彩色多普勒超声对腹主动脉瘤破裂的诊断价值分析

目的 探讨彩色多普勒超声对腹主动脉瘤破裂的诊断价值.方法 回顾性分析13例腹主动脉瘤破裂患者的彩色多普勒超声检查资料,并与手术或计算机断层扫描血管成像(CTA)、核磁共振成像(MRI)检查结果进行对比分析.结果 超声诊断腹主动脉瘤破裂11例,准确率84.6％,误诊2例,误诊率15.4％.腹主动脉瘤体最大直径5.1～9.6 cm.超声可显示瘤体及破口、瘤腔内附壁血栓、撕裂内膜、腹腔积液、腹腔内和腹膜后血肿,显示率分别为92.31％、38.46％、46.15％、15.38％、76.92％、46.15％、53.85％.结论 彩色多普勒超声诊断腹主动脉瘤破裂方便、快捷、无创,诊断准确率高,具有较高的临床应用价值.     

彩色多普勒超声对诊断腹主动脉瘤的应用价值

随着我国社会人口结构向老龄化发展和影像新技术的应用,腹主动脉瘤的发现率逐年增高,既往诊断依赖于血管造影,目前彩色多普勒技术已成为诊断腹主动脉瘤的主要方法之一.现就我院在2003年-2010年收集的23例临床资料完整的患者情况报道如下.     

彩色多普勒超声对主动脉瘤的诊断价值

目的 探讨彩色多普勒技术对主动脉瘤的诊断价值。方法 应用彩色多普勒技术分析临床证实为主动脉瘤的12例病人的超声图像,包括瘤体大小、形态、内部回声、血流方向、血流速度等。结果 彩色多普勒均能显示动脉瘤体大小、范围、动脉管壁情况及瘤腔内的血流信号,其中5例主动脉夹层可显示真、假腔及破口的血流频谱信号。有硬化斑及血栓者可见血流充盈缺损。结论 彩色多普勒超声对诊断主动脉瘤有较高的价值。     

彩色多普勒超声诊断主动脉瘤的观察与分析

目的 探讨超声诊断主动脉瘤的可靠性和准确性,评价其临床价值。方法 应用HP2500及TOSHIBA SSA-380A超声诊断仪,检查36例主动脉瘤患者,并将其部分超声检查结果与CT、核磁(MRI)、数字减影血管造影(DSA)及手术结果进行比较。结果 夹层动脉瘤与CT、MRI、DSA检查结果的符合率分别为86%、80%、89%;腹主动脉瘤与MRI、DSA及手术结果的符合率为100%。结论 彩色多普勒超声检查可发现有无主动脉瘤、动脉瘤的大小、范围、搏动和血流状态,对于夹层动脉瘤破裂口的观察、指导临床手术方案的选择有重要意义。     

彩色多普勒超声在诊断主动脉窦瘤破裂中的应用

目的:探讨经胸及经食道彩色多普勒超声心动图在诊断主动脉窦瘤破裂的应用价值。方法:用彩色多普勒超声心动图检查有级以上心脏杂音,诊断为主动脉窦瘤破裂合并室间隔缺损(VSD)及主动脉瓣关闭不全的患者,共16例。结果:16例主动脉窦瘤破裂患者中,右冠窦瘤破裂13例,无冠窦瘤破裂3例,合并室间隔缺损9例,合并主动脉瓣脱垂3例,合并肺动脉瓣狭窄及动脉导管未闭各1例。结论:彩色多普勒超声心动图可以直观地显示主动脉窦瘤的有无及其破裂口的大小和数目,还可以对主动脉窦瘤破裂合并心脏畸形的类型作出诊断,很有意义。     

彩色多普勒超声诊断胎儿心脏畸形的应用价值

目的探讨彩色多普勒超声诊断胎儿心脏畸形的应用价值。方法回顾性分析2011年5月至2013年2月在广州市妇女儿童医疗中心进行系统筛查的孕中期（孕20～28周）5 571例妇女的胎儿的彩色多普勒超声检查资料。结果其中39例检出心脏畸形,检出率为0.7%,均经引产尸解或新生儿超声心动图检查证实。漏诊3例,其中室间隔缺损2例,法洛四联症1例,均在出生后经超声心动图检查证实。结论彩色多普勒超声检查能在产前对大部分胎儿心脏畸形做出正确诊断。     

颈动脉彩色多普勒超声在亚临床期动脉粥样硬化诊断中的应用价值

动脉粥样硬化是中国老年人的常见病,是糖尿病、高血压、高脂血症人群发生心脑血管意外的重要原因之一,且发病年龄逐渐年轻化。流行病学研究和临床试验证实动脉硬化是一项独立的心血管危险因素。无论是猝死、心肌梗死、还是脑卒中,都是动脉粥样硬化性疾病的结果。     

超声在腹主动脉瘤诊治中的应用

腹主动脉瘤是腹主动脉局限性退化扩张,因其发病率和瘤体破裂后的死亡率不断增高而受临床外科医生的重视.超声作为一种无创性的检查,具有价格低廉、准确性高和重复性好等优势,在腹主动脉瘤筛选、诊断和治疗方面有极其重要的价值.本文对超声在腹主动脉瘤诊断、治疗中的应用情况作一综述.     

