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高頻彩色多普勒超聲診斷肌疝一例

Study on Evaluation of Hemodynamic Changes of Portal Veins in Patients with Liver Cirrhosis by Color Doppler

目的　分析彩色多普勒超聲對肝硬化患者門靜脈血流改變的評價作用。 方法　選擇2010年1月－2011年4月收治的50例肝硬化患者作為觀察組，其中代償期患者27例，失代償期患者23例；同時設置健康對照組50名，比較兩組的門靜脈內徑（Dpv）、門靜脈平均血流速度（Vpv）、門靜脈血流量（Qpv）。 結果　觀察組患者的Dpv增寬，Vpv減慢，Qpv減少，與對照組比較，差異均有統計學意義（P＜0.05）；且失代償期患者的改變更為明顯，與代償期患者間差異有統計學意義（P＜0.05）。 結論　彩色多普勒超聲檢查門靜脈血流改變可以對肝硬化患者進行初步確診。

視網膜母細胞瘤的彩色多普勒超聲診斷分析

膝、腕關節滑膜超聲在類風濕關節炎中的臨床價值比較

摘要:目的:探討類風濕性關節炎(RA)病人膝、腕關節滑膜關節滑膜的超聲檢查指標與RA臨床指標的相關性。方法:通過高頻超聲及彩色多普勒超聲對RA病人(50 例)的膝、腕關節的滑膜情況(包括滑膜厚度、關節積液程度、滑膜彩色血流分級)進行觀察,并獲取RA患者疾病活動度(DAS28)分值、炎癥指標C反應蛋白(CRP)、紅細胞沉降率(ESR)、標記性抗體抗瓜氨酸抗體(CCP)和類風濕因子(RF)滴度水平并對上述指標做相關分析。結果:①RA病人膝關節滑膜厚度、關節積液程度、滑膜血流信號分級等級與患者DAS28(r=0.35、r=0.38、rs =0.54,Plt;0.05)、CRP(r=0.41、r=0.45、rs =0.57,Plt;0.05)、ESR(r=0.38、r=0.42、rs=0.51,Plt;0.05)均呈正相關;腕關節滑膜厚度、滑膜血流等級信號與患者DAS28(r=0.55、rs=0.69,Plt;0.05)、CRP(r=0.53、rs =0.67,Plt;0.05)、ESR(r=0.48、rs=061,Plt;0.05)均呈正相關,且相關系數高于膝關節組;②膝關節組滑膜厚度與關節積液程度、滑膜血流分級等級均呈正相關(Plt;0.05),關節積液程度與滑膜血流分級呈正相關(Plt;0.05);腕關節組滑膜厚度與滑膜血流分級等級均呈正相關(Plt;0.05);③膝、腕關節之間僅滑膜血流信號等級成等級正相關(Plt;0.05)。結論:膝、腕關節滑膜超聲能較好地觀察類風濕性關節炎病人滑膜的病變,其指標能作為一種客觀有效的評價療效、判斷疾病活躍性及評估預后的指標,尤其應該以腕關節作為RA病人的優選關節。

Relationship Between The Changes of Hepatic Blood Flow Detected by Using Spectral Doppler Ultrasound and Serum TNF-α and IL-1 β Levels after Liver Ischemia/Reperfusion of Rat

Objective　To discuss the relationship between the changes of hepatic blood flow detected by usingspectral Doppler ultrasound and serum TNF- α and IL-1 β levels after liver ischemia/reperfusion （I/R） of rat. Methods　The hepatic ischemia 15 min and reperfusion models were established by using pringle method. The hepatic blood flow of hepatic artery and portal vein at 1， 6， and 24 hours after liver I/R were detected by using spectral Doppler ultrasound， the total blood flow volume （FV） was calculated， and the serum TNF- α and IL-1 β levels at each time point were detected. The correlation between the TNF-α， IL-1 β， and FV were analyzed. Results　The FV at 1 hour and 6 hours after reperfusion in I/R group were less than those in sham operation （SO） group 〔（52.08±11.88） mL/min vs. （85.32±29.85） mL/min and （44.69±8.75）mL/min vs. （81.41±28.67） mL/min， P＜0.05〕. The FV at 24 hours after operation or reperfusion of 2 groups was no significant differences （P＞0.05）. The serum content of TNF-α at 1 hour after reperfusion in I/R group was higher than that in SO group 〔（310.52±39.83）pg/mL vs. （240.74±31.65）pg/mL， P＜0.05〕. The serum contents of TNF-α at 6 and 24 hours after operation or reperfusion of 2 groups were no significant differences （P＞0.05）. The serum contents of IL-1β at 1 hour and 6 hours in I/R group were higher than those in SO group 〔（38.08±3.73） pg/mLvs. （22.03±0.79） pg/mL and （27.44±6.11） pg/mL vs. （21.78±0.71） pg/mL， P＜0.05〕. The serum content of IL-1β at 24 hours after operation or reperfusion of 2 groups was no significant differences （P＞0.05）. There was a negative correlation between the FV and TNF-α or IL-1β （r=-0.43， P＜0.05；r=-0.46， P＜0.05）. Conclusions　Spectral Doppler ultrasound can observe the changes of hepatic blood flow and evaluate the hepatic microcirculation indirectly. The hepatic blood flow after liver I/R decreases and it may be related to over expression of TNF-α and IL-1β.

