彩色多普勒在异位妊娠诊断中的临床运用

目的探讨彩色多普勒（CDFI）在诊断异位妊娠中的临床应用及诊断价值。方法对手术及病理已证实的40例异住妊娠患者附件区包块二维图像、血流分布及频谱特征进行分析。结果40例异位妊娠患者中，除2例为典型的（囊内可探及胚芽及胚心）外，其它38例均为非典型宫外孕，此40例中18例在附件包块内探及彩色血流信号，7例在附件包块周边探及血流信号，13例在包块的内部及周边均可记录到血流信号。2例未探及彩流。脉冲多普勒（Pw）频谱特征呈单相或双相，频谱增宽的高速低阻血流频谱，收缩期峰值流速15—38cm／s，平均流速（3．8±0．15）cm／s；舒张末期峰值流速7～24cm／s，平均流速（0．22±0．07）cm／s；阻力指数（RI）平均为（0．33±0．08）。结论临床拟诊异位妊娠时，CDFI在盆腔附件包块探及到的高速低阻的血流频谱对非典型宫外孕的诊断具有特异性。     

超声在乳腺实性肿块诊断中作用的探讨

目的探讨超声在乳腺实性肿块诊断中的临床价值。方法回顾分析经手术病理证实的208例乳腺实性肿块高频二维图像及彩色多普勒血流特征，并与病理进行对照。结果208例乳腺实性肿块中，乳腺癌74例，超声诊断符合率为93．2％（69／74）；乳腺纤维腺瘤78例，超声诊断符合率为94．8％（74／78）；乳腺增生结节56例，超声诊断符合率为91％（51／56）。结论肿块的形态、纵横比、钙化分布、供血状态、阻力指数、肿块超声测值与扪及测值之比及腋下异常淋巴结对乳腺实性肿块的鉴别诊断具有重要意义。     

彩色多普勒超声对宫外孕的诊断价值

目的探讨彩色多普勒超声对宫外孕的诊断价值，并提高超声对其诊断符合率。方法回顾性分析其手术及病理证实的185例宫外孕的彩色多普勒超声图像特征，并对误诊病例进行分析。结果185例宫外孕中，超声诊断符合率94．05％。结论彩色多普勒超声对宫外孕的判断具有重要的临床价值。     

宫外孕与妊娠黄体的经阴道彩色多普勒血流显像及频谱形态分析

目的 探讨宫外孕与妊娠黄体的经阴道彩色多普勒血流显像及频谱形态特征,以提高超声对宫外孕的诊断符合率.方法 对126例宫外孕及132例宫内或宫外孕伴黄体囊肿进行经阴道彩色多普勒超声检测,检测结果与其临床病理进行对照分析.结果 (1)宫外孕血流常显示为宫外孕病变处某局部富血流信号,血流均不来源于卵巢,而妊娠黄体血流则常显示黄体周边环状血流信号,血流均来源于卵巢内;(2)宫外孕的多普勒血流频谱可表现为多种形态:包括极低阻力型血流频谱、低阻力型血流频谱、高阻力型频谱、无舒张期血流频谱及舒张期反向血流频谱;而妊娠黄体则常表现为低阻力型及高阻力型血流频谱.结论 经阴道彩色多普勒血流显像及频谱形态特征能为宫外孕与妊娠黄体的鉴别诊断提供有价值的信息.     

经阴道彩色超声与经腹部黑白超声检测子宫肌瘤及腺肌症对照分析

本文介绍了经阴道彩色超声多普勒显像探查子宫肌瘤８４例，经腹部黑白超声探查子宫肌瘤９６例，均经手术病理检查证实。结果表明，经阴道彩色超声诊断与病理诊断在检测子宫肌瘤方面的符合率为９７．６％；在检测子宫肌瘤合并子宫内膜异位症方面的符合率为９２．５％。经腹部黑白超声诊断与病理诊断在检测子宫肌瘤的符合率为８４．３％；在检测子宫肌瘤合并子宫内膜异位症的符合率为５７．１％。本文同时研究讨论了子宫肌瘤的血液动力学变化。肌瘤按照彩色血流显像可初步分为四种类型：①彩色无血流显示；②彩色血流显示较丰富（星状分布）；③彩色血流显示丰富（网状分布）；④彩色血流显示极为丰富（彩球状）。     

