Correlation analysis of real-time three-dimensional ultrasound in diagnosis of left ventricular function, portal hemodynamics and severity of liver function in patients with liver cirrhosis

Objective:To analyze the correlation between real-time three-dimensional ultrasound in diagnosis of left ventricular function, portal hemodynamics and severity of liver function in patients with liver cirrhosis.Methods: 90 patients with cirrhosis admitted to our hospital from January 2017 to December 2018 were enrolled in the cirrhosis group, and the cirrhosis components were group A, B and C according to the Child-Pauh classification criteria. During the same period, 90 healthy subjects who underwent physical examination were selected as the control group;real-time three-dimensional ultrasonography was performed to examine left ventricular function and portal hemodynamic parameters;Pearson correlation was used to analyze left ventricular function, portal hemodynamics and liver. Functional severity relationship.Results: The left heart E and E/A levels in the cirrhosis group were significantly lower than those in the control group (P<0.05), and the A level was significantly higher than the control group (P<0.05). The Dpv and Q levels in the cirrhosis group were significantly higher than those in the healthy control group. The difference was statistically significant (P<0.05), and the level of Vpv was significantly lower than that of healthy controls (P<0.05). There were significant differences in E, A and E/A levels between different Child-Paugh patients (P<0.05). There were significant differences in portal hemodynamics Dpv, Vpv and Q between the different Child-Paugh grades, and the difference was statistically significant (P<0.05);left heart function E and E/A and liver function severity There was a significant negative correlation (P<0.05). There was a significant positive correlation between left cardiac function A and liver function severity (P<0.05). Portal vein hemodynamics Dpv, Vpv and QE were significantly associated with liver function severity. Positive correlation (P<0.05). Conclusion: Real-time three-dimensional ultrasound can effectively detect left ventricular function and portal hemodynamics changes in patients with cirrhosis, and left heart function, portal hemodynamics and liver function severity are significantly correlated.

Dynamic Characteristic Mechanism of Atrial Septal Defect Using Real-Time Three-Dimensional Echocardiography and Evaluation of Right Ventricular Functions

The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynamic characteristics of the area of ASD were observed, and the overall and local volume and functions of the patients with ASD were measured. RT 3DE was performed on the 27 normal controls and 28 patients with ASD. Based on the three-dimensional data workstations, the area of ASD was measured at P wave vertex, R wave vertex, T wave starting point, and T wave terminal point and in the T-P section. The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured. The measured value of the area of ASD was analyzed. The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared. The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane（LA 8-plane） method. Real-time three-dimensional volume imaging was performed in the normal control group and ASD group（n=30）. The right ventricular inflow tract, outflow tract, cardiac apex muscular trabecula dilatation, end-systolic volume, overall dilatation, end-systolic volume, and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method（4D RVQ） and compared. The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis. Dynamic changes occurred to the area of ASD in the cardiac cycle. The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent. The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared. The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve. The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same. The displacement of the tricuspid annulus exhibited directionality. The measured values of the area of ASD at P wave vertex, R wave vertex, T wave starting point, T wave terminal point and in the T-P section were properly correlated with the right atrial volume（P〈0.001）. The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated（P〈0.05）. The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group（P=0.0001）. The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group（P=0.043）. The right ventricular ejection fraction in the ASD group was lower than that in the normal control group（P=0.032）. The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction. The difference was statistically significant（P=0.005）. The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group（P=0.031）. The a RVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group（P=0.0005）. The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics. RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle. The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people. The right ventricular cardiac apex and the overall systolic function decrease.

Novel approach of ultrasound-guided lateral recess block for a patient with lateral recess stenosis: A case report

