目的 探讨常规超声心动图联合二维斑点追踪技术评估急性白血病患儿在接受蒽环类药物治疗后产生的心脏毒性,早期检测左心功能障碍。方法 采用前瞻性非随机观察研究,选取新诊断急性淋巴细胞白血病患儿20例,分别于确诊白血病后接受蒽环类药物治疗前、接受所有蒽环类药物剂量后以及确诊白血病1年后,进行常规超声心动图和二维斑点技术监测评估心脏毒性。结果 左室流出道速度积分TVI和E、E/E’在治疗期间下降,并在诊断后1年恢复至治疗前数值。在二维斑点追踪纵向应变中,GLPS-LAX、GLPS-A2C、LV-GLPS在完成所有蒽环类药物剂量后与诊断后比较差异有统计学意义,以及诊断后1年与蒽环类药物治疗后比较差异有统计学意义。但GLPS-A4C各时间点比较差异无统计学意义。结论 常规超声心动图联合二维斑点追踪技术的纵向整体应变可早期发现白血病患儿化疗所致的左室功能障碍。

Objective To evaluate cardiotoxicity in children with acute lymphoblastic leukemia treated with anthracyclines by echocardiography combined with 2D speckle tracking imaging,and to detect left heart dysfunction early．Methods In this prospective nonrandomized study,20 children with newly diagnosed acute lymphoblastic leukemia were assessed for cardiotoxicity by echocardiography and 2D speckle tracking imaging in three periods during the treatment．Results The left ventricular outflow tract velocity integral TVI and E,E/E’ decreased during treatment,and went back to the pre-treatment value one year after diagnosis．In the longitudinal strain of 2D speckle tracking imaging,in GLPS-LAX,GLPS-A2C,LV-GLPS,there were statistical differences between treatment completed and after diagnosis,and between 1 year after diagnosis and treatment completed．However,GLPS-A4C has no statistical significance．Conclusion sThe conventional echocardiography combined with longitudinal overall strain of 2D speckle tracking imaging can comprehensively evaluate the early changes of left ventricular dysfunction caused by chemotherapy in children with leukemia．

目的 探索视频喉镜下经食道超声(TEE)探头插入在急诊重症患者中的应用。方法 全麻下行非心脏手术的急诊重症患者60名,美国麻醉医师协会分级Ⅱ-Ⅳ级,采用随机数字法分成A组(n=30)和B组(n=30)2组。A组采用盲法插入TEE探头,B组采用视频喉镜辅助插入TEE探头。比较2组探头一次插入成功率、插入所需时间、插入时血流动力学变化、插入时不良反应的情况。结果 B组一次插入成功率(82.8%)高于A组(58.6%),差异有统计学意义(P<0.05)。B组第一次尝试成功插入所需时间长于A组,(24.6±3.1) s vs (15.5±3.0) s, 差异有统计学意义(P<0.05)。成功插入探头所需的总时间2组无差异,差异无统计学意义(P>0.05)。咽喉部损伤B组少于A组(3.4% vs 27.6%),差异有统计学意义(P<0.05)。探头插入时2组患者平均动脉压、心率无明显差异,差异无统计学意义(P>0.05)。结论 视频喉镜可以改善经食道超声探头插入的条件,提高插入成功率,减少相应并发症,可安全用于急诊重症患者的TEE探头插入。

Objective To explore the application of transesophageal echocardiography (TEE) probe insertion under video laryngoscopy in acute severe patients. Methods Sixty acute severe patients, ASA grade II-IV, underwent non-cardiac surgery under general anesthesia were divided into two groups (A and B) evenly by random number method.TEE probe was blindly inserted into the group A patients, and in group B, a video laryngoscope was used to assist the insertion.The first insertion success rate, the time required for insertion, the changes of hemodynamics during insertion, and the adverse reactions incidence during insertion of the two groups were compared. Results The first insertion success rate of the group B (82.8%) was significantly higher than that of the group A (58.6%), the difference was statistically significant (P<0.05). The time required for the first successful insertion of the group B was significantly longer than that of the group A, (24.6±3.1) s vs (15.5±3.0) s, and the difference was statistically significant (P<0.05). The total time required to insert the probe was not significantly different between the two groups (P> 0.05). Throat injury in the group B was significantly less than that in the group A (3.4% vs 27.6%), the difference was statistically significant (P<0.05). The hemodynamics (MAP and HR) of the two groups during insertion were not significantly different (P>0.05). Conclusions Video laryngoscope can improve the conditions of transesophageal ultrasound probe insertion, increase the success rate of insertion, and reduce the corresponding complications.It can be safely used for TEE probe insertion in acute severe patients in an emergency.