彩色多普勒超声在乳腺小肿块良恶性鉴别诊断中的应用价值

目的 探讨乳腺小肿块（直径〈2cm）的超声表现特征及彩色多普勒超声对其良恶性的鉴别诊断价值。方法 64例乳腺小肿块经手术病理证实,其中恶性肿块27例,良性肿块37例。分析乳腺小肿块患者的彩色多普勒超声表现特征,应用彩色多普勒血流显像（CDFI）观察其血流分布特征,频谱多普勒检测血流参数阻力指数（RI）的大小。结果 乳腺小肿块良性组和恶性组的形态、边界包膜、纵横比及内部有无微小钙化比较,差异有统计学意义（P〈0．05）。恶性肿块血流分级≥Ⅱ级,RI〉0．7,血流频谱表现为峰值前移,舒张末期无血流信号或可见反向血流;良性肿块血流分级多为0-I级,RI〈0．7,血流频谱表现为以静脉血流频谱为主。9例恶性肿块伴有同侧腋窝淋巴结肿大,2例良性肿块为反应增生肿大。结论 彩色多普勒超声对乳腺小肿块良恶性的鉴别诊断具有重要价值,结合声像图特征和CDFI表现能有效诊断。     

超声诊断乳腺癌

目的探讨二维超声及彩色多普勒超声在检查乳腺癌中的表现和特征，评价其在诊断乳腺癌中的应用价值。方法回顾性分析135例经手术及病理证实为乳腺癌患者的超声表现：包括二维声像图特征及彩色多普勒表现：肿块内部及周围的血供情况，血流峰值速度和阻力指数等血流动力学参数。结果135例乳腺癌中，乳腺浸润性导管癌128例，筛状癌3例，髓样癌1例，小叶癌原位癌2例和纤维腺瘤伴肉瘤变l例。超声所见：135例中超声发现肿块129例，大小为0．2em～3．4era不等，肿块纵横径比大于1占69％（89／129），肿块边界不整齐，约占70％（90／129），2例肿块不明显但局部可见沙粒样钙化点及局部血流信号异常。沙粒样钙化点占52．6％（70／129）；彩色多普勒发现血流信号占79．8％（103／129），频谱多普勒示血流峰值速度（PSV）为18-49ends，阻力指数（RI）为0．67～0．96，RI〉0．7占93．2％（96／103）。超声漏诊4例。结论当彩色多普勒超声在乳腺肿块内部或周围，或异常回声区内探及丰富血流信号，流速曲线显示为高速高阻时，要高度怀疑乳腺癌，彩色多普勒超声在乳腺良恶性肿瘤的诊断与鉴别诊断中发挥重要的作用。     

彩色多普勒超声诊断甲状腺疾病的临床价值分析

目的通过病理对照分析，评价二维及彩色多普勒超声对甲状腺疾病的诊断价值。方：法回顾性分析2002～2006年收治的甲状腺疾病患者398例，采用二维及彩色多普勒超声进行检测，全部进行术后病理诊断对照。结果本组中甲状腺疾病的诊断符合率为90．7％（361／398），其中良性病变符合率为91．6％（327／357），恶性病变符合率为83．0％（34／41）。结论应用二维声像图特征，结合彩色多普勒及脉冲多普勒血流参数测值，对甲状腺疾病可做出较准确的诊断。     

探讨彩色多普勒超声在甲状腺疾病诊断中的价值

目的探讨彩色多普勒超声在甲状腺疾病诊断中的价值。方法分析382例甲状腺疾病的彩色多普勒超声表现和结果，并与病理及实验室检查结果对照。结果甲状腺恶性病变诊断符合率为82．6％（19／23），良性病变的诊断符合率为94．7％（340／359）。结论应用二维声像图特征，结合彩色多普勒及脉冲多普勒血流参数测值，可以对甲状腺疾病做出较准确的诊断。     

彩色多普勒超声对未破型宫外孕的诊断价值

目的 探讨彩色多普勒超声（CDn）对未破裂型宫外孕的诊断价值。方法 用CDFI分别测定未破裂型宫外孕组（36例）、宫内早孕组（30例）及宫内假孕囊组（9例）的孕囊或假孕囊周边血流的平均速度与阻力指数（RI），然后进行统计学分析。结果宫内早孕组血流平均流速为（21．80±2．78）cm／s，RI为0．37±0．03；未破裂型宫外孕组的血流平均速度为（20．52±3．76）cm／s，RI为0．39±0．02；宫内假孕囊组的血流平均速度为（9．50±3．56）cm／s，RI为0．71±0．02。结论CDFI对未破裂型宫外孕的早期诊断，对真假孕囊的鉴别有参考价值。     

Effects of flow rate on hemodynamic parameters and agent consumption in low-flow desflurane anesthesia: An open-label, prospective study in 90 patients

Background:

In surgical patients, decreasing the fresh gas flow rate in anesthesia may minimize costs, reduce environmental pollution, and preserve heat and humidity in the respiratory system.

