SonoVue心肌声学造影结合冠状动脉造影早期诊断冠心病的临床研究

目的采用外周静脉注射声学造影剂声诺维,观察心肌灌注及心内膜缘显像,并且与患者的冠状动脉造影结果进行对比研究,评价声诺维对冠心病的早期诊断价值。方法分别在基础和非线性成像条件下,对28例患者经静脉注射声诺维2 ml,并与冠状动脉造影检查结果作对比分析。结果注射造影剂之前心内膜显示欠清的左室心内膜缘得到满意的显影;声诺维能很好显示心肌灌注情况。结论声诺维可以增强心内膜缘的显影,能显示心肌灌注,有助于冠心病的早期诊断。     

全氟显声学显像效果的研究

目的：以Optison和5％声振人血白蛋白注射液为对照，评价新一代超声造影剂全氟显的声学显像效果。方法：全氟显设置低、中、高三个剂量组，Optison剂量设置与前者相同，5％声振人血白蛋白注射液仅设高剂量组。观察造影剂注射前后左室显影等级及内膜边界改善的效果，同时评价其对实验犬心,率、血压的影响。结果：全氟显左室显影等级强度、内膜边界增强节段数均高于5％声振人血白蛋白注射液，但与同剂量Optison组间无差异。三种造影剂对实验犬心率、血压未见明显影响。结论：全氟显经静脉注射后可实现左室腔显影增强，提高内膜边界识别。 该造影剂与Optison性能相似，优于5％声振人血白蛋白注射液。     

司诺维实时声学造影评价心内膜缘和心肌灌注的临床研究

目的：评价第二代声学造影剂司诺维(Sonovue)临床使用的安全性、可行性和实用性。方法：研究对象为30例透声较差、心内膜显示不清的患者，采用Philips Sonos 5500和S3探头，探头频率为1～3MHz，每例患者均先后接受两次静脉注射司诺维2ml进行实时声学造影，分别评价心内膜缘和心肌灌注显像。结果：1，绝大部分患者使用司诺维后无毒副作用；2．司诺维改善了98％的心内膜显示不清节段的图像；3．正常冠脉供应节段的造影记分明显高于狭窄冠脉供应的节段；4．狭窄冠脉供应的部分节段即使造影评分正常，但再灌注时间较正常冠脉明显延长。结论：司诺维的临床使用安全可行，能够明显地改善心内膜边缘显像，实时正确地评价心肌灌注。     

新型多聚体超声造影剂的初步实验研究

目的观察自制新型多聚体超声造影剂的基本特性及其对实验犬左心室及心肌增强显像的效果。方法扫描电镜观察微泡大小形态及粒径分布，Coulter计数仪测定微泡浓度，4只杂种犬其中2只制成前壁心肌梗死模型，经股静脉0．5ml团注新型多聚体超声造影剂观察犬左室及心肌显影效果，同时监测心率技呼吸频率。结果该新型多聚体造影剂为含空气的冻干粉剂，平均粒径1．5μm，100％的微泡粒径小于8μm，通过周围静脉注射使左心室腔产生明显的增强显像，其中左心室2 以上程度的显影占总注射次数的92％，肺转运时间为2～3个心动周期。左心室显影峰值出现在左心室显影后3～5个心动周期，持续高强度显影15s以上，触发成像模式可屺心肌显像同时能检测梗死区心肌。造影过程中未见明显的心率、呼吸及心电图改变。结论新型多聚体超声造影剂可以获得良好的左心室及心肌增强显像，对实验犬的心率、呼吸无明显影响。     

靶向声学造影剂的研究进展

关于声学造影剂的研究 ,196 8年Gramiak和Shah[1] 首次报道了注射盐水后用M型超声使主动脉根部结构显影增强 ,之后 ,开始研制出各种能增强灰阶信号和多普勒信号的造影剂应用于心脏及非心脏领域。第一代声学造影剂只能在右心系统显影。第二代造影剂经静脉注射后可通过肺循环达左心 ,使左心腔显影。第三代造影剂使用低弥散度、高分子量的气体成分 ,提高了在循环中的稳定性 ,可通过冠脉循环达到心肌显影的目的。而与微泡造影剂相关的各种新型超声显像技术也得到发展 ,如 :二次谐波显像、间歇式超声显像、多普勒组织成像等 ,提高了图像质量和…     

