摘要
近年来,心血管超声诊断技术有了迅猛的发展,诊断水平有较明显的提高。本文简要介绍了一些有关的新技术或原有技术的新发展,内容包括:血管内超声显像(IVUS)、心腔超声造影或心肌超声显影(MCE)、超声负荷试验(Stress E- cho)、心血管超声三维成像(3D)、经食管超声显像(TEE)及新的室壁运动显影技术(DTI、CK)。血管内超声显像(IVUS)是将导管探头送入血管,进行超声显像的技术,探头发射的高频超声为20～30MHz。该技术可得到冠状动脉的横断面图像,因此可观察动脉硬化斑块,并确定斑块的厚度、大小、位置及形态学情况,亦可测量血管腔的大小及面积;它还可以与以导管为基础的介入治疗(球囊扩张、动脉硬化切除、置入支架)联合应用。心肌造影(MCE)是通过冠脉灌注造影剂来观察心肌显影的情况,可提供有用而可靠的心肌解剖及生理方面的信息。造影剂有四种:1.声振白蛋白;2.半乳糖微粒;3.氟化合物:(1)12氟戊烷,(2)PESDA,(3)6氟化硫,(4)用8氟化3碳包被人体白蛋白;4.脂类物质,用全氟丙烷包被脂类的微粒。造影剂最有效的临床应用之一是评价冠状动脉阻塞时的危险区面积(心肌有坏死危险的面积),也用于评价梗塞区的大小、侧支循环的建立、冠脉血流储备,并可判断心肌存活与否及检测冬眠心肌、顿抑心肌(均为缺血引起的可逆性心肌功能障碍)。超声负荷试验(Stress echo)是在增加患者负荷的情况下,观察其心脏的超声显像。最常用的负荷试验是蹬自行车试验及多巴酚丁胺药物负荷。该技术可用以检测冠心病及心肌梗塞;评价心梗后心肌的存活性,判断顿抑心肌及冬眠心肌,并可预告心肌梗塞患者的预后。三维超声(3D)是用三维重建技术显示心脏的立体图像。它可精确地及无创伤地评价心室收缩功能,如测量心室容积、射血分数及心输出量。还可以诊断瓣膜疾病及冠心病。
This article briefly reviews the new development of diagnostic ultrasound in cardioradology. These new developments include intravascular ultrasound imaging,stress eehoeardiography,contrast e- choeardiography,three-dimensional echoeardiography,transesophagedal echocardiography and new tech- niques such as DTI,and CK. IVUS:The small ultrasound imaging catheter possesses high frequency ultrasound 20～30MHz.The catheter-ultrasound system can provide circumferetial 2D imaging of the coronary arteries.IVUS provides the images of atherosolerosis plaque,which will define the definite thickness,size,position and morpholo- gy of the plaque,measure the lumen and are in vascular IVUS also used in conjunction with eatheferbased interventional therapy(balloon angioplasty,atherectomy and metallic stent). MCE:Contrast echocardiography provides an efficient and reliable method for combining tomic and physi- ologic information.The contrast agents include four types: 1.Sonicated contrast agent albumin 2.Galactose-stabilized microbubbles 3.Fluorocarbon chemicals: a.dodecafluoropentane such as the commercial prepared agent Echoger,QW 3600,QW 563A b.PESUA(perfluoropopane exposed sonicated dextrose ablumin) c.Sulphur Hexafluoride,BRI d.perflouropropane-filled albumin,FS069 4.Lipid-based contrast agent,MRXll5,a lipid-coated porfluoropropane contrast agent. One of the most useful clinical applications of contrast has been the assessment of"area at risk"during coronary occlusion,and also the assessment of infarct size,the collateral blood flow,and the coronary blood flow reserve (CFR),used to detect the hibernating myocordium,stunning myocardiun and myocar- dial viability. Stress echo:Bicycle exercise stress testing and dobutamin pharmacologic stress echo are the two most used agents for stress echo.Stress echo can be used in the detection of coronary artery disease and myocar- dial infarct.An exciting area in the field of stress echo is the assessment of myocardial viability,stunning myocardium,hibernating myoxardium,and the predicted
出处
《当代医学》
1997年第1期1-10,共10页
Contemporary Medicine
关键词
心血管疾病
超声诊断
血管内超声显像
心肌超声造影
超声负荷试验
三维成像
经食管超声
多普勒组织成像
彩色室壁运动分析技术
Cardiovascular disease
Diagnostic ultrasound
Intravascular ultrasound imaging
Myocardial contrast echocardiography
Stress echocardiography
Three-dimensional echo cardiography
Transesophageal echocardiography
Doppler tissue imaging
Color