Objective:

The aim of this study was to investigate the effects of 3 low-flowdesflurane rates on perioperative hemodynamic stability, end-tidal desflurane concentration, emergence and recovery characteristics, and agent consumption.

Methods:

This open-label, prospective study was conducted at the Departmentof Anesthesiology and Reanimation, University of Gaziantep, Gaziantep, Turkey. Nonpremedicated adult patients scheduled to undergo surgery (ureterolithotomy, cholecystectomy, pyelolithotomy, or thyroidectomy) were enrolled. Patients were anesthetized with propofol and fentanyl and intubated after neuromuscular blockade with vecuronium. Patients were randomly allocated to 1 of 3 groups according to the fresh gas flow rate: medium flow (2 L/min), low flow (1 L/min), and minimal flow (0.5 L/min). Intraoperative fentanyl volume was recorded. Heart rate, mean arterial pressure, and end-tidal desflurane concentration were recorded before (baseline) and after anesthesia induction; immediately before incision; and 5, 10, 15, 30, 45, and 60 minutes after incision. Emergence time and desflurane consumption after extubation were recorded. Aldrete scores were recorded at 5, 15, and 30 minutes after extubation.

Results:

Ninety patients (46 women, 44 men; mean [SD] age, 39.74 [13.73] years; 30 patients per treatment group) participated in the study. Means of hemodynamic parameters, intraoperative volume of fentanyl, end-tidal desflurane concentration, emergence time, and Aldrete score were statistically similar between the 3 groups. Mean (SD) desflurane consumption was significantly higher in the medium-flow group compared with the low- and minimal-flow groups (110.43 [28.18] g vs 98.40 [23.62] g and 79.80 [17.54] g, respectively; both, P < 0.01). Mean (SD) desflurane consumption was also significantly higher in the low-flow group compared with the minimal-flow group (P < 0.01).

Conclusion:

The results of the present study in adult surgical patients suggestthat desflurane may be used in low-flow anesthesia, even with the minimal fresh gas flow rate.     

Flow velocity analysis of umbilical and uterine artery flow in pre-eclampsia treated with propranolol or pindolol.

In a double blind study, 20 gravidas with pre-eclampsia were randomly allocated to treatment with either propranolol 120 mg/day or pindolol 15 mg/day for 7 days. Flow velocimetry was performed before and after treatment to assess the influence of these two regimens of beta blocker on the feto-placental circulation. A continuous wave Doppler unit was used to measure umbilical and uterine artery flow velocity waveforms. The systolic/diastolic (A/B) ratio and the systolic minus diastolic divided by systolic (A-B)/A ratio (resistance index) were used as indexes of blood flow resistance in the umbilical and uterine arteries, respectively. A resistance to flow in the uteroplacental circulation was significantly less in patients treated with pindolol compared to those treated with propranolol (P less than 0.01). The same pattern was also found in umbilical velocimetry, although the statistical significance was borderline (P = 0.06). Although both drugs were equally effective in reducing blood pressure at rest, their effect on the peripheral resistance was different. Pindolol appears to act in part through a peripheral vascular mechanism. Our data support this assumption because the flow in the uteroplacental bed, as reflected by a decrease in resistance index, improved when patients were treated with the drug pindolol.     

Determination of volume of arterial blood flow by an ultrasonic device

This paper describes the results of a reevaluation of the reliability of a newly developed ultrasonic volume flow meter which was developed by Yoshimura and his co-workers (1978). Measurements of volume blood flow (cc/sec) by this new technique were compared with measurement by the electromagnet flow meter. Experiments were performed with an in vitro model as well as with physiological pulsatile flow in an animal model. Results of the study indicated a high degree of correlation between values measured by both techniques with a correlation coefficient of 0.99 I believe that this is an important technical development in the field of noninvasive quantitative determination of blood flow.     