超声在腹主动脉瘤诊治中的应用

腹主动脉瘤是腹主动脉局限性退化扩张,因其发病率和瘤体破裂后的死亡率不断增高而受临床外科医生的重视。超声作为一种无创性的检查,具有价格低廉、准确性高和重复性好等优势,在腹主动脉瘤筛选、诊断和治疗方面有极其重要的价值。本文对超声在腹主动脉瘤诊断、治疗中的应用情况作一综述。     

Ruptured abdominal aortic aneurysms: experience with 70 cases

During the period 1965-1983, 270 patients underwent resection of abdominal aortic aneurysm. In 70 patients (26%) the aneurysm was ruptured. Overall hospital mortality of patients with ruptures was 34%. Five patients died before the graft could be completed. Common denominators associated with mortality were hypotension, renal failure, cardiac arrest, and postoperative hemorrhage. The average age over the first 10 years was 68, but subsequently, has risen gradually, with a corresponding increase in mortality despite improved surgical technique and postoperative care. Only with more widespread elective resections and earlier diagnosis of rupture followed by prompt operative management, can the outlook for patients with abdominal aortic aneurysm be improved.     

Ultrasonography performed by primary care residents for abdominal aortic aneurysm screening

A prospective pilot study was undertaken to assess a protocol to educate primary care residents in how to personally perform ultrasonography for abdominal aortic aneurysm screening. Resident exams were proctored by a primary care physician trained in ultrasonography and were scored on the level of competence in doing the examination. Patients had ultrasound performed by a resident, followed by repeat examination by the vascular lab. Primary care resident abdominal aortic imaging was achieved in 79 of 80 attempts. Four abdominal aortic aneurysms were identified. There were 75 normal examinations; resident ultrasonography results were consistent with the results of the vascular lab. Ten residents achieved an abdominal aortic ultrasound-independent competence level after an average of 3.4 proctored exams. The main outcome of this study is that a primary care resident, with minimal training in ultrasonography imaging, is able to rapidly learn the technique of ultrasonography imaging of the abdominal aorta.     

破裂性腹主动脉瘤腔内治疗并发症的单中心回顾性研究

目的:探究腔内修复治疗破裂性腹主动脉瘤后围术期并发症出现的相关特征。方法:回顾性分析自2013年10月到2019年10月期间,于首都医科大学附属北京安贞医院血管外科,住院并行腔内修复治疗的破裂性腹主动脉瘤患者53例。其中围术期未出现并发症者29例(54.7%),出现并发症者24例(45.3%)。将并发症组患者分为术后介入相关并发症组8例,术后系统性并发症组13例,术中死亡3例。比较并发症患者与无并发症患者在基线资料、动脉瘤解剖条件、术中及术后理化指标方面的差异。结果:系统性并发症患者在年龄、就诊时收缩压及舒张压、有无反复搬动、近端瘤颈成角,以及术中尿量、术后24 h内腹腔内压、PT、APTT、CKMB、TnI等改变较无并发症组,差异有统计学意义(P<0.05);介入相关并发症患者在近端瘤颈成角方面较无并发症组,差异有统计学意义(P<0.05)。结论:患者年龄、就诊时血压、近端瘤颈成角以及术前多次搬动可能对破裂动脉瘤腔内治疗后系统性并发症产生影响,术中尿量和术后24 h内的腹内压、凝血功能及心肌标志物的监测,对预测系统性并发症发生十分重要。     

老年髂动脉多发炎性动脉瘤的临床特点分析

目的了解髂动脉多发炎性腹主动脉瘤的临床特点,提高对本病诊断及药物治疗的认识。方法对1例发生于髂动脉的炎性腹主动脉瘤老年患者的临床资料进行分析,并复习有关文献。结果炎性腹主动脉瘤好发于70岁左右老年人,临床表现为突发腹痛或背痛,体重下降,C反应蛋白和红细胞沉降率升高,影像学检查可见动脉瘤壁增厚,炎症累及输尿管可引起肾盂积水,常规治疗需手术,早期经糖皮质激素及免疫抑制剂联合治疗可避免或推迟手术。结论突发严重腹痛的腹主动脉瘤患者,应尽早行影像学检查,发现动脉瘤壁增厚及肾盂积水支持本病诊断。早期糖皮质激素及免疫抑制剂治疗能显著缓解症状,并消除尿路梗阻。     

Inhibition of calcium channel blocker associated with lowering C-reactive protein level in rupture of abdominal aortic aneurysm