八氟丙烷人血白蛋白微球注射液改善左心室内膜显影的多中心临床研究

目的多中心Ⅱ期临床研究评价第二代声学造影剂八氟丙烷人血白蛋白微球注射液（HAM—ISOF）临床使用的安全性和可行性。方法研究对象为302例透声较差、心内膜显示不清的患者，每例患者静脉注射该造影剂0．01ml／kg进行实时声学造影，评价心内膜缘显影改善情况。结果（1）绝大部分患者使用HAM—ISOF后无毒副作用，不良反应率仅0．3％；（2）HAM—ISOF造影能明显地改善98．6％的心内膜显示不清节段的图像。结论HAM—ISOF的临床使用安全可行，能够明显地改善心内膜边缘显像。     

聚乳酸-羟基乙酸超声造影剂增强兔淋巴结显像的初步实验研究

目的 研究自制聚乳酸-羟基乙酸（poly lacticoglycolic acid，PLGA）超声造影剂增强兔肿瘤淋巴结显像的效果及其相关机制。方法采用乳液-溶剂蒸发法制备PLGA超声造影剂；经免大腿皮下注射VX2肿瘤细胞制备肿瘤淋巴结模型，肿瘤细胞生长14～18d后用于超声显像。通过问歇谐波显像观察PLGA造影剂对胭窝肿瘤淋巴结的增强作用，并通过巨噬细胞试验初步探讨增强淋巴结超声显像的相关机制。结果PLGA超声造影剂粒径分布均匀；可以明显增强肿瘤淋巴结显像；细胞试验表明巨噬细胞可以大量吞噬PLGA超声造影剂。结论PLGA超声造影剂是一种良好的肿瘤淋巴结显影剂。淋巴结内巨噬细胞吞噬造影剂后导致造影剂在淋巴结内滞留与聚集可能是其能够明显增强淋巴结显影的机制之一。     

自制脂膜氟碳声学造影剂长时间增强组织灰阶显像的机理初探

目的：通过对比观察自制脂膜氟碳声学造影剂“脂氟显”对正常兔肝，肾灰阶显像的增强效果，探讨其增强机理。方法：10只健康家兔经耳缘静脉团注0.01ml/k的脂氟显，采用视觉评分，动态观察肝，肾的二维灰阶增强效果。结果：脂氟显对肝实质，肾皮质的灰阶显像均有长时间增强效果，明显增强时间超过50分钟。结论：脂氟显能长时间增强组织的灰阶显像，其机理主要与造影剂在毛细血管的潴留有关。     

兔肝脏VX2肿瘤声学造影的对比研究——间断二次谐波显像与基波显像技术

目的:评价间断二次谐波显像对兔肝脏VX2肿瘤声学造影的增强效果及动态变化规律,并与基波显像进行对比分析。方法:13只患有VX2肿瘤的新西兰白兔经耳缘静脉注入氟碳声学造影剂,采用间断二次谐波显像及基波显像观察肿瘤造影效果。结果:间断二次谐波显像肿瘤均为3级显影;基波显像为11次1级,2次2级显影。间断二次谐波显像及基波显像产生的造影增强视频密度差值分别为118.38±18.41和40.02±10.18(P﹤0.001)。结论:间断二次谐波显像可以显著提高等回声小肝癌的诊断敏感性。     

