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Objective:To investigate the clinical efficacy of three-dimensional speckle tracking imaging in the dynamic evaluation of left ventricular systolic function in patients with pregnancy-induced hypertension.Methods:50 patients with pregnancy-induced hypertension, who received prenatal examination in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2019 to June 2020 and finally gave birth, were included in the observation group. An additional 50 healthy pregnant women who concurrently received prenatal examination were included as controls. All participants underwent routine echocardiography and three-dimensional speckle tracking imaging examinations. Parameters related to left ventricular systolic function were recorded. Routine echocardiography parameters and three-dimensional speckle tracking imaging parameters were compared between the observation and control groups.Results:There were no significant differences in routine echocardiography parameters (including heart rate, left ventricular end-diastolic diameter, interventricular septum thickness in end-diastole, left ventricular posterior wall thickness in diastole, and left ventricular ejection fraction) between before treatment, after treatment, and 3 months after delivery in the observation group, and between observation and control groups before treatment (all P > 0.05). The absolute values of left ventricular global longitudinal strain (LVGLS) [(-18.41 ± 2.23)% vs. (-26.03 ± 2.79)%], left ventricular global circumferential strain (LVGCS) [(31.29 ± 3.09)% vs. (37.45 ± 3.68)%], left ventricular global radial strain (LVGRS) [(-19.37 ± 2.19)% vs. (-24.59 ± 2.74)%], and left ventricular global area peak systolic strain (LVGAS) [(-26.61 ± 3.18)% vs. (-39.23 ± 3.96)%] measured before treatment were significantly lower in the observation group than in the control group ( t = 6.31 -14.87, all P < 0.05). The absolute values of LVGLS, LVGCS, LVGRS, and LVGAS in the observation group were significantly higher after treatment [(-24.79 ± 2.68)%, (35.94 ± 3.25)%, (-22.48 ± 2.41)%, (-37.54 ± 3.38)%] and 3 months after delivery [(-25.64 ± 2.72)%, (36.63 ± 3.47)%, (-23.91 ± 2.69)%, (-38.49 ± 3.64)%] than before treatment ( t = 4.08 - 10.59, P < 0.05). There were no significant differences in LVGLS, LVGCS, LVGRS, and LVGAS between observation group and control groups at each time point studied ( t = 0.47 - 1.19, P = 0.182 - 0.652 > 0.05). The absolute svalues of LVGLS, LVGCS, LVGRS and LVGAS in patients with pregnancy-induced hypertension were positively correlated with left ventricular ejection fraction values ( r = 0.638 - 0.775, P = 0.009 - 0.041 < 0.05). Conclusion:Three-dimensional speckle tracking imaging can be used to dynamically evaluate the impairment of left ventricular systolic function in patients with pregnancy-induced hypertension. This technique helps guide early intervention and prognosis evaluation and has a high clinical application value.