BACKGROUND Ultrasound guide technology,which can provide real-time visualization of the needle tip and tissues and avoid many adverse events,is widely used in mini-mally invasive therapy.However,the studies on ultrasound-guided Lateral recess block(LRB)are limited,this is probably because there is no recognized standard method for ultrasound scanning.This study aimed to evaluate the effect of ultrasound-guided LRB in patients with lateral recess stenosis(LRS).CASE SUMMARY A 65-year-old patient complained of low back pain accompanied occasionally by pain and numbness in the left lower limb.Physical examination showed ten-derness on the spinous process and paraspinal muscles from L1 to S1,extensor hallucis longus and tibialis anterior weakness(muscle strength:4-),and a positive straight leg raising test in the left lower limb(60°).Magnetic resonance imaging showed L4–L5 disc degeneration with left LRS and nerve root entrapment.Subsequently,the patient was diagnosed with LRS.This patient was treated with a novel ultrasound-guided LRB approach.The patient’s symptoms significantly improved without any complications at 1 wk postoperatively and at the 3-month follow-up.CONCLUSION This is the first report on the LRS treatment with ultrasound-guided LRB from the contralateral spinous process along the inner side of the articular process by out-plane technique.Further studies are expected to investigate the efficacy and safety of ultrasound-guided LRB for patients with LRS.

Real-time virtual sonography visualization and its clinical application in biliopancreatic disease

AIM:To evaluate the usefulness of real-time virtual sonography(RVS)in biliary and pancreatic diseases.METHODS:This study included 15 patients with biliary and pancreatic diseases.RVS can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography(CT)image,using pre-scanned CT volume data.The ultrasound used was EUB-8500with a convex probe EUP-C514.The RVS images were evaluated based on 3 levels,namely,excellent,good and poor,by the displacement in position.RESULTS:By combining the objectivity of CT with free scanning using RVS,it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular structures.The resulting evaluation levels of the RVS images were12 excellent(pancreatic cancer,bile duct cancer,cholecystolithiasis and cholangiocellular carcinoma)and 3 good(pancreatic cancer and gallbladder cancer).Compared with conventional B-mode ultrasonography and CT,RVS images achieved a rate of 80%superior visualization and 20%better visualization.CONCLUSION:RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.

Current use of intraoperative ultrasound in modern liver surgery

Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery.Intraoperative ultrasound(IOUS)has become an indispensable tool for modern liver surgeons,especially for minimally invasive surgeries,partially substituting for the surgeon’s hands.In fundamental mode,Doppler mode,contrast enhancement,elastography,and real-time virtual sonography,IOUS can provide additional real-time information regarding the intrahepatic anatomy,tumor site and characteristics,macrovascular invasion,resection margin,transection plane,perfusion and outflow of the remnant liver,and local ablation efficacy for both open and minimally invasive liver resections.Identification and localization of intrahepatic lesions and surrounding structures are crucial for performing liver resection,preserving the adjacent vital vascular and bile ducts,and sparing the functional liver parenchyma.Intraoperative ultrasound can provide critical information for intraoperative decision-making and navigation.Therefore,all liver surgeons must master IOUS techniques,and IOUS should be included in the training of modern liver surgeons.Further investigation of the potential benefits and advances in these techniques will increase the use of IOUS in modern liver surgeries worldwide.This study comprehensively reviews the current use of IOUS in modern liver surgeries.

实时三维超声彩色多普勒检查在孕中期胎儿畸形中的诊断价值

目的分析实时三维超声彩色多普勒检查在孕中期胎儿畸形中的诊断价值。方法选取安阳市第六人民医院2021年7月至2023年7月收治的250例有胎儿畸形高危因素的孕中期孕妇,利用实时二维超声检查、三维超声彩色多普勒检查胎儿发育情况;所有受试者均接受跟踪随访,将引产或死产后尸检结果、活产后新生儿检查结果记为“金标准”,分析实时三维超声彩色多普勒检查、二维超声检查对孕中期胎儿畸形诊断的价值。结果金标准诊断结果显示,250例受试者中有3例失访、20例转院,均剔除,余227例受试者中有80例孕中期胎儿畸形,其中鼻骨发育不良9例、无脑儿3例、脑积水5例、脊柱畸形3例、唇腭裂7例、心脏畸形26例、前腹壁畸形者3例、肢体畸形6例、肾脏疾病4例、胸腔疾病4例、单脐动脉10例。实时三维超声彩色多普勒检查畸形胎儿的检出率(93.67%)高于二维超声检查(80.32%),差异有统计学意义(P<0.05),实时三维超声彩色多普勒检查预测孕中期胎儿畸形的灵敏度为85.21%、特异度为93.75%、准确度为89.62%。结论实时三维超声彩色多普勒检查在孕中期胎儿畸形中的诊断价值较高。

