始用于心脏手术的术中监测。 资料与方法 (一)病人:1992年6月～1994年1月心脏手术中进行术中TEE检查的病人,共64例,男性     

四维子宫输卵管超声造影假阳性与假阴性的原因分析

目的:调查与分析四维子宫输卵管超声造影假阳性与假阴性的原因。方法:选择2015年6月到2019年8月在本院妇产科临床初步诊断为输卵管不孕症患者125例,所有患者都给予X线子宫输卵管碘油造影(Hysterosalp ingography,HSG)与四维子宫输卵管超声造影,记录诊断效果、不良反应,判断假阳性与假阴性的发生原因。结果:在125例患者中,HSG诊断输卵管通畅33例,通而不畅72例,阻塞20例;四维超声造影诊断为输卵管通畅33例,通而不畅74例,阻塞18例。将HSG检查作为金标准,四维超声造影检查输卵管阻塞准确率93.6%,Kappa值=0.929(P<0.05),出现假阳性与假阴性共8例。四维超声造影检查期间发生的阴道少量出血、造影剂过敏、恶心呕吐、腹痛等不良反应发生率为2.4%,显著低于HSG检查的13.6%(P<0.05)。单因素分析结果显示合并糖尿病、产次、初潮年龄、孕次与四维子宫输卵管超声造影的假阳性与假阴性显著相关(P<0.05);多因素Logistic回归分析结果显示合并糖尿病、产次、初潮年龄为导致四维子宫输卵管超声造影假阳性与假阴性的主要原因(P<0.05)。结论:四维子宫输卵管超声造影可实时动态观察输卵管通畅情况,应用安全性也比较好,但是也存在假阳性与假阴性情况,合并糖尿病、产次、初潮年龄为导致四维子宫输卵管超声造影假阳性与假阴性的主要原因。     

胎儿唇裂与唇腭裂产前超声诊断分析

目的:探讨超声诊断胎儿唇裂与唇腭裂的图像特征,以提高胎儿唇裂及唇腭裂的确诊率。方法:选取我院2013年1月~2013年12月的2381例产前超声筛查检查出的17例唇腭裂胎儿,经二维三维超声检查后与出生后颜面部检查结果比较。结果:17例唇腭裂胎儿共检查出16例,漏检1例,检出准确率94.12%,其中1例完全唇裂伴完全腭裂仅检查出唇裂,误检率5.88%。其中未合并其他畸形胎儿16例(94.12%,16/17),完全唇裂伴完全腭裂13例(76.47%,13/17),单纯唇裂2例(11.76%,2/17),单纯腭裂1例(5.88%,1/17);唇腭裂合并其他畸形胎儿1例。结论:产前进行超声检查在胎儿唇裂和唇腭裂诊断中具有显著作用,发现唇裂或唇腭裂后可经多次反复检查确诊,对于部分胎儿可能存在患有唇裂或唇腭裂而漏检情况。     

经阴道超声与宫腔镜对子宫内膜病变患者的诊断价值比较研究

目的:探讨经阴道超声与宫腔镜检查诊断子宫内膜病变的临床价值,为临床诊断子宫内膜病变提供理论依据。方法:选取2011年3月-2014年3月间我院收治的158例疑似子宫内膜病变患者,分别采用经阴道超声和宫腔镜进行检查,并以病理诊断结果为"金标准",比较两种检查方法的诊断价值。结果:病理检查结果中,143例患者被确诊为子宫内膜病变,其中子宫内膜增生23例(16.08%),子宫内膜息肉31例(21.68%),子宫粘膜下肌瘤24例(16.78%),子宫内膜癌19例(13.29%),慢性非特异性子宫内膜炎46例(32.17%)。宫腔镜对子宫内膜病变诊断的准确率为94.41%,高于阴道超声的81.12%,差异有统计学意义(P0.05),其中阴道超声和宫腔镜对子宫粘膜下肌瘤、子宫内膜癌诊断的准确率比较差异无统计学意义(P0.05),阴道超声对子宫内膜增生、子宫内膜息肉及慢性非特异性子宫内膜炎的诊断准确率均较宫腔镜降低,差异有统计学意义(P0.05)。阴道超声对子宫内膜病变诊断的特异度较宫腔镜更低(P0.05),但两者灵敏度、AUC比较差异无统计学意义(P0.05)。结论:经阴道超声诊断子宫内膜病变简单、有效,而宫腔镜诊断子宫内膜病变具有准确率以及特异度较高的特点。     