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Objective:To investigate the clinical value of real-time three-dimensional speckle tracking echocardiography in the evaluation of early cardiac function damage in patients with pregnancy induced hypertension.Methods:Sixty-five pregnant women with pregnancy induced hypertension (patient group) and 65 healthy pregnant women (healthy group) who received prenatal examination and delivered between January 2018 and June 2020 in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine were included in this study. The patient and healthy groups were subjected to routine echocardiography and real-time three-dimensional speckle tracking echocardiography at 24-36 and 32-34 weeks of gestation. The imaging parameters of routine echocardiography and real-time three-dimensional speckle tracking echocardiography measured at different periods of gestation were compared between the two groups.Results:At 24-36 weeks of gestation, there were no significant difference in routine echocardiography parameters of the left ventricle between patient and healthy groups ( t = 0.793-1.748; P = 0.129-0.458). Left ventricular diameter (LVD), intra-ventricular septum diastole (IVSD) and left ventricular posterior wall diameter (LVPWD) in the patient group at 32-34 weeks of gestation were (34.97 ± 2.66) mm, (11.96 ± 1.85) mm, (12.07 ± 1.73) mm, respectively, which were significantly greater than those in the healthy group at the same time [(31.56 ± 2.58) mm, (9.17 ± 1.70) mm, (9.23 ± 1.62) mm] and those in the patient group at 24-36 weeks of gestation [(32.36 ± 2.61) mm, (10.15 ± 1.79) mm, (10.19 ± 1.64) mm, t = 5.437, 6.274, 6.319, 3.621, 4.017, 5.241, all P < 0.001]. Left ventricular ejection fraction (LVEF) in the patient group at 32-34 weeks of gestation was (54.36 ± 4.71)%, which was significantly lower than (63.27 ± 5.04)% in the healthy group at the same time and (59.65 ± 4.62) % in the healthy group at 24-36 weeks of gestation ( t = 7.682, 5.483, both P < 0.001). At 24-36 and 32-34 weeks of gestation, the absolute values of real-time three-dimensional speckle tracking echocardiography parameters left ventricular global longitudinal strain, left ventricular global circumferential strain, left ventricular global radial strain and left ventricular global area strain in the patient group were (23.45 ± 2.58)%, (34.09 ± 3.28)%, (22.03 ± 2.31)%, (34.73 ± 3.58)%, (18.63 ± 2.42)%, (30.74 ± 3.07)%, (19.56 ± 2.28)%, (25.85 ± 3.37)%, respectively, which were significantly lower than those in the healthy group [(26.27 ± 2.74)%, (37.62 ± 3.61)%, (24.67 ± 2.59)%, (39.41 ± 3.96)%, (26.10 ± 2.81)%, (37.56 ± 3.64)%, (24.82 ± 2.59)%, (40.16 ± 3.96)%, t = 4.415, 5.013, 4.724, 6.253, 10.736, 8.592, 7.627, 14.319, all P < 0.001]. In patient group, the absolute values of left ventricular global longitudinal strain, left ventricular global circumferential strain, left ventricular global radial strain and left ventricular global area strain at 32-34 weeks of gestation were (18.63 ± 2.42)%, (30.74 ± 3.07)%, (19.56 ± 2.28)%, (25.85 ± 3.37)%], respectively, which were significantly lower than those at 24-36 weeks of gestation [(23.45 ± 2.58)%, (34.09 ± 3.28)%, (22.03 ± 2.31)% (34.73 ± 3.58)%, t = 7.529, 4.785, 5.194, 8.413, all P < 0.001]. Conclusion:Real-time three-dimensional speckle tracking echocardiography is advantageous in identifying the damage to cardiac function over routine echocardiography. Findings from this study provides a great clinical guiding value for protecting the cardiac function of patients with pregnancy induced hypertension.
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Objective:To observe the clinical effect of two-dimensional speckle tracking technique in diagnosis and prognosis evaluation of heart failure with left ventricular ejection fraction preservation.Methods:A total of 64 heart failure patients with reduced left ventricular ejection fraction (HFNEF) and 64 healthy volunteers in the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected from July 2016 to July 2018.Conventional echocardiography and two-dimensional speckle tracking were performed in all subjects.The hemodynamic parameters and strain parameters of two-dimensional speckle tracking were recorded.The differences of conventional echocardiographic parameters and two-dimensional speckle tracking strain parameters in different subjects were analyzed.Results:The E/A (0.79±0.24) and E/E' value (18.93±3.41) in HFNEF patients had statistically significant differences compared with healthy subjects [(1.28±0.35) and (6.84±1.37)] ( t=9.507, 