经会阴盆底二维超声、实时三维超声在女性尿失禁及膀胱脱垂评估中的应用

目的 评估经会阴盆底二维超声、实时三维超声在女性尿失禁(UI)及膀胱脱垂中的作用。方法 选取2021年2月至2023年2月郑州市第七人民医院收治的60例UI及膀胱脱垂女性患者纳入观察组,另取同期体检盆底功能正常的60例女性纳入对照组,两组研究对象均接受经会阴盆底二维、实时三维超声检查,对比不同状态下盆膈裂孔前后径、横径、面积与肛提肌厚度,分析两种检查的诊断效能,分析对照组、UI及膀胱脱垂患者的超声图像特征。结果 与对照组比较,观察组静息、张力、缩肛状态下的盆膈裂孔前后径、横径、面积均大,肛提肌厚度小(P<0.05);与会阴盆底二维超声对比,实时三维超声对UI及膀胱脱垂的诊断准确度、敏感度、阴性预测值更高(P<0.05);两种检查方式对UI及膀胱脱垂的诊断特异度、阳性预测值差异无统计学意义(P>0.05)。盆底功能正常女性:Valsalva动作后,膀胱颈距膀胱颈与耻骨联合下缘距离为12.6 mm,膀胱尿道后角为134.25°,尿道倾斜角为28.15°。UI超声图像特征:Valsalva动作之后,膀胱颈距膀胱颈与耻骨联合下缘的距离为-15.1 mm,膀胱尿道后角为164.19°,尿道倾斜角为59.83°,尿道内口表现为“漏斗状”。膀胱脱垂超声图像特征:膀胱尿道膨出Valsalva后,膀胱颈距膀胱颈与耻骨联合下缘距离为-6.9 mm,膀胱尿道后角为146.71°,尿道倾斜角为54.87°,尿道内口未见明显开放。孤立性膀胱膨出:Valsalva后膀胱颈距膀胱颈与耻骨联合下缘距离为-10.0 mm,膀胱后壁最低点与膀胱颈与耻骨联合下缘的距离为-24.3 mm,膀胱尿道后角为82.52°,尿道倾斜角为108.55°。结论 与经会阴盆底二维超声相比,实时三维超声对女性UI及膀胱脱垂患者的诊断准确度、敏感度更高,且UI与膀胱脱垂患者的超声图像特征明显不同,实时三维超声的应用价值较高。

实时三维超声联合颅内透明层在胎儿产前神经管畸形筛查中的应用价值

目的:探析实时三维超声联合颅内透明层在胎儿产前神经管畸形筛查中的应用效果。方法:选取2022年4月-2023年9月肇庆市妇幼保健院2500例进行产前检查的产妇(孕11-14周),所有产妇均采取实时三维超声与超声颅内透明层检查,分析检查结果。结果:经过胎儿随访/尸检发现,2500例胎儿中有11例胎儿神经管畸形。经实时三维超声检查,2500例胎儿中检出16例胎儿神经管畸形;经超声颅内透明层检查,检出17例胎儿神经管畸形;经联合检查,检出12例胎儿神经管畸形。实时三维超声与超声颅内透明层检查准确度、灵敏度及特异度未见明显差异(P>0.05);联合检查比单纯实时三维超声、超声颅内透明层检查诊断准确率、特异度及灵敏度高(P<0.05)。结论:实时三维超声联合颅内透明层在胎儿产前神经管畸形筛查中应用效果明显,可将胎儿畸形清楚地反映出来,值得采纳。