高分辨率磁共振成像对颅内动脉粥样硬化斑块的诊断价值

目的:探讨高分辨率核磁共振成像(magnetic resonance imaging,MRI)对颅内动脉粥样硬化斑块的诊断价值。方法:选择2016年1月至2018年6月在我院诊治的缺血性脑卒中患者134例作为研究对象,所有患者都给予数字减影血管造影(Digital subtraction angiography,DSA)与高分辨率MRI检查,记录颅内动脉粥样硬化斑块特征与分型,以DSA诊断为金标准,判断MRI的诊断价值(阳性预测值、特异度、灵敏度、阴性预测值)。结果:在134例患者中,高分辨率MRI显示未见斑块62例,Ⅰ型5例、Ⅱ型26例,Ⅲ型26例、Ⅳ型15例,与DSA诊结果一致124例,占比92.5%。高分辨率MRI与DSA诊断颅内动脉粥样硬化斑块的Kappa值为0.89,MRI对各分型的颅内动脉粥样硬化斑块的阳性预测值、特异度、灵敏度、阴性预测值分别为:Ⅰ型87.0%、99.2%、95.8%和99.2%,Ⅱ型81.0%、98.5%、83.4%和98.5%,Ⅲ型82.7%、82.7%、84.0%和95.7%,Ⅳ型100.0%、100.0%、100.0%和100.0%。结论:高分辨率MRI用于诊断颅内动脉粥样硬化斑块的价值与DSA检查有很好的一致性,可反映硬化斑块的分型。     

经胸壁超声心动图在先天性心脏病患者左心室功能评价中的应用价值

目的:比较常规超声和经胸壁超声心动图筛查胎儿先天性心血管畸形的应用价值。方法:选择2012年1月到2017年2月在我院诊治的35例疑似胎儿先天性心脏病的产妇作为研究对象,所有产妇都接受常规超声和经胸壁超声心动图检查,再将结果与病理检查结果进行对比分析,判断其诊断效能。结果:在35例产妇中,病理检查结果显示102处心脏异常情况,其中房室间隔异常35处,动脉心室连接异常28处,房室连接异常25处,动脉干异常14处。二维联合超声心动图对各种类型心血管畸形的正确诊断率都高于常规超声(P0.05)。35例产妇胎儿的PI值为53.44±7.55,CPR值为62.99±5.39。常规超声检查对胎儿先天性心血管畸形的诊断敏感度、特异度、阳性预测值及阴性预测值分别为84.9%、50.0%、96.6%和16.7%,而二维联合超声心动图检查的敏感度、特异度、阳性预测值及阴性预测值分别为97.0%、100.0%、100.0%和66.7%,二维联合超声心动图检查的敏感度、特异度、阳性预测值及阴性预测值都高于常规超声(P0.05)。结论:超声检查在胎儿先天性心血管畸形诊断中具有重要的意义,经胸壁联合超声心动图检查有利于对心脏形态学进行客观评估,提高诊断效果,有很好的应用价值。     

右心声学造影联合血清cTnI、NT-proBNP对心源性脑梗死的预测价值

摘要 目的：探讨右心声学造影联合血清心肌肌钙蛋白I（cTnI）、N-末端脑利钠肽前体（NT-proBNP）对心源性脑梗死（CE）的预测价值。方法：选择2020年7月至2023年6月湖南中医药高等专科学校附属第一医院收治的急性脑梗死患者128例,根据是否发生CE分为CE组（n=31）和非CE组（n=97）。两组均行右心声学造影检查,检测两组血清cTnI、NT-proBNP水平,比较两组右心声学造影参数及血清cTnI、NT-proBNP水平。受试者工作特征（ROC）曲线分析右心声学造影联合血清cTnI、NT-proBNP对CE的预测价值。结果：右心声学造影显示CE组卵圆孔未闭阳性率、右向左分流分级（1级+2级+3级）构成比、卵圆孔长径均显著高于非CE组（P<0.05）。CE组卵圆孔未闭患者活动性房间隔构成比显著高于非CE组卵圆孔未闭患者（P<0.05）。CE组血清cTnI、NT-proBNP水平显著高于非CE组。ROC曲线分析结果显示,卵圆孔未闭、右向左分流分级1级+2级+3级、卵圆孔长径、活动性房间隔、cTnI、NT-proBNP对CE具有一定的预测价值,其中联合检验对CE的预测效能最高,曲线下面积（AUC）为0.867（0.812～0.928）。结论：右心声学造影联合血清cTnI、NT-proBNP检查可用于CE的预测。     

