新冠病毒感染专题

肺部超声在老年新型冠状病毒肺部感染的应用价值

Application value of lung ultrasound in elderly patients with COVID-19

:21-24
 
目的 探讨肺部超声(LUS)在高龄(≥75 岁)感染新型冠状病毒肺炎(COVID-19)患者中的应用及后续对病程的监测及诊断价值。方法 回顾性分析2022年11月1日—2023年1月15日本院内科收治的25例COVID-19高龄患者进行病例归纳总结,除临床资料外,动态监测肺部超声检查情况,并与肺CT结果对比,观察检查结果,以及对病程转归的预判及影响。结果 LUS检查提示患者出现不同程度肺间质损伤,包括离散型B线(间质渗出)或融合型B线(渗入肺泡)以及肺实变(肺泡萎陷)。随着病情好转,LUS可见肺实变范围缩小,B线逐步稀疏到消散,A 线出现。结论 LUS与同期胸部CT结果一致性良好。LUS检查安全简便,重复性好,可实时动态监测,即可作为初筛手段,亦可运用于特殊人群,协助临床治疗决策。
Objective To explore the application and follow-up monitoring and diagnostic value of lung ultrasound (LUS) in elderly patients(≥75y) with novel coronavirus pneumonia (COVID-19). Methods Data of 25 COVID-19 elderly patients admitted to the Department of Internal Medicine from November 1, 2022 to January 15, 2023 were retrospectively analyzed and summarized. In addition to clinical data, dynamic monitoring of LUS was performed, and the results were compared with lung CT results. The examination results, as well as the prediction and impact on the course of disease were observed. Results LUS imaging indicated that patients had different degrees of interstitial lung injury, including discrete type B line (interstitial exudation) or fusion type B line (alveolar infiltration) and lung consolidation (alveolar collapse). With the improvement of the disease, the range of lung consolidation seen in LUS was reduced, the B-line was gradually sparse to dissipate, and the A-line appeared. Conclusions The results of LUS and chest CT in the same period are consistent. LUS examination is safe, simple, reproducible, and can be monitored dynamically in real time. It can be used as a primary screening method, and also be used in special patients to assist clinical treatment decision-making.
论著

子宫瘢痕的超声弹性成像结合厚度分析对剖宫产后再妊娠产妇子宫破裂的预测应用

Application of ultrasound elasticity imaging combined with thickness analysis for prediction of uterine rupture in pregnant women after cesarean section

