目的:探讨颈动脉(CA)、股动脉(FA)的内—中膜厚度(IMT)及其血流参数对高血压病的诊断价值。方法:对52例原发性高血压病患者利用高频超声进行CA、FA的IMT检查,并与45例正常对照组结果进行对比研究。结果:高血压组的受检者CA、FA的内中膜厚度较正常对照组的明显增厚,差异有统计学意义(Plt;0.01)。高血压组的受检者CA、FA内径较正常对照组增宽,有显著性差异(Plt;0.01)。高血压组与正常对照组的血流速度测量:高血压组CA、FA平均流速(MV)、加速度时间(AT)明显低于正常对照组,差异有统计学意义(Plt;0.01)。高血压组的CA收缩/舒张期血流速度比值(S/D),搏动指数(PI)、阻力指数(RI),均高于正常对照组,差异有统计学意义(Plt;0.01〉。高血压组的FA收缩/舒张期血流速度比值(S/D)、搏动指数(PI)、阻力指数(RI)与正常对照组比较差异无统计学意义。高血压组与正常对照组钙斑形成比较差异有统计学意义(Plt;0.01)。结论:高血压病的CA、FA内—中膜及血流参数均有不同程度改变,超声检查对临床预警和防治具有重要意义。
A method of ultrasonic simulation based on the FIELD II software platform for carotid artery plaque was proposed according to the analysis for geometrical shape, tissue characteristics and acoustic properties of carotid artery plaques in clinic, and then a simulation system was developed by using the MATLAB graphical user interface (GUI). In the simulation and development, a three-dimensional geometric model of blood vessel with plaques was set up by using the metaball implicit surface technique, and a tissue model was established based on the scatterers with spatial position of gamma random distribution. Comparison of the statistical and geometrical characteristics from simulated ultrasound B-mode images with those based on clinical ones and preset values, the results fully demonstrated the effectiveness of the simulation methods and system.
Objective To investigate the clinical characteristics and mechanisms of ocular manifestations related to carotid artery stenosis. Methods The general clinic data and related ocular manifestations in 124 patients with carotid artery stenosis were retrospectively. Results In the 124 patients, 36 (29%) had ocular manifestations, and 28 (22. 6 %) complained the ocular discomfort as the first symptom. Among the 36 patients, 31 patients (86.1%) had been disclosed unilateral or double stenosis of internal carotid artery by carotid Doppler ultrasound examination, and the result of digital subtract angiography revealed middle and severe degree of internal carotid artery stenosis in 8 and 23 patients respectively. There was no statistic difference of incidence of ocular manifestations between 67 patients of severe internal carotid artery stenosis and 34 patients with middle one（chi;２test,P =0.266 2，P＞0.05). The ocular manifestations included amaurosis fugax (52.8%),acute decline or loss of the visual ability and defect of visual fields (36.1%), binocular diplopia (13.9%), ptosis (13.9%), and persistent high intraocular pressure(2.8%) one patient might had several ocular manifestations simultaneously. In 36 patients, central retinal artery occlusion had been diagnosed in 4, venous stasis retinopathy in 1,central or branch retinal vein occlusion in 6, neovascular glaucoma in 1, and anterior ischemic opticneuropathy in 2. One patient with double occlusion of internal carotid artery didnrsquo;t have any ocular manifestation. Conclusion Carotid artery stenosis, especially internal carotid artery may lead to acute or chronic ocular ischemic lesions, and the occurrence of ocular manifestations in chronic ocular ischemic lesions relates to compensa tion of collateral circulation；patients with ocular ischemic lesions are recomm end to undergo a routine carotid artery examination. (Chin J Ocul Fundus Dis, 2006,22:376-378)
ObjectiveTo evaluate the efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis. MethodsThe clinical data of patients with coronary heart disease and carotid stenosis treated in Fuwai Hospital from November 2019 to September 2021 were retrospectively analyzed. All patients underwent staged carotid artery stenting and coronary artery bypass grafting. The incidence and risk factors of severe complications such as myocardial infarction, cerebral infarction and death during the perioperative period and follow-up were analyzed. ResultsA total of 58 patients were enrolled, including 47 males and 11 females with an average age of 52-77 (64.2±5.6) years. No complications occurred before coronary artery bypass grafting. There was 1 myocardial infarction, 1 cerebral infarction and 1 death after the coronary artery bypass grafting. The early complication rate was 5.2%. During the follow-up of 18.3 months, 1 cerebral infarction and 2 deaths occurred, and the overall complication rate was 10.3%. According to Kaplan-Meier survival curve analysis, patients with symptomatic carotid stenosis (log-rank, P=0.037) and placement of close-cell (log-rank, P=0.030) had a higher risk of postoperative ischemic cerebrovascular event, and patients with previous cerebral infarction had a higher risk of postoperative severe complications (log-rank, P=0.044). ConclusionStaged carotid artery stenting and coronary artery bypass grafting is safe and feasible for the treatment of coronary heart disease complicated with carotid stenosis.
