四期团注法对比剂注射方案用于CT血管造影检查胸痛三联征

目的 观察四期团注法对比剂注射方案应用于胸痛三联征CT血管造影(CTA)的可行性.方法 回顾性分析49例接受胸痛三联征CTA检查患者,根据对比剂注射方案分为四期组和三期组,对比其主动脉、冠状动脉、肺动脉管腔内CT值及图像信噪比(SNR).结果 相比三期组,四期组对比剂用量下降17.89％.2组各血管管腔内CT值及SNR...     

最佳心电脉冲窗技术在双源CT冠状动脉成像中的应用

目的 评价最佳心电脉冲窗技术对降低双源CT冠状动脉成像(CTCA)辐射剂量的价值。方法 201例患者接受双源CT冠状动脉检查,并分成A、B两组。A组使用最佳心电脉冲窗技术,慢心率(＜70次/分)、中等心率(70~80次/分)和快心率(＞80次/分)患者使用的最佳心电脉冲窗范围分别为61%~77% R-R间期、30%~78% R-R间期和32%~49% R-R间期。B组使用常规心电脉冲窗技术,范围均为25%~80% R-R间期。比较两组的辐射剂量和图像质量。结果 A组慢心率、中等心率和快心率患者接受的有效辐射剂量依次为(5.41±1.36)mSv、(7.82±1.80)mSv和(4.36±0.88)mSv,B组慢心率、中等心率和快心率患者接受的有效辐射剂量依次为(10.20±3.41)mSv、(8.82±2.21)mSv和(7.61±2.19)mSv,A组和B组各心率段有效辐射剂量比较差异均有统计学意义(P均＜0.05),慢心率、中等心率和快心率患者使用最佳心电脉冲窗技术时分别减少约46.96%、11.34%和42.71%的辐射剂量,而两组图像质量比较差异无统计学意义(P＞0.05)。结论 运用最佳心电脉冲窗技术能明显降低双源CTCA的辐射剂量,而图像质量不受影响。     

多层螺旋CT血管成像诊断胸痛三联征的临床价值

目的:探讨多层螺旋CT血管成像(CTA)技术在诊断胸痛三联征中的应用价值。方法:回顾性分析我院2019年2月—2020年2月间收治的152例高度可疑胸痛三联征患者的临床资料,所有患者入院后均行CTA检查,对冠状动脉、肺动脉及主动脉血管进行图像重建,分析影像学特征。结果:152例患者通过CTA检出冠状动脉狭窄98例(64.5%),肺动脉栓塞28例(18.4%),主动脉夹层6例(3.9%),未见异常20例(13.2%)。冠状动脉成像质量优良率为95%。结论:多层螺旋CT血管成像(CTA)技术在胸痛三联征诊断中具有重要价值,可提高诊断正确率,应在临床推广应用。     

冠状动脉CT血管造影成像中前瞻性与回顾性心电门控技术的比较

目的 评价前瞻性与回顾性心电门控冠状动脉CT血管造影成像的图像质量及辐射剂量.方法 选择心率≤65次/分,节律规则的冠状动脉受检者69例,随机分为实验组(34例)和对照组(35例),分别采用前瞻性和回顾性心电门控进行CT冠状动脉检查.记录两组的辐射剂量并进行统计学分析,同时采用双盲法对图像质量进行评价.结果 实验组和对照组的平均辐射剂量分别为(2.00±0.23)mSv、(10.20±0.96)mSv,差异有统计学意义(P＜0.001).两组各段冠状动脉图像质量方面差异无统计学意义(P＞0.05).结论 冠状动脉CT血管造影成像的前瞻性心电门控技术可大幅降低冠状动脉成像时的辐射剂量,对于心率较低的受检者具有推广价值.     

胸痛三联扫描技术的临床应用价值

目的:探讨胸痛三联扫描技术的临床应用价值.方法:选择2020年3月—10月在本院进行GE Revolution 256排螺旋CT胸痛三联征检查的患者100例作为观察样本,全部病例均通过M P R(多平面重建)、V R(容积再现)、M I P(最大密度投影)、C P R(曲面重建)等方法完成主动脉、肺动脉、冠状动脉成像,...     

256排CT冠状动脉追踪冻结技术在胸痛三联检查中的应用价值

目的:探讨256排CT冠状动脉追踪冻结技术(Snap-shot freeze,SSF)对急性胸痛患者自由呼吸状态下胸痛三联(Triple-rule-out,TRO)检查中冠状动脉图像质量及可判读性的影响.方法:将30例急性胸痛患者行256排CT TRO检查.所有病例图像均使用标准算法(Standerd algorith...     