:40-45
 
目的 探讨子宫瘢痕的超声弹性成像结合厚度分析对剖宫产后再妊娠产妇子宫破裂的预测应用。方法 选择2020年1月—2021年12月在中山市中医院分娩的剖宫产术后再次妊娠经阴道分娩(VBAC)产妇作为研究对象。根据纳入和排除标准,共纳入子宫破裂的VBAC产妇32例、非子宫破裂的VBAC产妇90例。通过住院病历信息系统查询研究对象的基本信息及其在妊娠晚期(≥37周)用B超对研究对象行子宫瘢痕厚度和弹性的测量结果,采用受试者工作特征曲线(ROC)曲线分析子宫瘢痕厚度和弹性SI值对子宫破裂的预测作用。结果 子宫破裂组中年龄>35岁、妊娠>2次、与上次剖宫产间隔<2年、新生儿体质量≥3 kg、单层缝合者的比例高于非子宫破裂组(P<0.05)。122例产妇子宫瘢痕厚度的均值为(3.42±0.49)mm,SI的均值为(2.57±0.45)。ROC曲线分析结果显示:子宫瘢痕厚度单独预测子宫破裂的曲线下面积(AUC)为0.805(95%CI:0.730~0.880,P<0.05),cut off值为3.05 mm,灵敏度为0.726,特异度为0.910,约登指数为0.636;子宫瘢痕SI单独预测子宫破裂的AUC为0.730(95%CI:0.635~0.824,P<0.05),cut off值为2.11,灵敏度为0.767,特异度为0.781,约登指数为0.548;子宫瘢痕厚度联合预测子宫破裂的AUC为0.874(95%CI:0.812~0.937,P<0.01),灵敏度为0.875,特异度为0.811,约登指数为0.686。子宫瘢痕厚度结合子宫瘢痕SI值预测子宫破裂的AUC高于单独使用子宫瘢痕厚度(Z=7.611,P=0.041)和子宫瘢痕SI值(Z=25.864,P=0.025)。结论 子宫瘢痕的超声弹性成像SI值联合子宫厚度可有效提高超声对于VBAC产妇子宫破裂的预测效能,具有一定的应用意义。
Objective To study the application of ultrasound elasticity imaging combined thickness analysis of uterine scar in predicting uterine rupture in women pregnant after cesarean section.Methods Pregnant women with vaginal birth after cesarean(VBAC)from January 2020 to December 2021 in Zhongshan Hospital of Traditional Chinese Medicine were selected as the research subjects.A total of 32 VBAC parturients with uterine rupture and 90 VBAC parturients without uterine rupture were included according to the inclusion and exclusion criteria.The basic information of the subjects was queried through the medical record information system of the hospital.In the third trimester(≥37 weeks),the thickness and elasticity of uterine scar were measured by ultrasound,and the predictive effect of uterine scar thickness and elastic SI value on uterine rupture was analyzed by ROC curve.Results Chi-square test showed that the incidence of uterine rupture was higher in patients with age>35 years,pregnancy>2 times,interval from last cesarean section<2 years,newborn weight≥3kg,and the proportion of uterine rupture in single suture was higher than that in double suture(P<0.05).The mean uterine scar thickness of 122 subjects was(3.42±0.49)mm,and the mean SI was(2.57±0.45).The area under curve(AUC)of uterine scar thickness alone for predicting uterine rupture was 0.805(95%CI:0.730-0.880,P<0.05),the cut off value was 3.05 mm,the sensitivity was 0.726,the specificity was 0.910,and the Youden coefficient was 0.636 by ROC curve analysis.The AUC of uterine scar SI alone for predicting uterine rupture was 0.730(95%CI:0.635-0.824,P<0.05),the cut off value was 2.11,the sensitivity was 0.767,the specificity was 0.781,and the Youden coefficient was 0.548 by ROC curve analysis.The AUC of uterine scar thickness combination for predicting uterine rupture was 0.874(95%CI:0.812-0.937,P<0.01),the sensitivity was 0.875,the specificity was 0.811,and the Youden coefficient was 0.686 by ROC curve analysis.The AUC predicted by uterine scar thickness combined with uterine scar SI value was higher than that predicted by uterine scar thickness alone(Z=7.611,P=0.041)and uterine scar SI value(Z=25.864,P=0.025).Conclusions Elastic SI value of ultrasound imaging of uterine scar combined with uterine thickness can effectively improve the prediction efficiency of ultrasound for VBAC maternal uterine rupture,which has certain application significance,but further demonstration is still needed.
综述

白内障超声乳化术对糖尿病患者眼表影响的研究进展

Research progress on the effects of phacoemulsification on the ocular surface in patients with diabetes mellitus

:112-119
 
糖尿病已成为全球最严重的健康问题之一。需要白内障手术的糖尿病患者也日益增多,虽然糖尿病的眼表并发症很常见,但由于糖尿病患者全身和眼部疾病十分复杂,使得眼前段如角结膜和泪腺的糖尿病并发症往往被忽视。糖尿病患者白内障超声乳化术有引发或加重眼前节疾病的风险,包括干眼病(DED)、角膜上皮糜烂、上皮缺损迁延不愈,甚至威胁视力的角膜溃疡。这些风险里最为常见的是DED,并且可能因白内障超声乳化手术而加重。眼科医生需要在手术前预先评估已存在的DED是否需要术前治疗,并且需要注意在已存在 DED 的情况下,各项术前检查数据测量的准确性会降低,以及尽可能减少对眼表造成损害的各种手术因素;并考虑通过管理减少术后 DED。本综述就评估白内障超声乳化术对合并糖尿病的老年性白内障患者的眼表术中的影响因素进行分析。
Diabetes mellitus(DM)has become one of the most serious health problems in the world. The number of diabetic patients requiring cataract surgery is also increasing. Although ocular surface complications of DM are common,the complexity of systemic and ocular disease in diabetic patients makes diabetic complications in the anterior segment,such as the cornea and lacrimal gland,often be overlooked. Phacoemulsification in diabetic patients carries the risk of triggering or exacerbating ocular segment disease,including dry eye disease,corneal epithelial erosion,persistent epithelial defects and even vision-threatening corneal ulcers. The most common of these risks is dry eye disease,and it can be exacerbated by cataract phacoemulsification. Ophthalmologists need to preemptively assess the need for preoperative treatment of pre-existing dry eye disease(DED),be aware of the reduced accuracy of preoperative data measurements in the presence of DED,and minimize surgical factors that can damage the ocular surface;and consider management to reduce postoperative DED. In this review,we analyze the factors that influence phacoemulsification in ocular surface surgery for senile cataract patients with diabetes.
论著