经阴道实时三维子宫输卵管超声造影联合抗人绒毛膜促性腺激素抗体评估不孕症输卵管通畅程度的临床价值

目的探讨经阴道实时三维子宫输卵管超声造影(RT-3D-HyCoSy)联合抗人绒毛膜促性腺激素(HCG)抗体评估不孕症输卵管通畅程度的临床价值。方法选取2022年1—12月抚州市第一人民医院收治的120例不孕症患者作为研究对象,所有患者经腹腔镜通液术确诊,且均实施T-3D-HyCoSy检查,并检测患者血清抗HCG抗体水平。以腹腔镜通液术结果作为诊断金标准,比较RT-3D-HyCoSy、抗HCG抗体及RT-3D-HyCoSy联合抗HCG抗体检查对不孕症输卵管通畅程度的诊断效能。结果腹腔镜通液术诊断结果显示,120例(240条输卵管)不孕症患者中,输卵管通畅136条,占比56.67%;输卵管不通畅104条,占比43.33%。120例不孕症患者中,抗HCG抗体呈阳性者51例,阳性率为42.50%。RT-3D-HyCoSy联合抗HCG抗体诊断的灵敏度、特异度及准确度均高于RT-3D-HyCoSy、抗HCG抗体单一诊断,RT-3D-HyCoSy灵敏度、特异度及准确度均高于抗HCG抗体,差异有统计学意义(P<0.05)。结论临床上针对RT-3D-HyCoSy联合血清抗HCG抗体检查诊断不孕症输卵管通畅程度具有较高应用价值,可为临床医师诊疗提供更为有利且切实可靠的参考信息。

三维超声联合实时剪切波弹性成像对女性盆底功能障碍的诊断价值

目的探讨三维超声联合实时剪切波弹性成像(SWE)对女性盆底功能障碍(PFD)的诊断价值。方法选取2022年1月至2023年12月于我院进行产后复查的42例PFD产妇作为研究组,另选取同期我院产后复查盆底功能正常的45例产妇作为对照组。两组产妇均行三维超声及实时SWE检查。比较两组静息及最大缩肛状态肛提肌裂孔面积(LHA)、左右径(LHLD)、前后径(LHAP)及杨氏模量值,并分析LHA、LHLD、LHAP及杨氏模量值单项及联合诊断PFD的效能情况。结果研究组静息及最大缩肛状态LHA、LHLD、LHAP高于对照组,杨氏模量值低于对照组(P<0.05);绘制受试者工作特征(ROC)曲线分析结果显示,LHA、LHLD、LHAP及杨氏模量值联合诊断PFD的曲线下面积(AUC)为0.862,高于各指标单独诊断。结论三维超声联合实时SWE检查能够更为准确地评估盆底功能,用于诊断女性PFD价值较高。

多模态超声对右心结构和功能的评估研究

目的运用多模态超声检查技术进行右心室结构和功能的综合评估,为右心相关的疾病诊治提供更客观、高效的超声检测工具。方法前瞻性收集2022年2月至2023年2月义乌市中心医院诊治右心相关疾病的患者88例(观察组)和健康志愿者80名(对照组),采用常规二维超声测量三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期速度(S')和右心室面积变化分数(FAC)、三尖瓣口舒张早期与晚期血流峰值速度的比值(E/A)、右心房内径(RAD)、下腔静脉内径及吸气末内径塌陷率,二维斑点追踪技术(2D-STE)测量右心室游离壁心肌整体纵向应变(RVGLS),实时三维超声(RT-3DE)测量右心室射血分数(RVEF)。结果观察组TAPSE、S'、FAC、E/A和RVEF明显低于对照组,RVGLS高于对照组(均P<0.05)。Spearman秩相关显示,RVGLS与TAPSE、S'、FAC、E/A和RVEF均呈负相关,RVEF与TAPSE、S'、FAC和E/A均呈正相关(均P<0.05)。最后,TAPSE、S'、FAC、E/A、RVEF和RVGLS的观察者内和观察者间的组内相关系数均≥0.899(均P<0.05),提示多模态超声的重复性较好。结论综合应用多模态超声技术能够提供更多有关右心室结构和功能的信息,在客观、准确诊治右心相关疾病方面具有重要的应用价值。

Modified B-ultrasound method for measurement of antral section only to assess gastric function and guide enteral nutrition in critically ill patients

AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patients. METHODS First,30 healthy volunteers were selected. The modified B-ultrasound method and the traditional B-ultrasound method were applied to assess gastric function. The correlation of indices of gastric function between the two groups was analyzed statistically. In addition,64 critically ill patients were selected,and the modified B-ultrasound method and the gastric juice withdrawal method were applied to guide the implementation of EN. Daily caloric value,the time required to achieve complete EN,ICU stay,hospitalization time,and serum prealbumin and albumin levels were recorded and compared between the two groups. Kaplan-Meier survival curve was used to compare the complications of EN between the two groups. RESULTS In healthy subjects,there was a good correlation among gastric emptying time,antral contraction frequency andantral motility index between the two groups(r = 0.57,0.61 and 0.54,respectively). The study on critically ill patients also revealed that a better effect of EN was achieved in the modified B-ultrasound method group,in which patients had shorter ICU stay and hospitalization time and higher levels of serum prealbumin and albumin. The Kaplan-Meier survival analysis revealed that the improved B-ultrasound method was associated with significantly fewer EN complications(P = 0.031).CONCLUSION The modified B-ultrasound method can provide a good real-time assessment of gastric function and has a better effect than the traditional method in guiding EN in critically ill patients.

State-of-the-art imaging techniques in endoscopic ultrasound

Endoscopic ultrasound (EUS) has recently evolved through technological improvement of equipment,with a major clinical impact in digestive and mediastinal diseases.State-of-the-art EUS equipment now includes real-time sono-elastography,which might be useful for a better characterization of lesions and increased accuracy of differential diagnosis (for e.g.lymph nodes or focal pancreatic lesions).Contrast-enhanced EUS imaging is also available,and is already being used for the differential diagnosis of focal pancreatic masses.The recent development of low mechanical index contrast harmonic EUS imaging offers hope for improved diagnosis,staging and monitoring of anti-angiogenic treatment.Tridimensional EUS (3D-EUS) techniques can be applied to enhance the spatial understanding of EUS anatomy,especially for improved staging of tumors,obtained through a better assessment of the relationship with major surrounding vessels.Despite the progress gained through all these imaging techniques,they cannot replace cytological or histological diagnosis.However,real-time optical histological diagnosis can be achieved through the use of single-fiber confocal laser endomicroscopy techniques placed under real-time EUS-guidance through a 22G needle.Last,but not least,EUS-assisted natural orifice transluminal endoscopic surgery (NOTES) procedures offer a whole new area of imaging applications,used either for combination of NOTES peritoneoscopy and intraperitoneal EUS,but also for access of retroperitoneal organs through posterior EUS guidance.

Real Time Ultrasound Elastography for the Differentiation of Benign and Malignant Thyroid Nodules

The purpose of this study was to evaluate the predictive value of real-time ultrasound elastography (RUE) in differentiating benign from malignant thyroid nodules, with fine needle aspiration cytology analysis as the reference standard. A total of 78 consecutive patients with thyroid nodules who were selected for fine needle aspiration biopsies were examined in this prospective study. 78 nodules in these patients were examined by conventional ultrasound, and ultrasound elastography. The final diagnosis was obtained from cytological findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). On real-time ultrasound elastography, 47 of 62 benign nodules (76%) had a score of 1 or 2, whereas 15 of 16 malignant nodules had a score of 3 to 5, with sensitivity of 93.7%, specificity of 90%, a positive predictive value of 71%, and a negative predictive value of 98%. Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer. Utilization of ultrasound elastography could reduce the rate of thyroid biopsies because of its high elasticity being highly associated with benign cytology.

Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain

BACKGROUND Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain.However,ganglion impar block combined with pulsed radiofrequency(GIB-PRF)for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance.AIM To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIBPRF in treating perineal pain.METHODS Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016.Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure,and visual analogue scale(VAS)scores at 24 h before and after treatment and 1,3,and 6 mo later were analyzed to evaluate clinical efficacy.RESULTS Ultrasound-guided GIB-PRF was performed successfully in all patients,and no complications occurred.Compared with pretreatment scores,the VAS scores were significantly lower(P<0.05)at the four time points after treatment.The VAS scores at 1 and 3 mo were slightly lower than those at 24 h(P>0.05)and were significantly lower at 6 mo after treatment(P<0.05).There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo(P>0.05).CONCLUSION Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain.The 6-mo short-term clinical efficacy was favorable,but the long-term outcomes need future study.