自制高分子材料超声造影剂及初步实验研究

目的自制一种新型的高分子材料超声微泡造影剂,并观察其对新西兰大白兔的肾能量多普勒显像效果.方法采用水/油/水(water/oil/water,w/o/w)乳液-溶剂蒸发、冷冻干燥法制备聚乳酸/羟基乙酸(poly lacticcoglycolic acid,PLGA)超声微泡造影剂,用扫描电镜观察微泡大小、形态,用血细胞计数仪测定微泡浓度.用生理盐水稀释粉末样PLGA超声微泡造影剂至浓度为108/ml左右,然后按0.2 ml/kg的剂量经兔耳缘静脉注射至兔体内,用能量多普勒观察其对兔肾显影的增强效果,同时监测兔基本生命体征变化.结果 PLGA超声微泡造影剂均一度高,平均粒径3 μm左右,最大直径6 μm.与造影前相比,PLGA超声微泡造影剂能够明显增强兔肾能量多普勒显影效果,并且显像时间长.显像过程中未见兔基本生命体征有明显的变化.结论 PLGA超声微泡造影剂能够明显增强兔肾能量多普勒显影效果,显像时间长,尚未发现明显的副作用,是一类具有广泛应用前景的新型超声造影剂.     

左室声学造影评价老年人左室收缩功能的临床研究

目的探讨声学造影评价老年人左室收缩功能的价值及安全性。方法观察76例至少有2个节段心内膜显示不清的60岁以上患者,经静脉注射声诺维声学造影剂后,分析左室内膜边界显影改善效果,采用双平面Simpson法测量造影剂应用前、后的左室射血分数。结果声学造影前后的心内膜边界显影评分分别为(14.06±1.58)分、(21.38±1.66)分,差异有统计学意义(P0.001);造影前后的左室射血分数分别为(52.66±5.75)%、(64.37±4.58)%,差异有统计学意义(P=0.000),且所有患者均未出现头晕、心悸、胸痛等不适。结论声学造影用于评价60岁以上人群左室收缩功能安全且有效。     

Improvement of endocardial border delineation in suboptimal stressechocardiograms using the new left heart contrast agent SH U 508 A

Recent studies have shown that the saccharide based echocardiographic contrast agent SH U 508 A opacifies the left ventricle after i.v. injection, thus possibly improving endocardial border definition. This study was performed to determine whether SH U 508 A can enhance the wall motion analysis in suboptimal echocardiographic images at rest and following pharmacological stress. Ten male patients (mean 58 years) exhibiting ≥30% endocardial border dropout were examined prior to a diagnostic left heart catheterization. Five patients were stressed with Dobutamine, 5 with Dipyridamole. The wall motion was assessed visually (qualitatively) as well as computer-aided (quantitatively). The concordance between left ventricular angiography as ‘gold standard’ and resting echocardiography regarding the wall motion analysis was significantly improved from 64.5% to 90.3% following the injection of SH U 508 A (p < 0.05). A delineation score (0 = not delineated, 1 = delineated) of 12 individual wall segments was used. The mean delineation score at baseline was 6.1 ±1.4 at rest and 6.6 ±1.9 during stress. SH U 508 A significantly (p < 0.01) increased the score to 9.6 ±1.9 and 10.3 ±1.7, respectively. The intraobserver variability for assessing the delineation score was significantly (p < 0.04) improved by SH U 508 A. SH U 508 A, however, did not improve the quantitative assessment of the left ventricular function. Only 40% of the patients could be analyzed following SH U 508 A injection. No severe adverse reactions were seen. SH U 508 A led to a significant, clinically important, improvement in the interpretation of stress echocardiograms in patients with inconclusive routine echocardiograms.     

国产八氟丙烷微泡造影剂左心室超声显像效果研究

目的评价八氟丙烷微泡超声造影剂(C3F8)的左心室超声显像效果。方法7头实验猪分别接受低剂量(0．002ml／kg)和高剂量(0．02ml／kg)C3F8静脉注射，观察造影剂注射前后左心室显影等级、左室内膜边界改善效果和Simpson法左室射血分数测定，同时评价其对实验猪的心率、呼吸的影响。结果C3F8注射后左室显影等级强度和内膜边界增强节段数均显著改善，部分心肌也可以显影；对心率和呼吸未见明显影响。结论经静脉注射C3F8可使得左心室显影明显增强，显著改善左心室内膜边界显示，安全性好。     

Is there a role for intravenous transpulmonary contrast imaging in pediatric stress echocardiography?