高频超声联合超微血流成像对肱三头肌肌腱断裂伴骨化性肌炎的诊断价值

Diagnostic value of high-frequency ultrasound combined with superb microvascular imaging in triceps brachii tendon rupture with ossifying myositis

:24-29
 
目的 探讨与分析高频超声联合超微血流成像对肱三头肌肌腱断裂伴骨化性肌炎的诊断价值。方法 选择2020年7月—2022年5月在本院诊治的84例肱三头肌肌腱断裂患者作为研究对象,所有患者均行关节镜及超声检查,超声检查包括高频超声、超微血流成像,记录超声特征并判断诊断价值,根据关节镜检查结果分为骨化性肌炎组和非骨化性肌炎组。结果 84例患者中,经关节镜检查判断为合并骨化性肌炎24例(骨化性肌炎组),占比28.6%。骨化性肌炎组超声表现为肱三头肌肌腱纤维呈连续性中断,含稍强回声的非均质等回声,近侧断端肌腱有回缩并增厚。非骨化性肌炎组(60例)超声表现为肱三头肌肌腱纤维呈连续性中断,局限性边界清晰非均质性稍低回声,两断端中间呈不均质低回声。骨化性肌炎组的骨质破坏、软组织肿胀与关节积液等占比分别为75.0%、79.2%、79.2%,均高于非骨化性肌炎组的20.0%、25.0%、35.0%(P<0.05)。骨化性肌炎组的肌腱面积、肌腱厚度、血管条数均比非骨化性肌炎组更高(P<0.05)。84例患者中,高频超声、超微血流成像与两者联合诊断为肱三头肌肌腱断裂伴骨化性肌炎分别为18例、23例、24例,高频超声、超微血流成像与两者联合诊断肱三头肌肌腱断裂伴骨化性肌炎的灵敏度为70.8%(17/24)、91.7%(22/24)、100.0%(24/24),特异度为98.3%(59/60)、98.3%(59/60)、100.0%(60/60)。结论 肱三头肌肌腱断裂伴骨化性肌炎比较常见,高频超声联合超微血流成像在肱三头肌肌腱断裂伴骨化性肌炎的应用可有效反映病灶形态特征与血流特征,在诊断上具有很高的灵敏度与特异度。
Objective To explore and analyze the diagnostic values of high-frequency ultrasound combined with superb microvascular imaging(SMI)in triceps brachii tendon rupture with ossifying myositis.Methods From July 2020 to May 2022,84 cases of patients with triceps brachii tendon rupture who were diagnosed and treated in our hospital were selected as research subjects.All patients underwent arthroscopy and ultrasonography,ultrasonography including high-frequency ultrasound and SMI,to record ultrasound characteristics and determine diagnostic value,and patients were divided into ossifying myositis group and non-ossifying myositis group according to the results of the arthroscopic examination.Results In 84 patients,there were 24 patients(28.6%)diagnosed as ossifying myositis by arthroscopy(ossifying myositis group).The ultrasound findings of the ossifying myositis group were interruption of the triceps brachii muscle tendon fibers with slightly strong echogenicity and heterogeneous isoechogenicity.The proximal severed tendon had retraction and thickening.In the non-ossifying myositis group(n=60),the ultrasound findings showed a interruption of the triceps brachii muscle tendon fibers,with clear localized boundaries and slightly heterogeneous hypoechogenicity,and there was an uneven hypoechogenicity between the two broken ends.The proportions of bone destruction,soft tissue swelling and joint effusion in the myositis group were 75.0%,79.2% and 79.2%,which were significantly increased compared to 20.0%,25.0% and 35.0% in the non-ossifying myositis group(P<0.05).The tendon area,tendon thickness and vascular number in the ossifying myositis group were significantly higher than those in the non-ossifying myositis group(P<0.05).In the 84 patients,there were 18 cases,23 cases and 24 cases diagnosed of triceps tendon rupture with ossifying myositis by high-frequency ultrasound,SMI and their combination.The sensitivity of high-frequency ultrasound,SMI and their combination in the diagnosis of triceps tendon rupture with ossifying myositis were 70.8%(17/24),91.7%(22/24) and 100.0%(24/24),with specificity of 98.3%(59/60),98.3%(59/60) and 100.0%(60/60).Conclusions Triceps brachii tendon rupture with ossifying myositis is relatively common.The application of high-frequency ultrasound combined with SMI in triceps brachii tendon rupture with ossifying myositis can effectively reflect the morphological and blood flow characteristics of the lesion,with high sensitivity and specificity in diagnosis.
临床诊疗

