目的研究心内直视手术时肺动脉灌注低温保护液,对围体外循环期细胞因子水平的影响。方法60例先天性心脏病患者随机分为肺保护组(n=30)和对照组(n=30),均在体外循环下行心内直视手术,肺保护组体外循环期间肺动脉灌注低温保护液,而对照组...目的研究心内直视手术时肺动脉灌注低温保护液,对围体外循环期细胞因子水平的影响。方法60例先天性心脏病患者随机分为肺保护组(n=30)和对照组(n=30),均在体外循环下行心内直视手术,肺保护组体外循环期间肺动脉灌注低温保护液,而对照组不灌注肺低温保护液,其他处理与肺保护组相同。分别于麻醉诱导期、阻断升主动脉后10 m in、开放升主动脉后10 m in、2、12、24 h共6个时点分别采取桡动脉血,测定白介素6(IL-6)、白介素8(IL-8)、白介素10(IL-10)及肿瘤坏死因子α(TNF-α)水平。结果两组患者体外循环后上述参数水平开始升高,升主动脉开放后到达峰值,以后逐渐下降,但24 h仍高于术前(P>0.05),但肺保护组IL-6、IL-8、TNF-α水平在各时间点上升幅度低于对照组(P<0.01或P<0.05),各时间点IL-10水平上升幅度高于对照组(P<0.01)。结论肺动脉灌注低温保护液,能有效地降低围体外循环期损伤性炎性因子IL-6、IL-8、TNF-α的水平,同时增加保护性炎性因子IL-10的表达,从而减轻体外循环心脏手术时机体的炎症反应。展开更多
Background The lung functional status could be displayed on lung perfusion images. With the images, the radiotherapy plans of lung cancer could be guided to more optimized. This study aimed to assess quantitatively th...Background The lung functional status could be displayed on lung perfusion images. With the images, the radiotherapy plans of lung cancer could be guided to more optimized. This study aimed to assess quantitatively the impact of incorporating functional lung imaging into 3-dimensional conformal radiotherapy （3DCRT） and intensity-modulated radiation therapy （IMRT） planning for non-small cell lung cancer （NSCLC）. Methods Ten patients with NSCLC who had undergone radiotherapy were included in this study. Before radiotherapy, each patient underwent CT simulation and lung perfusion imaging with single photon emission computed tomography （SPECT）. The SPECT images were registered with simulation planning CT and used to contour functional lung （lung-F） and non-functional lung （lung-NF）. Two 3DCRT plans and two IMRT plans were designed and compared in each patient： two anatomic plans using simulation CT alone and two functional plans using SPECT-CT in addition to the simulation CT. Dosimetric parameters of the four types of plans were compared in terms of tumor coverage and avoidance of normal tissues. Total radiation dose was set at 66 Gy （2 Gyx33 fractions）. Results In incorporating perfusion information in 3DCRT and IMRT planning, the reductions on average in the mean doses to the functional lung in the functional plan were 168 cGy and 89 cGy, respectively, compared with those in the anatomic plans. The median reductions in the percentage of volume irradiated with 〉5 Gy, 〉10 Gy, 〉20 Gy, 〉30 Gy and 〉40 Gy for functional lung in the functional plans were 6.50%, 10.21%, 14.02%, 22.30% and 23.46% in 3DCRT planning, respectively, and 3.05%, 15.52%, 14.16%, 4.87%, and 3.33% in IMRT planning, respectively. No greater degree of sparing of the functional lung was achieved in functional IMRT than in 3DCRT. Conclusion Function-guided 3DCRT and IMRT plannings both appear to be effective in preserving functional lung in NSCLC patients.展开更多