不典型胸痛40例冠状动脉造影分析

不典型胸痛伴心电图负荷试验阳性时,临床上往往诊断为冠心病。不典型胸痛中究竟有多少为冠心病,国内尚少研究。本文分析我院自2002年来以不典型胸痛为突出表现,高度疑为冠心病而收住院的40例患者的冠状动脉造影资料,旨在探讨不典型胸痛患者冠心病的诊断问题。1临床资料1.1一般资料本组男32例,女8例,年龄37~66(48.8±7.97)岁,病程均在0.5 a以上。本组均以发作性胸痛、胸闷为突出表现,持续时间超过0.5 h,硝酸甘油含化或休息后胸痛缓解不确切。其中1例伴频发室性期前收缩,1例伴窦性心动过缓,其他病例均无心律失常。全部病例未见明显心肺器质性病变。胸痛病因难以确定,需行冠状动脉造影以排除冠心病。典型心绞痛、有心肌梗死史的胸痛、伴糖尿病的胸痛以及以心律失常为突出表现者未包括在本组病例中。1.2冠状动脉造影方法采用Judk ins法,血管内径狭窄≥50%时诊断为冠心病。2结果本组中14例造影证实有冠状动脉病变,其中2例狭窄程度在20%~40%,其余12例狭窄在50%~70%,符合冠心病诊断仅12例,占所有病变的30%。14例受累的血管为:左前降支10例,左回旋支1例,右冠状动脉3例,均为单支血管病变。其余26例...     

冠状动脉造影正常的高血压和非高血压胸痛患者的临床特征比较

高血压是冠状动脉粥样硬化性心脏病(CHD)的一个独立危险因子[1].许多有胸痛症状的高血压患者,临床上疑诊为冠心病,但其中相当一部分患者行冠状动脉造影检查结果正常.     

冠状动脉造影对鉴别剧烈胸痛的意义

【病例】男,45岁。因剧烈胸痛4小时急诊入冠心病监护病房。4小时前开始胸部呈压榨样疼痛,无放射痛,伴恶心,无大汗、憋气,无发热。既往无高血压、冠心病病史,吸烟25年。查体:体温36.5℃,心率62/m in,呼吸16/m in,血压120/70 mmHg。双肺未闻及干湿啰音,心界不大,心尖及心前区无异常搏动,律齐。心电图检查示V2~6导联ST段抬高0.1~0.3 mV,T波高尖,动态观察心肌酶无异常。诊断:急性前间壁心肌梗死。行冠状动脉造影示未见冠状动脉狭窄,排除冠心病,早期复极综合征可能性大。复查心电图无动态改变,证实为早期复极综合征。早期复极综合征是一种以S…     

PACE技术在流利型失语症中的应用(附2例报告)

采用A-B-A个例设计方法对1例底节性失语,具有传导性失语特征的患者进行了提高失语症患者的交际效果技术(Promoting Aphasic's Communicative Effectiveness,PACE)治疗。对1例感觉性失语进行了刺激法与PACE技术的对照治疗。治疗前后经改良波士顿诊断性失语症检查听理解分测验与呼名分测验检查。结果表明,PACE技术可以改善某些流利型失语症的听理解、呼名能力,对复杂概念的听理解改善较刺激法大。尤其是可以使那些尚未能应用非语言方式进行交际的患者逐步学会运用非语言的交际技能。     

基于HEART评分急性非创伤性胸痛患者分诊工具的构建

目的 通过科学的方法,构建急性非创伤性胸痛患者分诊工具,为急诊临床实践提供客观可靠的参考依据。方法 以HEART评分为理论基础,通过文献研究、分析甘肃省某三级甲等医院急性非创伤性胸痛患者回顾性资料,采用Delphi法对22名从事急诊护理管理、急危重症、心内科临床或护理工作的专家进行2轮函询,并确定指标权重。结果 2轮函询专家有效回收率均为100%,专家权威系数分别是0.931、0.832,肯德尔和谐系数分别是0.223、0.305（P<0.001）。最终形成的急性非创伤性胸痛患者分诊工具包括一级指标10项、二级指标36项。结论 急性非创伤性胸痛患者分诊工具构成合理,研究方法适用,研究结果可信度高,为急诊胸痛分诊提高效率、优化流程提供了客观依据。     

The role of coronary CT angiography (CTA) for patients presenting with acute chest pain. Defining problem-specific,evidence-based indications of a novel imaging modality

In the current issue, Stillman et al. (Int J Cardiovasc Imaging, 2007) discuss the role of coronary CTA in patients presenting with acute chest pain. The authors conclude, that CTA will provide novel information on the presence and significance of CAD in patients presenting with acute chest pain. Based on the lack of evidence-based data, specific recommendations for its appropritate use are incomplete. Most experts agree, that there is the need for large clinical trials to determine the accuracy and precision of MDCT for triage of patients with acute chest pain.     