经腹部浅表超声检查对急性阑尾炎患者检出率的影响

:129-132
 
目的 分析经腹部浅表超声检查对急性阑尾炎患者检出率的影响。方法 选取濮阳市人民医院2018年12月—2020年6月疑似急性阑尾炎患者146例,均行腹部超声、浅表超声检查,以术后诊断为金标准,比较腹部、浅表超声单独及联合诊断效能、对不同类型急性阑尾炎检出率,分析不同类型急性阑尾炎影像学结果。结果 以术后诊断为金标准,146例疑似急性阑尾炎患者中阳性87例,阴性59例;腹部超声检出阳性80例,阴性66例;浅表超声检出阳性91例,阴性55例;腹部浅表超声检出阳性86例,阴性60例;腹部浅表超声诊断急性阑尾炎准确度99.32%(145/146)、灵敏度98.85%(86/87)、特异度100.00%(59/59)高于腹部超声[70.55%(103/146)、71.26%(62/87)、69.49%(41/59)]及浅表超声[69.86%(102/146)、77.01%(67/87)、59.32%(35/59)]单独诊断,漏诊率1.15%(1/87)、误诊率0.00%(0/59)低于腹部超声[28.74%(25/87)、30.51%(18/59)]及浅表超声[22.99%(20/87)、40.68%(24/59)]单独诊断(P<0.05);腹部浅表超声对不同类型急性阑尾炎总检出率高于单独检查(P<0.05)。结论 腹部浅表超声应用于急性阑尾炎诊断,可提高诊断准确度、灵敏度、特异度,降低漏诊率及误诊率,对不同类型急性阑尾炎检出率提高有积极作用,可收集患者详细声像信息,为临床治疗方案制定提供方向。
论著

超声引导下外周静脉置入中心静脉导管老年患者常见并发症的预防与护理

Preventing and nursing of common complications in elderly patients with ultrasound-guided PICC catheterization