目的 探讨对侧颈动脉已被切除的颈动脉体瘤的手术方法。方法 左颈动脉体瘤患者1例，女，54岁。右侧颈动脉31年前因右颈动脉体瘤手术已经切除，本次手术以成对的蚊式钳逐步直接分离至瘤体与颈内动脉的Gordon-Tayler白线，在保证颈内动脉完整的情况下，完整切除瘤体及包裹其内的颈外动脉。结果 患者术后无声音嘶哑、呛咳、头晕等并发症，顺利出院。结论 充分的术前准备及正确的分离平面是保证手术顺利的关键。
Hypertensive retinopathy (HR) often coexist with carotid lesions in hypertensive patients. Carotid lesions are closely associated with cardiovascular and cerebrovascular diseases, as well as end events, offering early important evidence to screening high risk patients. HR has significant value to predict target organ damage (TOD) of hypertension including carotid lesion. In addition, hypertensive retinopathy and carotid lesions-related ischemic ocular diseases will cause serious vision function damage. This article is going to summarize the value and correlation between hypertensive retinopathy and carotid lesions in terms of clinical manifestations, pathological physiological mechanism and target organ damage.
【Abstract】ObjectiveTo investigate the effects of CO2 pneumoperitoneum on blood flow of carotid arteries in atherosclerosis rabbits.MethodsFifty Japan white rabbits were randomly divided into control group and three atherosclerosis groups. In atherosclerosis group, the rabbits were randomly subjected to CO2 pneumoperitoneum with an intraabdominal pressure of 0 mm Hg, 10 mm Hg or 15 mm Hg for 2 hours, after the model were created by feeding the rabbits with high fatty diet. The blood flow of the common carotid arteries were measured by electromagnetic blood flowmeter. Artery blood samples were collected for blood gas analysis at 30 minute intervals. ResultsHigher insufflation pressures and longer duration of CO2 pneumoperitoneum were associated with greater increase in blood flow of common carotid arteries. Compared with those in control group and atherosclerosis group with 0 mm Hg CO2 pneumoperitoneum, there were statistically significant increases in blood flow of the common carotid arteries during CO2 pneumoperitoneum in 10 mm Hg and 15 mm Hg pneumoperitoneum group, the changes in 15 mm Hg pneumoperitoneum group were more significant than those in 10 mm Hg pneumoperitoneum group (Plt;0.05). When compared with the blood flow before insufflation, those in 10 mm Hg and 15 mm Hg pneumoperitoneum group also increased significantly during CO2 pneumoperitoneum, even at 30 minute after desufflation (Plt;0.05). However, those in control group and 0 mm Hg pneumoperitoneum group did not change significantly (Pgt;0.05). There were significant decrease in pH and significant increase in PCO2 in both 10 mm Hg and 15 mm Hg groups, when compared with presufflation values or those in control group and 0 mm Hg pneumoperitoneum group(Plt;0.05). The changes in pH and PCO2, however, were no significant at any time point in control group and 0 mm Hg pneumoperitoneum group (Pgt;0.05). HCO3- did not change significantly in either group(Pgt;0.05).ConclusionUnder atherosclerosis conditions, CO2 pneumoperitoneum has an adverse influence on the blood flow of the common carotid arteries which may be associated with increased intrabdominal pressure,absorbed CO2 gas.
目的:探讨老老年患者颈动脉中层厚度(IMT)及其相关危险因素的关系,为老老年患者心脑血管疾病的预防及治疗提供临床参考。方法:根据年龄将139例老老年患者纳入分析,有血糖、血压、血脂代谢紊乱的123例作为观察组,无血糖、血压、血脂代谢紊乱的16例作为对照组,分别进行颈动脉超声检查、动态血压监测、糖化血红蛋白及血脂等生化指标检查,并结合临床资料进行分析。结果: 老老年患者均无一例外地存在着IMT增厚,在相同的年龄情况下,吸烟史、血脂紊乱、糖调节异常、血管炎症反应与IMT的增厚呈正相关,各组未显示出统计学差异,IMT的发生发展与年龄、性别、吸烟史、血糖、血压控制水平及血脂紊乱等因素在两组对照中均未显示出统计学差异,多因素Logistic回归分析,显示年龄、吸烟史及病程为危险因素(OR为0500～1196)。结论:老老年患者均不同程度地存在着IMT增厚,其中增龄是其最主要的危险因素,但是对合并有血糖、血压、血脂代谢紊乱的老老年患者也应该积极重视对各种危险因素的筛选和干预,特别在疾病发生发展的早期可能对延缓病变的进展和减少心脑血管事件有一定意义,可是其用药的安全性在该类患者就显得尤为重要。