目的:与计算机断层摄影术肺动脉造影(CTPA)比较,探讨双源计算机断层摄影术(CT)双能量肺灌注成像(DEPI)对肺栓塞的诊断价值。方法:49例疑似肺栓塞患者进行DEPI扫描,最终19例CTPA确诊肺栓塞的患者纳入研究。以80 k V的数据得到CTPA图像,...目的:与计算机断层摄影术肺动脉造影(CTPA)比较,探讨双源计算机断层摄影术(CT)双能量肺灌注成像(DEPI)对肺栓塞的诊断价值。方法:49例疑似肺栓塞患者进行DEPI扫描,最终19例CTPA确诊肺栓塞的患者纳入研究。以80 k V的数据得到CTPA图像,采用肺灌注成像软件(Lung PBV)后处理得到DEPI图像,以肺段为单位观察CTPA图像上肺栓塞的位置、类型,DEPI图像上肺灌注缺损的位置及形态,并对两者的类型进行相关性分析,计算CTPA与DEPI诊断肺栓塞的一致性,并对不一致的原因进行分析。结果:380个肺段,CTPA检出162个肺段有肺栓塞,DEPI检出155个肺段有灌注缺损或降低,部分型肺栓塞主要为斑点状、斑片状灌注缺损或无缺损,完全型肺栓塞则以段或亚段分布的灌注缺损为主,两者存在相关性(χ2=305.5,P=0.000)。CTPA与DEPI诊断肺栓塞的符合率为83.42%,KAPPA系数值为0.659。结论:DEPI的表现与CTPA上肺栓塞的程度及类型有关,两者联合有助于肺栓塞的诊断。展开更多
目的探讨心电图T波倒置在急性肺血栓栓塞症(APE)患者危险评估中的临床应用价值。方法回顾性研究1999年5月—2006年12月我科收治的确诊为APE患者65例。内容包括:(1)一般临床资料;(2)心电图异常类型及T波倒置导联数;(3)放射性核素肺通气/...目的探讨心电图T波倒置在急性肺血栓栓塞症(APE)患者危险评估中的临床应用价值。方法回顾性研究1999年5月—2006年12月我科收治的确诊为APE患者65例。内容包括:(1)一般临床资料;(2)心电图异常类型及T波倒置导联数;(3)放射性核素肺通气/灌注扫描图像半定量分析及全肺灌注缺损百分数(PPDS);(4)超声心动图测定右心室前后径、肺动脉收缩压(SPAP);(5)动脉血气分析(pH、PaCO2和PaO2);(6)用受试者工作特征(ROC)曲线评估T波倒置导联数预测PPDS>50%和SPAP>50 mm Hg的准确性。结果共40例APE患者纳入本研究,男23例,女17例,年龄19～76岁,平均(51±14)岁。PPDS>50%者21例,SPAP>50 mmHg者13例。心电图T波倒置导联数与核素肺灌注缺损面积呈线性正相关(P<0.01);与血气氧分压呈线性负相关(P<0.05);与肺动脉收缩压呈等级正相关(P<0.01)。以肺灌注缺损大于50%为分界点做出ROC曲线,曲线下面积为0.796。结论心电图T波倒置导联数可以用以预测较大面积的急性肺栓塞。展开更多
文摘目的研究心内直视手术时肺动脉灌注低温保护液,对围体外循环期细胞因子水平的影响。方法60例先天性心脏病患者随机分为肺保护组(n=30)和对照组(n=30),均在体外循环下行心内直视手术,肺保护组体外循环期间肺动脉灌注低温保护液,而对照组不灌注肺低温保护液,其他处理与肺保护组相同。分别于麻醉诱导期、阻断升主动脉后10 m in、开放升主动脉后10 m in、2、12、24 h共6个时点分别采取桡动脉血,测定白介素6(IL-6)、白介素8(IL-8)、白介素10(IL-10)及肿瘤坏死因子α(TNF-α)水平。结果两组患者体外循环后上述参数水平开始升高,升主动脉开放后到达峰值,以后逐渐下降,但24 h仍高于术前(P>0.05),但肺保护组IL-6、IL-8、TNF-α水平在各时间点上升幅度低于对照组(P<0.01或P<0.05),各时间点IL-10水平上升幅度高于对照组(P<0.01)。结论肺动脉灌注低温保护液,能有效地降低围体外循环期损伤性炎性因子IL-6、IL-8、TNF-α的水平,同时增加保护性炎性因子IL-10的表达,从而减轻体外循环心脏手术时机体的炎症反应。
文摘Background The lung functional status could be displayed on lung perfusion images. With the images, the radiotherapy plans of lung cancer could be guided to more optimized. This study aimed to assess quantitatively the impact of incorporating functional lung imaging into 3-dimensional conformal radiotherapy （3DCRT） and intensity-modulated radiation therapy （IMRT） planning for non-small cell lung cancer （NSCLC）. Methods Ten patients