:72-76
 
目的 探讨超声引导下外周静脉置入中心静脉导管(PICC)老年患者常见并发症的预防与护理措施。方法 回顾性分析本院2019年12月—2021年1月间收治的116例PICC置管老年患者,根据是否实施超声引导下PICC置管并发症专项预防护理(后简称专项护理)将入选患者分配为实施组及对照组各58例,对比2组患者穿刺效果、并发症发生情况,评估2组患者护理前后的心理状态变化情况,调查患者满意度。结果 实施组一次穿刺成功、头端到位率、头端最佳率均高于对照组,平均穿刺次数、操作时间均少于对照组,差异均有统计学意义(P<0.05);实施组各种并发症总发生率为18.97%,对照组为46.55%,2组差异有统计学意义(P<0.05);置管后2组患者焦虑自评量表、抑郁自评量表评分均低于置管前,且实施组均低于对照组,差异均有统计学意义(P<0.05);实施组患者总满意率为96.55%,对照组为77.59%,实施组高于对照组,差异有统计学意义(P<0.05)。结论 专项预防护理措施能够提高老年患者超声引导下外周静脉置入中心导管的穿刺准确性,降低置管相关并发症发生风险,缓解患者心理压力,提高患者满意度。
Objective To explore the preventing and nursing measures of common complications in elderly patients with ultrasound-guided peripherally inserted central catheter (PICC). Methods The data of 116 elderly patients with PICC catheterization in our hospital from December 2019 to January 2021 were retrospectively analyzed.Patients were divided into implementation group and control group (58 cases each) according to whether they received special preventive nursing for complications of ultrasound-guided PICC catheterization (specialized nursing). The catheterization outcomes and complications of the two groups were compared, the changes in the psychological state were evaluated, and satisfaction rate of the patients was investigated. Results The success rate of the first catheterization, the head-end in place, and ideal placement of the head-end in implementation group were higher than those of the control group, the average number of catheterization and operation time were less than those of the control group, and the differences were statistically significant (P<0.05). The total incidence of various complications in the implementation group was 18.97%, while that in the control group was 46.55%, the difference between two groups was statistically significant (P<0.05). The scores of Self-Rating Anxiety Scale and Self-Rating Depression Scale of the two groups after PICC catheterization were lower than those before catheterization, and the implementation group was lower than the control group, the differences were statistically significant (P<0.05). The total satisfaction rate of patients in the implementation group was 96.55%, and that in the control group was 77.59%, which difference was statistically significant (P<0.05). Conclusion Special preventive nursing measures could improve the catheterization accuracy of ultrasound-guided PICC for elderly patients, reduce the risk of catheter-related complications, relieve the psychological pressure of patients, and improve patients’ satisfaction.
论著

术前超声在预测困难的腹腔镜胆囊切除术中的价值

The value of preoperative ultrasound in predicting difficult laparoscopic cholecystectomy

:95-99
 
目的 探讨术前超声有关指标在预测腹腔镜胆囊切除术(LC)难易度中的价值,以预判LC手术的风险,减少手术的盲目性。方法 257例术前获得的超声参数包括:胆囊大小、胆囊壁厚度、胆囊黏膜面情况、胆囊内胆汁透声情况、胆囊结石最大直径、胆囊颈部结石嵌顿情况。术后资料包括手术时间、术中出血量、是否放置引流管、是否中转进腹手术、术后并发症。计算257例手术的平均时间并将其称为标准手术时间,将超过标准手术时间的、术中出血≥100 mL、术后放置引流管、中转开腹的手术定义为有难度手术。以此标准将257例手术患者分为容易组和困难组,应用χ2检验进行单因素分析,LC手术困难的危险因素;再对这些指标进行Logistic多元回归分析,确定预测LC难易的独立危险因素。结果 单因素分析,术前超声指标:胆囊大小>50 cm2、胆囊壁厚度>4 mm、胆囊结石最大直径>2 cm、胆囊颈部结石嵌顿、胆囊内胆汁透声差,是LC难度的危险因素。Logistic多元回归分析证实,胆囊大小、胆囊壁厚度、胆囊内胆汁透声差、胆囊颈部结石嵌顿等4项超声检测指标是困难LC的独立危险因素。结论 手术前胆囊超声检查可以客观评估LC难度,对指导术者选择LC病例具有一定的预测价值。
Objective To explore the value of preoperative ultrasound indicators in predicting the difficulty of laparoscopic cholecystectomy (LC), in order to predict the risk of LC surgery and reduce the blindness of surgery. Methods The preoperative ultrasonographic parameters of 257 cases included gallbladder size, gallbladder wall thickness, gallbladder mucosal surface, bile sound transmission in gallbladder, maximum diameter of gallstone, and gallstone incarceration in gallbladder neck. Postoperative data included operation time, intraoperative blood loss, whether drainage tube was placed, whether transfer to abdominal surgery, and postoperative complications. The average operation time of the 257 cases was calculated and called the standard operation time, and the operation that exceeded the standard operation time, intraoperative bleeding ≥100 mL, postoperative drainage tube placing, and conversion of abdominal operation were defined as difficult operation. According to this standard, 257 patients were divided into the easy group and the difficult group. The χ2 test was used for univariate analysis to identify the risk factors of difficult LC operation. Logistic multiple regression analysis was performed to determine the independent risk factors for predicting LC difficulty. Results According to unifactor analysis, preoperative ultrasound indicators: gallbladder size >50 cm2, gallbladder wall thickness >4 mm, maximum diameter of gallstone >2 cm, gallbladder neck stone incarceration, and poor bile ultrasound transmission in gallbladder were risk factors for LC difficulty. Logistic multiple regression analysis confirmed that gallbladder size, gallbladder wall thickness, poor bile ultrasound transmission in gallbladder and stone incarceration in gallbladder neck were independent risk factors for difficult LC. Conclusions Ultrasound examination of gallbladder before operation could objectively evaluate the difficulty of LC, and had certain predictive value for guiding the surgeon to select LC cases.
论著