Preventive health care, 1999 update: 2. Echocardiography for the detection of a cardiac source of embolus in patients with stroke

OBJECTIVE: To develop guidelines for the use of echocardiography in the investigation of patients with stroke. OPTIONS: (1) Routine transthoracic echocardiography (TTE); (2) routine transesophageal echocardiography (TEE); (3) routine TTE followed by TEE if the TTE findings are noncontributory; (4) selective TTE or TEE in patients with cardiac disease who would not otherwise receive anticoagulant therapy. OUTCOMES: This article reviews the available evidence on the yield of TTE and TEE in detecting cardiac sources of cerebral emboli in patients with stroke, the effectiveness of treatment for cardiac sources of emboli and the effectiveness of screening echocardiography for secondary stroke prevention. EVIDENCE: MEDLINE was searched for relevant articles published from January 1966 to April 1998; also reviewed were additional articles identified from the bibliographies and citations obtained from experts. BENEFITS, HARMS AND COSTS: Echocardiography can detect intracardiac masses (thrombus, vegetation or tumour) in about 4% (with TTE) to 11% (with TEE) of stroke patients. The yield is lower among patients without clinical evidence of cardiac disease by history, physical examination, electrocardiography or chest radiography (less than 2%) than among patients with clinical evidence of cardiac disease (less than 19%). The risks of echocardiography to patients are small. TTE has virtually no risks, and TEE is associated with cardiac, pulmonary and bleeding complications in 0.18%. Patients with an identified intracardiac thrombus are at increased risk for embolic events (absolute risk uncertain, range 0%-38%), and this appears to be reduced with anticoagulant therapy (absolute risk reduction uncertain). Anticoagulant therapy carries a risk of major hemorrhage of 1% to 3% per year. The overall effectiveness of echocardiography in the prevention of recurrent stroke is unknown. VALUES: The strength of evidence was evaluated using the methods of the Canadian Task Force on Preventive Health Care. RECOMMENDATIONS: There is fair evidence to recommend echocardiography in patients with stroke and clinical evidence of cardiac disease by history, physical examination, electrocardiography or chest radiography (grade B recommendation). There is insufficient evidence to recommend for or against TEE in patients with normal results of TTE (grade C recommendation). There is insufficient evidence to recommend for or against routine echocardiography in patients (including young patients) without clinical cardiac disease (grade C recommendation). Routine echocardiography is not recommended for patients with clinical cardiac disease who have independent indications for or contraindications to anticoagulant therapy (grade D recommendation). There is fair evidence to recommend anticoagulant therapy in patients with stroke and intracardiac thrombus (grade B recommendation). There is insufficient (no) evidence to recommend for or against any specific therapy for patent foramen ovale (grade C recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care.     

Percutaneous closure of a patent foramen ovale after cryptogenic stroke

A patent foramen ovale is a common intracardiac finding that is located between the left and right atrium. It can cause right-to-left shunting and has a high prevalence in patients who suffer a cryptogenic stroke. Earlier trials did not show superiority of percutaneous patent foramen ovale closure with standard medical therapy over standard medical therapy alone in the treatment of cryptogenic stroke. Interestingly, several meta-analyses show positive results regarding closure, suggesting underpowering of the individual trials. Recently, two large prospective trials and one long-term follow-up study showed benefit of percutaneous closure over standard medical therapy in treatment of cryptogenic stroke. A larger right-to-left shunt or the presence of an atrial septal aneurysm were predictors for a recurrent event. Therefore, percutaneous patent foramen ovale closure after cryptogenic stroke should be recommended over antiplatelet therapy alone in patients younger than 55 years of age with a high-risk patent foramen ovale.     

Multimodality imaging of anomalous pulmonary veins

Partial anomalous pulmonary venous connection (PAPVC) is an extremely rare congenital condition where one or more of the pulmonary veins are connected to the venous circulation. Although initially suspected with unexplained right ventricular enlargement on transthoracic echocardiography (TTE), cardiac MRI is able to delineate the anatomical variant. We present a case of a 65-year-old male diagnosed with left sided PAPVC using multimodality cardiac imaging.     

Decrease in shunt volume in patients with cryptogenic stroke and patent foramen ovale

Background  

In patients with patent foramen ovale (PFO) there is evidence supporting the hypothesis of a change in right-to-left shunt (RLS) over time. Proven, this could have implications for the care of patients with PFO and a history of stroke. The following study addressed this hypothesis in a cohort of patients with stroke and PFO.     