Ultrasonographic features of gastrointestinal stromal tumors

Objective To analyze features of color Doppler ultrasonography in gastrointestinal stromal tumors. Method The ultrasound images of gastrointestinal stromal tumors (51 cases) and gastrointestinal cancers (59 cases) confirmed by operation and pathology were compared and analyzed. Results The gastric stromal tumor mainly occurred at the bottom of the stomach and the body of the stomach (17 cases), the intestinal stromal tumor mainly occurred at the small intestine (24 cases). The gastric cancer mainly occurred at the gastric antrum (18 cases), the intestinal cancer all occurred at the colon (20 cases) and rectum (12 cases). Compared with the gastrointestinal cancers, the gastrointestinal cavity was not surrounded by tumor, the peripheral boundary was clear, the morphology was more regular, the internal echo was uneven, and there was no peripheral lymph node metastasis in the gastrointestinal stromal tumors, the differences were statistically significant (P<0.05). There were no significant differences in the degree of blood flow and tumor diameter between the gastrointestinal stromal tumors and the gastrointestinal cancers (P>0.05), but the blood flow of the intestinal stromal tumor was significantly more abundant as compared with the intestinal cancer (P<0.05). Conclusion Color Doppler ultrasonography, as a simple and rapid method, has a certain diagnostic value for differentiation of gastrointestinal stromal tumors and gastrointestinal cancers.

Application of Transcranial Doppler Monitoring in Aortic Dissection Surgical Procedure

Objective To evaluate the applicability of Transcranial Doppler (TCD) monitoring in brain protection in the process of aortic dissection surgical procedure. Methods From Feburary 2007 to November 2007, six patients with type I aortic dissection underwent surgical procedure in Xuanwu Hospital of Capital Medical University. All patients are male with their age ranged from 48 to 60 years. During the operation, right subclavian arterial cannulation technique was used to protect the brain, and TCD monitoring was adopted to guide cerebral perfusion. The function of nervous system after operation was observed, and the minimental state examination (MMSE) was used to assess the cognitive function of the patients. A twoyear followup was done to monitor patients’ aorta condition. Results The time of cardiopulmonary bypass (CPB) was 136 to 350 minutes. The time of selected cerebral perfusion was 20 to 65 minutes. The lowest cerebral blood flow was 31% of basic level according to TCD monitoring. All patients were successfully treated without neurological complication and cognitive dysfunction when discharged from hospital. MMSE score was 28 to 30 points. During the twoyear followup after operation, all aortic false lumen were closed and there was no dissection recurrence. Conclusion Monitoring blood change with TCD monitoring technique is safe and effective in evaluating brain protection by selective cerebral perfusion in aortic dissection surgical procedure.