彩色多普勒超声估测肾血流

90例正常人应用彩色多普勒超声方法估测肾血流,其中74例检出,说明这一方法检出率高。应用体外实验的两种方法对彩色多普勒超声估测肾血流的可靠性验证,实验结果相关密切,提示彩色多普勒超声测定肾血流可靠性好。从实验数据散点图的离散度小可看出彩色多普勒超声测定肾血流这一方法是可信的。     

冠脉血流显像技术对急性主动脉瓣返流时冠脉血流及冠脉血流储备的实验研究

目的：应用冠脉血流显像技术探讨急性主动脉瓣返流对冠脉血流和冠脉血流储备的影响。方法：应用冠脉血流显像技术首先对７只健康犬开胸后的心外膜冠状动脉（以左前降支代表）的血流进行检测,记录舒张期血流速度峰值（ＣＰＶ）、加速时间（ＡＴ）、减速时间（ＤＴ）和全心动周期的速度时间积分（ＶＴＩ）及动脉舒张压（ＤＢＰ）做为对照组;然后用猪尾管经股动脉插入,至主动脉瓣口处造成轻、中、重度返流。记录各返流程度的舒张期血     

根据跨瓣压差选择适用于半球体血流会聚公式的最佳Nyquist速度

应用数字计算机分析彩色多普勒血流会聚区，证明计算流量与实际流量之比为１时，半球体血流会聚公式中所用速度与跨瓣压差间有明显的相关性，协方差分析示这种关系在不同瓣口间无明显差异。本研究为准确应用半球体血流会聚公式提供了一种根据临床可测跨瓣压差选择最佳Ｎｙｑｕｉｓｔ速度的方法。     

Measurement of blood flow by ultrasound: accuracy and sources of error

Doppler ultrasound has now developed to the point where the rate of flow of blood in a given vessel can be measured with appropriate instrumentation. The theoretical basis of Doppler flow measurement is reviewed in this paper, with particular emphasis on the potential and actual sources of error. Three distinct approaches are identified, and the strengths and weaknesses of each discussed. The separate errors involved in estimating the vessel cross-sectional area, the angle of approach, and the Doppler shift are analyzed, together with the question of the uniformity of scattering from the blood. In vivo and in vitro tests of the accuracy obtained using a number of Doppler flow measuring instruments are then reviewed. It is concluded that the Doppler methods are capable of good absolute accuracy when suitably designed equipment is used in appropriate situations, with systematic errors of 6% of less. There are, however, considerable random errors, attributable primarily to errors in measuring the cross-sectional area and the angle of approach. Repeating the measurement of flow several times and averaging the results can reduce these random errors to an acceptable level.     

Color Doppler sonographic signs of respiration-dependent hepatofugal portal flow

PURPOSE: The role of respiration in modulating blood flow in the portal vein is unclear. The aim of this study was to investigate the phenomenon of respiration-dependent periodic hepatofugal portal venous blood flow as detected on color Doppler sonography. METHODS: Within 1 year, we identified 13 patients with respiration-dependent reversal of blood flow in the portal vein that was diagnosed on color Doppler sonography. This phenomenon was investigated by color Doppler sonographic examination of the portal venous flow during both mid-inspiration breath-holding and a respiratory cycle including deep inspiration; evaluation of hepatic vein Doppler waveforms as normal (triphasic) or decreased (flattened); and echocardiographic examination to determine the presence or absence of tricuspid regurgitation. RESULTS: The patients' median age was 53 years (range, 26-87 years). Seven of the 13 patients had heart disease (tricuspid regurgitation) with or without liver disease, 3 had liver disease without heart disease, and 3 had other diseases with no evidence of heart or liver disease. On Doppler sonography, 10 of the 13 patients had increased portal venous pulsatility (7 of the 10 had tricuspid regurgitation; the other 3 did not); the remaining 3 patients had neither increased pulsatility nor tricuspid regurgitation. Sonographic follow-up within 4 weeks in 4 of the 13 patients revealed loss of the respiration-dependent hepatofugal portal flow. CONCLUSIONS: Respiration-dependent hepatofugal portal flow is a rare finding associated with periodic portal hypertension in patients with right heart insufficiency and liver disease. Its clinical significance is unclear. Among our patients, its occurrence was predominantly associated with an increased venous pulsatility index due to tricuspid regurgitation or venous outflow obstruction. Further study is needed to investigate whether periodic respiration-dependent hepatofugal portal flow is predictive of the occurrence of continuous flow reversal.     

彩色多普勒超声估测肾血流

90例正常人应用彩色多普勒超声方法估测肾血流,其中74例检出,说明这一方法检出率高。应用体外实验的两种方法对彩色多普勒超声估测肾血流的可靠性验证,实验结果相关密切,提示彩色多普勒超声测定肾血流可靠性好。从实验数据散点图的离散度小可看出彩色多普勒超声测定肾血流这一方法是可信的。