RT-3DE、TDI及2D-STI超声技术对乳腺癌蒽环类化疗患者亚临床心脏毒性的预测价值

目的探讨实时三维心脏超声(RT-3DE)、组织多普勒成像(TDI)及二维斑点追踪成像(2D-STI)超声技术对乳腺癌蒽环类化疗患者亚临床心脏毒性的预测价值。方法回顾性分析2021年8月至2022年10月陕西省人民医院收治的30例选择蒽环类药物化疗的乳腺癌患者的临床资料,所有患者均于化疗前、化疗3周期后及化疗6周期后进行RT-3DE、TDI及2D-STI检查,比较患者不同时间点的左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、三维左室射血分数(3D-LVEF)、二尖瓣环口舒张早期流速(E)与二尖瓣环舒张早期组织舒张速度平均值之比(E/e’)、2D整体纵向应变(2D-GLS)指标的变化,统计化疗6个周期后乳腺癌患者的亚临床心脏毒性发生率,并绘制受试者工作特征曲线(ROC)分析RT-3DE、TDI及2D-STI参数诊断亚临床心脏毒性的效能。结果化疗3个周期及6个周期后,患者的LVEDV、LVESV、E/e’分别为(94.72±11.26)m L、(38.25±4.58)m L、(7.03±1.65)和(94.59±10.03)mL、(39.01±5.07)mL、(7.12±1.70),与化疗前的(96.46±12.04)m L、(39.20±5.14)mL、(6.89±1.76)比较,差异均无统计学意义(P>0.05);化疗3个周期及6个周期后,3D-LVEF、2D-GLS分别为(61.58±3.09)%、(-18.17±2.06)%和(58.61±2.60)%、(17.31±1.97)%,明显低于化疗前的(64.01±3.61)%、(20.79±2.58)%,且化疗6周期后,患者的3D-LVEF明显低于化疗3周期后,差异均有统计学意义(P<0.05);化疗6周期后,30例乳腺癌化疗患者中,4例出现亚临床心脏毒性,占比13.33%;经ROC分析结果显示,3D-LVEF、2D-GLS、3D-LVEF+2D-GLS诊断亚临床心脏毒性的曲线下面积(AUC)值分别为0.784、0.752、0.815,其中3D-LVEF+2D-GLS诊断效能最高,其次为3D-LVEF、2D-GLS。结论RT-3DE能够在早期识别出乳腺癌蒽环类化疗患者亚临床心脏毒性,且有较高的诊断效能,但是于部分患者中其价值在一定程度上受到了限制,针对此类患者需结合2D-STI进行诊断。

经会阴盆底实时三维超声评估不同分娩方式对产妇盆膈裂孔解剖结构及膀胱颈移动度的影响

目的:应用经会阴盆底实时三维超声分析不同分娩方式对女性产后盆膈裂孔解剖结构及膀胱颈移动度的影响。方法:回顾性收集2020年1月-2021年10月本院分娩的170例产妇临床资料,根据产妇分娩方式分为阴道分娩组(n=104)和剖宫产组(n=66),同期健康体检未育未产健康女性50例为对照组(n=50),比较各组产后6周、3个月在静息状态、valsala动作、缩肛动作下盆膈裂孔的前后径、左右径、面积变化及膀胱颈移动度差异。阴道分娩组、剖宫产组均在产后3个月时进行盆底功能康复3个月,比较两组康复前及康复3个月后Ⅰ、Ⅱ类肌肌力变化。结果:产后6周、产后3个月在静息状态、valsala动作、缩肛动作下其盆膈裂孔前后径、左右径、面积阴道分娩组均高于剖宫产组,且两组均高于对照组,阴道分娩组及剖宫产组产后3个月均低于产后6周但均高于对照组;阴道分娩组及剖宫产组产后3个月时膀胱颈移动度均较产后6周时下降但均高于对照组,且阴道分娩组高于剖宫产组(均P<0.05)。康复前后,阴道分娩组Ⅰ、Ⅱ类肌肌力均低于剖宫产组,康复3个月后两组Ⅰ、Ⅱ类肌肌力均较康复前上升且阴道分娩组低于剖宫产组(均P<0.05)。结论:不同分娩方式对女性产后盆膈裂孔解剖结构影响存在差异,且阴道分娩影响最大;经会阴盆底实时三维超声可直观、准确评估盆膈裂孔形态变化及膀胱颈移动度,有助于临床早期诊断。