高尿酸血癥與頸總動脈血管損害相關性的彩色多普勒超聲研究

目的 應用二維超聲及 M 型超聲探討高尿酸血癥與頸總動脈血管損害的相關性。 方法 選擇 2011 年 1 月—2015 年 12 月無高血壓、高血糖、高血脂及吸煙史患者 121 例，其中高尿酸血癥患者 59 例，觀察頸總動脈 118 根（高尿酸血癥組）；無高尿酸血癥患者 62 例，觀察頸總動脈 124 根（正常組）。應用二維超聲分別觀察頸總動脈斑塊數量、測量兩組患者頸總動脈內中膜厚度，應用二維引導的M型超聲測量頸總動脈前壁搏動幅度（搏幅）和前壁搏幅達峰時間、前壁搏幅斜率。 結果 高尿酸血癥組觀察頸總動脈 118 根，共發現頸總動脈粥樣斑塊 83 個（70.3%）；正常組觀察頸總動脈 124 根，共發現頸總動脈粥樣斑塊 31 個（25.0%）；兩組粥樣斑塊數與頸總動脈總數之比差異有統計學意義（P<0.05）。高尿酸血癥組與正常組頸總動脈內中膜厚度分別為（0.93±0.17）、（0.56±0.30）mm，前壁搏幅分別為（0.43±0.19）、（0.73±0.27）mm，前壁搏幅達峰時間分別為（64.5±13.3）、（64.5±14.8）ms，前壁搏幅斜率分別為（1.21±0.33）、（1.36±0.19）mm/s，兩組頸總動脈內中膜厚度、血管前壁搏幅及血管前壁搏幅斜率差異有統計學意義（P<0.05），血管前壁搏幅達峰時間差異無統計學意義（P>0.05）。 結論 高尿酸血癥與頸總動脈血管內皮損害及動脈粥樣硬化有直接的相關性。

急性視網膜壞死綜合征的形態和血液動力學觀察

Application of color doppler flow imaging in the diagnosis of ocular toxocariasis in children

Objective To summarize the characteristics of color doppler flow imaging (CDFI) of ocular toxocariasis (OT) in children. MethodsA retrospective clinical study. From July 2014 to June 2020, 61 OT patients with 61 eyes diagnosed through clinical and laboratory testing in the Department of Ophthalmology of Beijing Tongren Hospital of Capital Medical University were included in the study. There were 45 males with 45 eyes and 16 females with 16 eye (male: female=2.81:1). Age were (6.93±2.50) years. The right eye and left eye were 29 and 32 eyes, respectively. Both eyes of the patient underwent two-dimensional ultrasound and CDFI examination. Two dimensional ultrasound was used to estimate the axial length (AL) of the affected eyes and healthy eyes on the opposite side. Among them, 52 cases were measured for AL using optical biometry and/or A-mode ultrasound. Vitreoretinal surgery was performed within one week after ultrasound examination. Two-dimensional ultrasound was used to observe the morphology of vitreous opacity, its connection to the eyeball wall, and whether posterior vitreous detachment and retinal detachment have occurred. CDFI examination was used to observe the presence of blood flow signals on the pathological membrane. The detection rates of different forms of vitreous opacity and traction retinal detachment were calculated. The location of proliferative lesions in the eye was analyzed. Paired t-test was performed to compare the AL of the affected eye and the healthy eye on the opposite side. Perform Kappa consistency test on the location of proliferative lesions was used during CDFI examination and vitreoretinal surgery. ResultsAll affected eyes have varying degrees of vitreous opacity. Among them, 23 eyes (37.7%, 23/61) showed typical "Christmas tree" like turbidity; 27 eyes (44.3%, 27/61) had clustered and striped echoes; 9 eyes (14.8%, 9/61) had weak punctate and strip echoes. Two eyes (3.3%, 2/61) showed a large amount of dense punctate and strip-shaped echoes. There were 50 eyes (82.0%, 50/61) with traction retinal detachment, of which 46 eyes (92.0%, 46/50) had visible blood flow signals on the detached retina, and the remaining 4 eyes (8.0%, 4/50) had no blood flow signals. During CDFI and surgery, there were 5 (8.2%, 5/61) and 4 (6.6%, 4/61) eyes with visible proliferative lesions in the periphery, respectively; 18 (29.5%, 18/61) and 14 (23.0%, 14/61) eyes were distributed in the posterior pole, respectively; there were 38 (62.3%, 38/61) and 43 (70.5%, 43/61) eyes with both peripheral and posterior polar regions, respectively. The consistency between CDFI and surgery in detecting the location of proliferative lesions was good (κ=0.832, 95% confidence interval 0.691-0.973, P＜0.001). The two-dimensional ultrasound measurement results showed that the AL of the affected eye was shorter than that of the contralateral healthy eye in 46 cases (75.4%, 46/61). Among the 52 patients who underwent AL biometry, the AL of the affected eye was shorter than that of the contralateral healthy eye by (0.63±0.68) mm, and the difference was statistically significant (t=－6.738, P＜0.05). ConclusionsCDFI can clearly display various intraocular lesions (vitreous opacity and traction retinal detachment) and eyeball sizes in children with OT. Vitreous opacity is often manifested as "Christmas tree" like, clustered, strip-shaped.