Background As to abdominal aortic aneurysm (AAA) disease, our major challenge faced in clinical practice is effective drug therapies to prevent rupture of AAA. At present, there wasn’t definite evidence that other drugs had a role in inhibiting AAA rupture except for beta blocker. In our study, we evaluated the role of calcium channel blocker (CCB) played in prevention of AAA rupture. Methods A total of 460 subjects with AAA, aged 29 to 89 years, at least twice admitted into our hospital from January 2000 to April 2010. All of them accepted ultrasound examination for scanning abdominal aortic aneurysm at each admission period. Results Our results revealed that AAA patients suffered from rupture took little CCB and beta-blockers. Treatment with CCB or beta blocker was negatively related to risk of rupture of abdominal aortic aneurysm, and drugs such as statins, angiotensin II receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEI) hadn’t positive or negative effect on AAA. C reactive protein level was lower in patients with taking CCB than those without CCB. Conclusions CCB therapy was negatively related to AAA rupture, and possibly was another kind of drug for.     

Positive predictive value of clinical suspicion for abdominal aortic aneurysm

To measure the positive predictive value (PPV) of clinical suspicion of abdominal aortic aneurysm (AAA), as confirmed by ultrasonography, we reviewed the records of 343 patients at a university medical center referred to ultrasonography for newly suspected AAA. Positive predictive value was 11.1% for large aneurysms of at least 5.0 cm and 18.7% for aneurysms of at least 3.5 cm, and was higher for men and older patients. For patients under 50 years of age, PPV was only 2.6%. Ultrasonography for clinically suspected AAA has a low positive predictive yield, particularly for men under age 50 and for women. Received from the Department of Radiology, Medical College of Wisconsin, Milwaukee. Supported in part by the 1993 American Roentgen Ray Society Scholarship (CEK).     

血浆同型半胱氨酸水平与腹主动脉瘤的相关性研究

目的探讨血浆同型半胱氨酸(Hcy)水平与腹主动脉瘤的相关性。方法回顾性分析2011年7月²012年7月入住我院血管外科经CT诊断为腹主动脉瘤患者(病例组)58例,另选健康体检者63例为对照组。常规检测血生化指标,采用循环酶法检测Hcy水平。结果与对照组比较,病例组高同型半胱氨酸血症(HHcy)发生率明显升高(65.5%vs 27.0%,P<0.01),Hcy水平明显升高[(19.02±9.80)μmol/L vs(13.37±4.54)μmol/L,P<0.01]。多元logistic回归分析显示,HHcy较非HHcy发生腹主动脉瘤的风险增加4.12倍(OR=5.12,95%CI:2.332012年7月入住我院血管外科经CT诊断为腹主动脉瘤患者(病例组)58例,另选健康体检者63例为对照组。常规检测血生化指标,采用循环酶法检测Hcy水平。结果与对照组比较,病例组高同型半胱氨酸血症(HHcy)发生率明显升高(65.5%vs 27.0%,P<0.01),Hcy水平明显升高[(19.02±9.80)μmol/L vs(13.37±4.54)μmol/L,P<0.01]。多元logistic回归分析显示,HHcy较非HHcy发生腹主动脉瘤的风险增加4.12倍(OR=5.12,95%CI:2.33¹1.27,P=0.00)。调整相关危险因素后,未明显改变相关结果(OR=3.35,95%CI:1.1411.27,P=0.00)。调整相关危险因素后,未明显改变相关结果(OR=3.35,95%CI:1.14⁹.80,P=0.03)。病例组HHcy患者与Hcy水平正常者腹主动脉瘤最大直径比较,差异无统计学意义[(5.66±1.49)cmvs(5.11±0.98)cm,P=0.18],年龄与腹主动脉瘤最大直径不相关(r=0.09,P=0.48)。结论 HHcy患者发生腹主动脉瘤的风险更大。降低Hcy水平可能有助于减缓腹主动脉瘤的发展。     

Low prevalence of abdominal aortic aneurysm in the Seychelles population aged 50 to 65 years

Abstract

The prevalence of abdominal aortic aneurysm (AAA) and its risk factors are well known in Western countries but few data are available from low- and middle-income countries. We are not aware of systematically collected population-based data on AAA in the African region. We evaluated the prevalence of AAA in a population-based cardiovascular survey conducted in the Republic of Seychelles in 2004 (Indian Ocean, African region). Among the 353 participants aged 50 to 64 years and screened with ultrasound, the prevalence of AAA was 0.3% (95% CI: 0–0.9) and the prevalence of ectatic dilatations of the abdominal aorta was 1.5% (95% CI: 0.2–2.8). The prevalence of AAA in the general population seemed lower in Seychelles than in Western countries, despite a high prevalence in Seychelles of risk factors of AAA, such as smoking (in men), high blood pressure and hypercholesterolaemia.