超声评分法在体表高分化脂肪肉瘤和脂肪瘤鉴别诊断中的应用价值

The value of ultrasonography scoring system for differential diagnosis of well-differentiated superficial liposarcomas and lipoma

:27-31
 
目的 探讨超声评分法在体表高分化脂肪肉瘤(WDLPS)和良性脂肪瘤(LP)鉴别诊断中的价值,为两者的鉴别诊断和治疗方式选择提供依据。方法 回顾性分析经病理证实的 14 例(共15个肿块)体表WDLPS和 37 例(共40个肿块)LP临床资料及超声声像图特征,比较2组患者的发病年龄、性别、发病部位、肿块长径、短/长径比、肿块形态、边界、有无包膜、内部回声、回声分布、位置及血流分级等指标。筛选出有统计学差异指标,绘制ROC曲线,计算评分系统的诊断效能。结果 WDLPS和 LP患者在年龄、肿块长径、短/长径比值、有无包膜、位置以及血流分级6个指标有统计学差异(P<0.05),对以上6个指标赋予0或1分建立病灶评分系统,总分0~6分。计算不同分值对WDLPS的诊断效能,以总分≥3分时诊断效能最高,灵敏度86.7%,特异度77.5%,正确率80%,阳性预测值59.1%,阴性预测值93.9%。结论 基于超声图像特征的评分方法在总分≥3分时,对术前鉴别WDLPS和LP具有较好的诊断效能,能够为临床治疗方案选择提供重要参考依据,值得推广应用。
Objective To evaluate the value of ultrasonography scoring system in differential diagnosis of well-differentiated liposarcomas (WDLPS) and benign lipoma (LP), and to provide evidence for the differential diagnosis and treatment choice. Methods Fourteen WDLPS cases (total of 15 masses) and 37 LP cases (total of 40 masses) were diagnosed by surgical histopathology, which clinical data and the ultrasound images were analyzed retrospectively. The parameters including age, gender, region, mass length, length/width ratio, shape, margin, envelope echoes, echogenicity, texture, location, blood flow were compared between the groups above. A scoring system was established by analyzing the parameters with statistical differences, and the ROC curve was plotted to calculate the best cut-off value and evaluate the diagnostic efficiency of the scoring system. Results There were statistically significant differences between two groups in the following six parameters: age, mass length, length/width ratio, envelope echoes, location, blood flow(P<0.05). The scoring system was established by assigning 0 or 1 point to each factor, and the total score was 0~6 points. The highest diagnostic efficiency of WDLPS was observed at the cut-off value ≥ 3. The sensitivity, specificity, accuracy, the positive predictive value and the negative predictive value was 86.7%, 77.5%, 80%, 59.1%, 93.9% respectively. Conclusions The ultrasonography-based scoring system has a better diagnostic efficacy in differentiating WDLPS and LP, which can provide an important reference basis for the selection of clinical treatment, and is worthy of promotion and application.
论著