OBJECTIVE: Intravenous transpulmonary contrast echocardiography plays a significant role in the enhancement of endocardial border delineation during stress echocardiography in the adult population. The current study was conducted to evaluate the feasibility of intravenous transpulmonary contrast in pediatric patients and to compare the quality of endocardial visualization by harmonic 2-dimensional (2D) imaging alone with harmonic 2D echocardiography with contrast imaging. METHODS: Twenty-two children, age 9.3 +/- 3.9 underwent dobutamine (19 patients) or exercise (3 patients) stress echocardiography. None had intracardiac shunting. Each patient underwent both harmonic 2D imaging alone and harmonic 2D imaging with contrast administration at peak stress. Oxygen saturation, heart rate, and blood pressure were monitored. Endocardial delineation was evaluated by qualitative grading of 22 endomyocardial regional segments in each patient. Contrast images were graded by an echocardiographer who was blinded to the scores previously assigned to harmonic 2D echocardiography images. RESULTS: There were no changes in saturation, heart rate, or blood pressure during or after contrast administration. Use of contrast significantly improved endocardial visualization in 11 of 22 segments (P <.05), particularly lateral, apical, and anterior left ventricular wall segments. CONCLUSION: Intravenous intrapulmonary administration is feasible and has no obvious adverse effects in a small pediatric patient group. Contrast echocardiography improves endocardial border delineation over harmonic imaging in pediatric stress echocardiography.     

自制脂质微泡造影剂显影效果的研究

目的:以白蛋白微泡作对照,比较自制脂质微泡的心脏显影效果。方法:以胆固醇、卵磷脂为原料声振制备脂质微泡。以东冠注射液和全氟显作比较,评价自制脂质微泡左室及心肌的显影效果。经股静脉弹丸注射不同剂量的3种造影剂,剂量设置为:极高(0.225ml/kg)、高(0.15ml/kg)、中(0.1ml/kg)、低(0.05ml/kg)、极低(0.025ml/kg),全氟显只设极低剂量组。比较造影前后左室腔显影等级、显影时间、左室内膜边界增强节段数及心肌显影情况。结果:脂质微泡在极低剂量组和低剂量组右室显影好,但左室显影较淡;中等剂量组的显影效果与全氟显极低剂量组及东冠注射液极高剂量组相似,但显影时间仍较全氟显短。脂质微泡心肌显影只在极高剂量组较明显。结论:以胆固醇、卵磷脂为主要成分的脂质壳含气微球能实现左室及心肌显影,有望开发出新一代的心肌声学造影剂。自制脂质微泡显影效果优于东冠注射液,但逊色于全氟显。     

利声显在多普勒超声心动图中的作用评价

为评价外周静脉注射造影剂利声显（Ｌｅｖｏｖｉｓｔ）对超声心动图多普勒信号的增强作用，对包括二尖瓣返流、主动脉瓣返流和房间隔缺损等３０例受试者进行研究。结果示：造影剂在右心腔显影后立即在左心腔显影；注射利声显后所有受试者的连续多普勒频谱信号评分增加，频谱示返流及分流的速度峰值及积分都增加；彩色多普勒示返流及分流束的面积和周长均增加。结论认为利声显是一种跨肺循环的造影剂，能增强二尖瓣返流、主动脉瓣返流及左向右分流的多普勒信号强度，安全性好     

Effect of practolol on blood flow distribution in the myocardium during acute regional ischaemia in cats

The β-adrenergic blocking agent practolol was given to 11 cats with acute coronary artery ligation, and regional myocardial tissue blood flow was measured by the distribution of 15 μm labelled microspheres. Practolol reduced heart rate and cardiac contractility, but left ventricular end-diastolic pressure rose in eight animals. In three animals, however, the haemodynamics were essentially unchanged and these are referred to as non-responders. No changes in regional myocardial blood flow were observed after practolol administration, either in ischaemic, border or normal areas of the left ventricle. This indicates less serious imbalance between oxygen demand and delivery in ischaemic tissue. There was no endocardial/epicardial redistribution of tissue flow. Practolol did not appear to improve coronary perfusion, and beneficial clinical effects of practolol are therefore probably related to reduction of myocardial oxygen demands.