经会阴实时三维超声联合盆底表面肌电图评价不同分娩方式对初产妇产后早期盆底结构和功能的影响

目的探讨经会阴实时三维超声与盆底表面肌电图评价不同分娩方式对初产妇产后早期盆底结构和功能的影响。方法选取2020年10月至2021年10月在郑州大学第二附属医院分娩的513例初产妇作为研究对象。根据分娩方式分为A组(阴道分娩,n=251)、B组(中转剖宫产,n=65)、C组(选择性剖宫产,n=197)。比较三组产后42 d、产后6个月的盆底超声、盆底肌电参数。结果A组产后42 d的膀胱颈移动度和肛提肌裂孔面积大于B组、C组,且B组大于C组(P<0.05);A组、B组的尿道旋转角大于C组(P<0.05);A组的膀胱尿道后角大于C组(P<0.05)。A组产后42 d的各项肌电值低于B、C组,且B组的快肌、慢肌肌电值低于C组,后静息肌电值高于C组(P<0.05)。三组产后6个月的盆底超声参数与肌电值比较,差异无统计学意义(P>0.05)。结论经会阴实时三维超声联合盆底表面肌电图对临床全面评估产妇盆底结构和功能具有重要价值。阴道分娩对产后早期的女性盆底整体上损伤更严重,但剖宫产初产妇,尤其是中转剖宫产者,更易发生盆底肌高张。

心脏超声对高血压病左室肥厚伴左心衰竭患者的诊断价值及心功能分析

目的探讨心脏超声对高血压左心室肥厚伴左心衰竭患者的诊断价值及对心功能的评估作用。方法从2020年1月至2022年12月湖北省钟祥市中医院收治的高血压左心室肥厚病例中选择119例左心衰竭患者与31例无左心衰竭患者,将患者分别设为研究组、对照组。在患者中开展二维心脏超声、实时三维心脏超声检查,对比二维心脏超声、实时三维心脏超声对高血压左心室肥厚患者左心衰竭的诊断结果,对比2组高血压左心室肥厚患者经实时三维心脏超声测量的左心功能相关指标。结果对于高血压左心室肥厚患者发生的左心衰竭进行诊断时,实时三维心脏超声的检出率比二维心脏超声高(P<0.05)。研究组在左心射血分数(LVEF)、舒张早期心室充盈速度峰值与舒张晚期心室充盈速度峰值比值(E/A)两项测得的数值均比对照组低,研究组在左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)测得的数值均比对照组高(P均<0.05)。结论对于高血压左心室肥厚患者发生的左心衰竭,心脏超声可起到良好的诊断作用,尤其是实时三维心脏超声,可提高左心衰竭的检出率,对左心功能进行准确评价,诊断价值良好。

经会阴三维盆底超声联合实时剪切波弹性成像对初产妇产后盆底功能的评估

目的探讨经会阴三维盆底超声联合实时剪切波弹性成像(SWE)对初产妇产后盆底功能的评估价值。方法采用前瞻性队列研究方法,选择2020年1月至2022年1月于信阳市中医院进行产后复查的113例初产妇,所有产妇均进行经会阴三维盆底超声及SWE检查并记录检查结果;依据产妇体格检查、盆腔器官脱垂分期评估、压力诱发试验、棉签试验等临床综合指标检查结果将其分为盆底功能障碍组及盆底功能正常组,比较两组一般资料及超声检查参数,绘制受试者工作曲线(ROC)评价经会阴三维盆底超声联合SWE对初产妇产后盆底功能的评估价值。结果产后复查时,113例初产妇中出现盆底功能障碍67例,占59.29%;与盆底功能正常组相比,盆底功能障碍组静息及最大缩肛状态下肛提肌裂孔左右径(LHLD)、前后径(LHAP)、面积(LHA)值均较大(P<0.05);与盆底功能正常组相比,盆底功能障碍组静息及最大缩肛状态下耻骨直肠肌的杨氏模量平均值均较小(P<0.05);ROC曲线显示,LHLD、LHAP评估初产妇产后盆底功能的AUC分别为0.630、0.593,评估价值较低,LHA及杨氏模量平均值单独及两种检查方法联合评估初产妇产后盆底功能的AUC分别为0.785、0.744、0.891,均有一定评估价值,且联合评估价值更高。结论经会阴三维盆底超声联合SWE对初产妇产后盆底功能具有一定评估价值。