目的 分析经胸超声心动图在Stanford A 型主动脉夹层的直接征象、间接征象和优缺点,探讨超声心动图在其诊断及预后评估中的应用价值。方法 回顾性收集2018年9月—2020年6月在我院诊治的A型主动脉夹层患者的临床资料,分析超声心动图的应用价值,以及住院期间发生不良预后的高风险因素。结果 经胸超声心动图直接征象诊断 A 型主动脉夹层的敏感性低于CTA,但对受累主动脉瓣结构及其功能评价优于CTA。 院内不良预后的发生率为42%, A型夹层的病因多与高血压相关,主动脉瓣返流、心包积液、手术时间长等是其高风险因素。结论 经胸超声心动图对A型主动脉夹层的早期诊断有较高的初筛价值,在局限于主动脉窦部夹层及观察主动脉瓣是否受累及有独特的优势,对于手术方式的选择和预后的判断有指导意义。

Objective To analyze the direct signs, indirect signs, advantages and disadvantages of transthoracic echocardiography in Stanford A-type aortic dissection, and explore the application value of echocardiography in its diagnosis and prognostic evaluation. Methods Retrospectively collect the clinical data of patients with type A aortic dissection diagnosed and treated in our hospital from Sept 2018 to Jun 2020, and analyze the application value of echocardiography and the high-risk factors for poor prognosis during hospitalization. Results The direct signs of transthoracic echocardiography were less sensitive than CTA in the diagnosis of type A aortic dissection, but it was better than CTA in evaluating the structure and function of the affected aortic valve. The incidence of poor prognosis in the hospital was 42%. The cause of type A dissection was mostly related to hypertension. Aortic regurgitation, pericardial effusion, and long operation time were high-risk factors. Conclusion Transthoracic echocardiography has a higher initial screening value for the early diagnosis of type A aortic dissection. It has unique advantages in confining to the aortic sinus dissection and observing whether the aortic valve is involved, the choice of surgical methods and the judgment of prognosis has guiding significance.

目的 了解新生儿先天性心脏病的患病情况,为制定和采取干预措施提供依据。方法 对2015年10月—2016年9月分娩的5 769名新生儿进行心脏彩超检查,根据筛查结果进行统计分析。结果 共筛查出182例新生儿先天性心脏病,患病率3.15%,先天性心脏病新生儿中女婴比例较高,差异边缘显著,早产儿比例较高,差异有统计学意义,产母年龄和正常组分布相近。先天性心脏病类型中室间隔缺损和房间隔缺损的构成比分别排第一位(48.90%)和第二位(38.46%),严重先天性心脏病仅占5.43%。结论 新生儿先心病的发病率较高,采用心脏彩超筛查可尽早发现先心病患儿,同时需做好先心病患儿的随访工作,及时进行干预。

Objective To investigate the prevalence of neonatal congenital heart diseases (CHD) and providing basis for integrating efficient interventions. Methods The color Doppler echocardiography screening were applied to 5 769 newborns from Oct 2015 to Sep 2016, and the data was collected and analyzed. Results 182 cases of neonatal CHD were detected, and the prevalence rate of neonatal CHD was 3.15%. The proportion of girls and premature infants in the newborns with CHD was significantly higher than normal newborns, but the age distribution of their mothers was similar. In the 182 CHD cases, ventricular septal defect(48.90%) and atrial septal defect(38.46%) accounted for the most, while the constituent ratio of severe CHD was only 5.43%. Conclusion The prevalence of neonatal CHD was relatively high, and the color Doppler echocardiography screening could find out neonatal CHD earlier. The follow-up examinations and interventions should be conducted in time.

目的 分析肺动脉栓塞超声心动图表现,探讨超声心动图估测肺动脉高压对肺动脉栓塞的诊断意义。方法 回顾性分析确诊肺动脉栓塞患者的超声心动图影像表现,就超声诊断征象进行对比分析。结果 累及肺动脉主干、两侧肺动脉近端的肺动脉栓塞检出率92.31%。肺动脉栓塞患者肺动脉高压检出率达78.38%。结论 经胸超声心动图估测肺动脉收缩压具有重要的诊断提示意义。

Objective To analyze the doppler echocardiography in the cases of pulmonary embolism and evaluate the relationship between pulmonary hypertension and pulmonary embolism. Methods To retrospectively analyze the echocardiography findings of the pulmonary hypertension. The causes of disease were classification analyzed. Results The detection rate of the embolus in the main pulmonary trunk and proximal pulmonary arteries is 92.31%. The detection rate of the pulmonary hypertension is 78.38%. Conclusion The estimation of pulmonary artery pressure in the echocardiography is helpful to diagnosis.