Percutaneous treatment of patients with heart diseases: selection, guidance and follow-up. A review

Aortic stenosis and mitral regurgitation, patent foramen ovale, interatrial septal defect, atrial fibrillation and perivalvular leak, are now amenable to percutaneous treatment. These percutaneous procedures require the use of Transthoracic (TTE), Transesophageal (TEE) and/or Intracardiac echocardiography (ICE). This paper provides an overview of the different percutaneous interventions, trying to provide a systematic and comprehensive approach for selection, guidance and follow-up of patients undergoing these procedures, illustrating the key role of 2D echocardiography.     

Cohort study of multiple brain lesions in sport divers: role of a patent foramen ovale.

OBJECTIVE: To investigate the role of a patient foramen ovale in the pathogenesis of multiple brain lesions acquired by sport divers in the absence of reported decompression symptoms. DESIGN: Prospective double blind cohort study. SETTING: Diving clubs around Heidelberg and departments of neuroradiology and neurology. SUBJECTS: 87 sport divers with a minimum of 160 scuba dives (dives with self contained underwater breathing apparatus). MAIN OUTCOME MEASURES: Presence of multiple brain lesions visualised by cranial magnetic resonance imaging and presence and size of patent foramen ovale as documented by echocontrast transcranial Doppler ultrasonography. RESULTS: 25 subjects were found to have a right-to-left shunt, 13 with a patent foramen ovale of high haemodynamic relevance. A total of 41 brain lesions were detected in 11 divers. There were seven brain lesions in seven divers without a right-to-left shunt and 34 lesions in four divers with a right-to-left shunt. Multiple brain lesions occurred exclusively in three divers with a large patent foramen ovale (P = 0.004). CONCLUSIONS: Multiple brain lesions in sport divers were associated with presence of a large patent foramen ovale. This association suggests paradoxical gas embolism as the pathological mechanism. A patent foramen ovale of high haemodynamic relevance seems to be an important risk factor for developing multiple brain lesions in sport divers.     

经胸超声心动图引导下行房间隔缺损封堵术治疗先天性房间隔缺损的临床研究

目的:探讨经胸超声心动图引导下行房间隔缺损封堵术治疗先天性房间隔缺损(Atrial septal defect,ASD)的临床疗效。方法:比较先天性ASD患者行超声心动图组(49例)或介入组(53例),患者的疗效及心脏功能的变化。结果:超声心动图组并发症发生率显著低于介入组(P0.05);术后4周,两组患者的心率、舒张期室间隔厚度(Interventricular septal thickness,IVST)、左室后壁厚度(Left ventricular posterior wall thickness,LVPWT)、左心室心肌重量(Left ventricular mass,LVM)和左心室心肌重量指数(Left ventricular mass index,LVMI)明显降低(P0.05),左心室射血分数(Left ventricular ejection fraction,LVEF)和左心室高峰充盈率(Left ventricular peak filling rate,LVPFR)均显著升高(P0.05),其余指标则无明显变化(P0.05);但术后1周超声心动图组的LVEF、IVST和LVMI即显著高于术前(P0.05)。结论:胸超声心动图引导下行ASD封堵术与X线介入封堵术疗效相当,但前者可能对ASD患者的心脏功能的改善更为显著。     

Diagnostic Value of Transthoracic Echocardiography in Patients with Coarctation of Aorta: The Chinese Experience in 53 Patients Studied between 2008 and 2012 in One Major Medical Center

Although aortography is well known as the “gold standard” for the diagnosis of coarctation of aorta (CoA), the method is invasive, expensive and not readily accepted by some patients. Ultrasound diagnosis for CoA is non-invasive, inexpensive, readily accepted by every patient, and can be repeated as frequently as necessary. The purpose of this presentation is to evaluate the applicability of transthoracic echocardiography for the diagnosis of CoA. The echocardiographic appearances of 53 patients with CoA who had undergone surgery during a 5-year period from January 2008 to October 2012 were analyzed retrospectively, and the results were compared with findings at surgery. Fifty-three patients with CoA include six with isolated CoA and 47 of CoA associated with other cardiac anomalies. Of the 53 operated patients, 48 were correctly diagnosed preoperatively by echocardiography, while two were misdiagnosed as interrupted aortic arch and the diagnosis were missed in three other patients. Thus the diagnostic accuracy rate was 90.6%, and the misdiagnosis rate was 9.4%. Preoperative echocardiographic evaluation offers very satisfactory anatomic assessment in most patients with CoA. It makes preoperative angiography unnecessary. Thus transthoracic echocardiography should be the first-line method for the diagnosis of coarctation of the aorta.