Observer reproducibility and validity of systems for clinical classification of angina pectoris: comparison with radionuclide imaging and coronary angiography

OBJECTIVE: To assess reproducibility and validity of clinical classification of angina pectoris (AP) patients. DESIGN: Fifty-six patients scheduled for coronary angiography because of stable AP were classified by two independent observers with regard to (i) type and (ii) severity of chest pain (Canadian Cardiovascular Society, CCS) and (iii) cardiac functional status (New York Heart Association, NYHA). Myocardial perfusion imaging (MPI) was performed in 55 including measurement of ejection fraction in 46, angiography was undertaken in 51. RESULTS: Observers agreed 100% on the presence (n = 45) or absence (n = 11) of angina. They agreed in 52 (93%), 48 (86%), and 42 (75%) patients with regard to type of pain, CCS grade, and NYHA class, respectively. In the remaining patients, they disagreed by one class only. The positive and negative predictive values of typical/atypical angina for perfusion abnormalities and coronary disease were 55%/82% and 53%/ 82%, respectively. CONCLUSIONS: Observer agreement was excellent for presence, type, and severity of chest pain but moderate with regard NYHA class. Clinical judgment could not predict with reasonable accuracy abnormal perfusion or coronary artery disease.     

Telemetry Bed Usage for Patients with Low-risk Chest Pain: Review of the Literature for the Clinician

Background

Telemetry monitoring in patients with low-risk chest pain is highly utilized, despite the lack of quality data to support its use.

Study Objectives

To review the medical literature on the utility of telemetry monitoring in patients with low-risk chest pain and to offer evidence-based recommendations to emergency physicians.

Methods

A PubMed literature search was performed and limited to human studies written in English language articles with keywords of “telemetry” and “chest pain.” Studies identified then underwent a structured review from which results could be evaluated.

Results

There were 114 paper abstracts on telemetry monitoring screened; 30 articles were considered relevant. Twelve appropriate articles were rigorously reviewed and recommendations given.

Conclusions

Insufficient data exist to support telemetry use in low-risk chest pain patients. Telemetry monitoring is unlikely to benefit low-risk chest pain patients with a normal/nondiagnostic electrocardiogram, a normal first set of cardiac enzymes, and none of the following: hypotension, rales above the bases, or pain worse than baseline angina.     

Telemetry Bed Usage for Patients with Low-Risk Chest Pain: An Updated Review of the Literature for the Clinician

BackgroundTelemetry monitoring in patients with low-risk chest pain continues to be highly used despite a 2011 literature review and recommendations by the Clinical Practice Committee (CPC) of the American Academy of Emergency Medicine that did not find quality data to support its use.ObjectiveTo update the medical literature review on the utility of telemetry monitoring in patients with low-risk chest pain and to offer evidence-based recommendations to emergency physicians.MethodsA PubMed literature search was performed for systematic reviews in English relevant to low-risk chest pain between 2011 and 2019 and then expanded to all citations by removing the systematic review criteria. Studies identified then underwent a structured review from which results could be evaluated in the context of the associated 2011 literature review and CPC recommendations.ResultsThe initial search yielded 2 potentially relevant studies, although none directly addressed telemetry. The expanded search resulted in 76 abstracts that were screened. Two addressed telemetry, including the last CPC statement, which were reviewed and recommendations given.ConclusionsNo further quality data were identified to support the use of telemetry monitoring in patients with low-risk chest pains. Telemetry monitoring is unlikely to benefit patients with low-risk chest pain with a low-risk HEART Score.     

Practicality, safety and accuracy of computed tomography coronary angiography in the evaluation of low TIMI-risk score chest pain patients: a pilot study

Objectives: The present pilot study aimed to assess the practicality, safety and accuracy of performing CT coronary angiography (CT‐CA) in the evaluation of acute chest pain of patients with low thrombolysis in myocardial infarction (TIMI) risk scores. Methods: The present prospective observational study was undertaken in a university teaching hospital between November 2004 and December 2005. Participants were a convenience sample of patients admitted to hospital for investigation of chest pain with TIMI risk scores <3. Consenting patients underwent CT‐CA within 48 h of presentation. Outcomes of interest were practicality (proportion of diagnostic quality scans obtained and preparation time for CT‐CA), rate of serious adverse events, and accuracy at the patient level using selective coronary angiography as the reference standard. Results: Thirty‐four patients were recruited. Diagnostic quality scans were obtained in 26/34 or 76% of patients (four failed CT‐CA and four non‐diagnostic scans). The median CT preparation time was 1.9 h (range 0.17–4.0). No serious adverse events were found. Fourteen of those 26 patients with diagnostic CT‐CA subsequently had selective coronary angiography, of which nine were positive. The sensitivity and specificity of CT‐CA in identifying patients with significant coronary artery disease were 9/9 (100%; 95% confidence interval 72–100%) and 4/5 (80%; 95% confidence interval 28–100%), respectively. Conclusions: The majority of acute chest pain patients with low TIMI risk scores were successfully scanned with a 16‐slice CT to produce CT‐CA studies with good diagnostic quality and accuracy. No major adverse events were found. The place of CT‐CA in diagnostic workup for chest pain remains to be defined.