甲苯磺酸瑞马唑仑与丙泊酚在超声胃镜检查的有效性及安全性对照研究

Comparative study on the efficacy and safety of remimazolam tosilate and propofol in painless ultrasonic gastroscopy

:22-26
 
目的 比较甲苯磺酸瑞马唑仑和丙泊酚在超声胃镜检查中的有效性和安全性。方法 采用随机对照的研究方法,选择接受超声胃镜病人60例,分为观察组(29例)和对照组(31例)。观察组采用甲苯磺酸瑞马唑仑麻醉,对照组采用丙泊酚。观察麻醉过程中不同时点的血流动力学指标、改良警觉/镇静(MOAA/S)评分各时刻的变化、苏醒及离室时间、围术期不良事件。结果 观察组的血流动力学影响更小;观察组可进入足够的镇静深度,而对照组的镇静程度更深;2组起效时间相似,且迅速苏醒而离室,但在苏醒及离室时间方面观察组稍短;不良事件对照组高于观察组。结论 甲苯磺酸瑞马唑仑应用于无痛超声胃镜检查,其对血流动力学影响小,能产生足够的镇静深度,能使患者迅速苏醒,且不良事件发生率低,总体有效性和安全性优于丙泊酚。
Objective To compare the efficacy and safety of remimazolam tosilate and propofol in painless ultrasonic gastroscopy. Methods In a randomized, single-blind controlled study, 60 patients undergoing ultrasonic gastroscopy were selected and divided into observation group (31 cases) and control group (29 cases). Observation group was anesthetized with remimazolam tosilate, while control group was anesthetized with propofol. Two groups' hemodynamic index, perioperative adverse events, changes of MOAA/S score, awakening and departure time were observed at different time points during anesthesia. Results The observation group had less changes on hemodynamics. The observation group had enough depth of sedation, while the control group had a deeper degree of sedation. The onset time of the two groups was similar and both awoke quickly and left, but the awakening time and leaving time in the observation group were slightly shorter. Adverse events in the control group were more than those in the observation group. Conclusions Remimazolam tosilate for painless ultrasonic gastroscopy had little effect on hemodynamics, which can generate enough depth of sedation, and make patients wake up quickly. In addition, the incidence of its adverse events was low, and the overall effectiveness and safety were superior to those of propofol.
临床诊疗

超声检查在甲状腺囊实性结节随访中的作用

The role of ultrasonography in follow-up of cystic solid thyroid nodules

:136-139
 
目的 探究超声检查对于甲状腺囊性结节随访中的作用和临床价值,探讨其临床应用意义。方法 以2018年1月—2019年1月在本院就诊,经过临床金标准诊断为甲状腺囊实性结节的83名患者作为研究对象,采用历史性队列研究方法对患者进行为期18个月的随访观察,对患者在随访期内,使用超声检查所得知的甲状腺囊实性结节的大小、形态、边界、内部回声、钙化及血流信号等特征进行记录,并与患者初次就诊时的记录进行对比分析。结果 根据随访记录得知,83例患有甲状腺囊实性结节的患者当中,75例患者在随访后发现具有甲状腺恶性结节症,其余8例患者不具有甲状腺恶性结节特征。随访后83例患者的甲状腺囊实性结节均呈现好转,主要表现为:甲状腺囊实性结节出现不同程度的吸收;结节体积减小,个数无变化;结节吸收后在超声下显示在同一部位的结节表现为低或极低回声结节;囊性液体成分明显减少,部分原结节较小的患者,囊性成分出现消失。根据对随访前后患者甲状腺囊实性结节的平均体积对比有统计学差异(P<0.05),随访后的结节半径明显小于随访前。甲状腺囊实性结节体积有效缩小率为68%~88%。结论 通过对甲状腺囊实性结节定期进行超声复查可以实现对甲状腺结节的动态观察,有助于对患者的病情进行掌握,且由于甲状腺囊实性结节患者在后期结节吸收过程中常常出现恶性结节特征。通过使用超声检查对患者进行长期随访不仅可起到早期诊断甲状腺恶性肿瘤的意义,还可以避免,因过度诊断为甲状腺恶性结节,而使用细胞穿刺检查等有创检查对患者造成的不便。
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