with NSCLC who had undergone radiotherapy were included in this study. Before radiotherapy, each patient underwent CT simulation and lung perfusion imaging with single photon emission computed tomography （SPECT）. The SPECT images were registered with simulation planning CT and used to contour functional lung （lung-F） and non-functional lung （lung-NF）. Two 3DCRT plans and two IMRT plans were designed and compared in each patient： two anatomic plans using simulation CT alone and two functional plans using SPECT-CT in addition to the simulation CT. Dosimetric parameters of the four types of plans were compared in terms of tumor coverage and avoidance of normal tissues. Total radiation dose was set at 66 Gy （2 Gyx33 fractions）. Results In incorporating perfusion information in 3DCRT and IMRT planning, the reductions on average in the mean doses to the functional lung in the functional plan were 168 cGy and 89 cGy, respectively, compared with those in the anatomic plans. The median reductions in the percentage of volume irradiated with 〉5 Gy, 〉10 Gy, 〉20 Gy, 〉30 Gy and 〉40 Gy for functional lung in the functional plans were 6.50%, 10.21%, 14.02%, 22.30% and 23.46% in 3DCRT planning, respectively, and 3.05%, 15.52%, 14.16%, 4.87%, and 3.33% in IMRT planning, respectively. No greater degree of sparing of the functional lung was achieved in functional IMRT than in 3DCRT. Conclusion Function-guided 3DCRT and IMRT plannings both appear to be effective in preserving functional lung in NSCLC patients.
文摘目的:与计算机断层摄影术肺动脉造影(CTPA)比较,探讨双源计算机断层摄影术(CT)双能量肺灌注成像(DEPI)对肺栓塞的诊断价值。方法:49例疑似肺栓塞患者进行DEPI扫描,最终19例CTPA确诊肺栓塞的患者纳入研究。以80 k V的数据得到CTPA图像,采用肺灌注成像软件(Lung PBV)后处理得到DEPI图像,以肺段为单位观察CTPA图像上肺栓塞的位置、类型,DEPI图像上肺灌注缺损的位置及形态,并对两者的类型进行相关性分析,计算CTPA与DEPI诊断肺栓塞的一致性,并对不一致的原因进行分析。结果:380个肺段,CTPA检出162个肺段有肺栓塞,DEPI检出155个肺段有灌注缺损或降低,部分型肺栓塞主要为斑点状、斑片状灌注缺损或无缺损,完全型肺栓塞则以段或亚段分布的灌注缺损为主,两者存在相关性(χ2=305.5,P=0.000)。CTPA与DEPI诊断肺栓塞的符合率为83.42%,KAPPA系数值为0.659。结论:DEPI的表现与CTPA上肺栓塞的程度及类型有关,两者联合有助于肺栓塞的诊断。
文摘目的探讨心电图T波倒置在急性肺血栓栓塞症(APE)患者危险评估中的临床应用价值。方法回顾性研究1999年5月—2006年12月我科收治的确诊为APE患者65例。内容包括:(1)一般临床资料;(2)心电图异常类型及T波倒置导联数;(3)放射性核素肺通气/灌注扫描图像半定量分析及全肺灌注缺损百分数(PPDS);(4)超声心动图测定右心室前后径、肺动脉收缩压(SPAP);(5)动脉血气分析(pH、PaCO2和PaO2);(6)用受试者工作特征(ROC)曲线评估T波倒置导联数预测PPDS>50%和SPAP>50 mm Hg的准确性。结果共40例APE患者纳入本研究,男23例,女17例,年龄19～76岁,平均(51±14)岁。PPDS>50%者21例,SPAP>50 mmHg者13例。心电图T波倒置导联数与核素肺灌注缺损面积呈线性正相关(P<0.01);与血气氧分压呈线性负相关(P<0.05);与肺动脉收缩压呈等级正相关(P<0.01)。以肺灌注缺损大于50%为分界点做出ROC曲线,曲线下面积为0.796。结论心电图T波倒置导联数可以用以预测较大面积的急性肺栓塞。