23.294; P=0.000, 0.000). There were no statistically significant differences in HR, LAD, LVD, LVSD, LVPWD, LVEF and LVFS between HFNEF patients [(71.37±5.93)times/min, (35.32±4.37)mm, (47.13±5.01)mm, (9.24±1.76)mm, (9.35±1.82)mm, (63.98±5.37)%, (35.49±4.46)%] and healthy subjects [(70.14±5.28)times/min, (37.64±4.69)mm, (49.26±5.54)mm, (9.39±1.82)mm, (9.48±1.90)mm, (66.35±5.41)%, (34.02±4.17)%] ( t=0.384-1.628; P=0.102-0.564). In HFNEF patients, the anterior septum, anterior wall, posterior wall, inferior wall and posterior wall of apical segment of left ventricle, the inferior wall and posterior wall of papillary muscle and the posterior wall, inferior wall and posterior wall of basal segment, SRs and ROT of left ventricle were significantly lower than those of healthy subjects, while GLS (-13.52±4.18) and GCS (-10.43±3.85) of left ventricle in HFNEF patients were significantly higher than those of healthy subjects [(-19.89±4.61) and (-15.67±4.24)] ( t=8.947~14.063; P=0.000-0.000<0.05). After treatment, the clinical symptoms of HFNEF patients improved significantly in the whole apical segment of left ventricle, inferior and posterior wall of papillary muscle segment, posterior lateral wall, inferior wall, posterior wall SRs and left ventricular GLS, GCS and ROT ( t=7.258-13.193; P=0.000-0.000<0.05). Two-dimensional strain GLS and GC values in HFNEF patients were negatively correlated with E/A values and positively correlated with E/E' value ( r=-0.817, -0.763; P=0.004, 0.012<0.05), while two-dimensional strain ROT results were positively correlated with E/A values and negatively correlated with E/E' values ( r=-0.805, -0.759; P=0.006, 0.014<0.05). Conclusion:Left ventricular systolic function damage has occurred in HFNEF patients.Two-dimensional speckle tracking technique is highly sensitive to the changes of myocardial systolic function for HFNEF patients.It has high clinical value in the diagnosis and prognosis evaluation of HFNEF.Relevant clinical workers should pay attention to it.
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Objective@#To explore the diagnostic value of ultrasound imaging for fetal central nervous system(CNS) malformation in early pregnancy.@*Methods@#From January 2017 to January 2018, a total of 190 cases of CNS malformation in early pregnancy, who were diagnosed by ultrasound imaging in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine were selected to analyze the clinical value of ultrasound imaging in the diagnosis of fetal CNS malformation in early pregnancy.@*Results@#Of the 190 pregnancies, 184 patients had satisfactory median sagittal section of the head and chest, horizontal cross section of the lateral ventricle, long axis of the spine, and cerebellum and posterior fossa pool.In 184 cases, the probability of display from 1 to 11+ 6 weeks was 93.33%, the probability of display from 12 to 12+ 6 weeks was 97.20%, and the probability of display from 13 to 13+ 6 weeks was 97.06%.Compared the display rates of CNS ultrasound examinations at different gestational weeks, the difference was not statistically significant (χ2=0.981, P>0.05). Three cases of 6 cases of CNS malformation diagnosed in early pregnancy were combined with other malformations.One case considered Cantrell's hypothyroidism with CNS malformation, 1 case with left iliac crest and right circumflex, 1 case with median cleft lip and palate, single atrioventricular with pulmonary atresia.The bilateral humerus was missing, in addition, 4 fetuses had an NT value more than 3 mm.The specificity of diagnosis of fetal CNS malformation in early pregnancy was 100.00%, the sensitivity was 85.71%, the specificity was 100.00%, and the positive predictive value was 99.46%.@*Conclusion@#Ultrasound imaging in the diagnosis of fetal CNS malformation in early pregnancy can improve the diagnosis rate and has high clinical value.
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Objective To explore the diagnostic value of ultrasound imaging for fetal central nervous system (CNS) malformation in early pregnancy.Methods From January 2017 to January 2018,a total of 190 cases of CNS malformation in early pregnancy , who were diagnosed by ultrasound imaging in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine were selected to analyze the clinical value of ultrasound imaging in the diagnosis of fetal CNS malformation in early pregnancy.Results Of the 190 pregnancies,184 patients had satisfactory median sagittal section of the head and chest ,horizontal cross section of the lateral ventricle ,long axis of the spine, and cerebellum and posterior fossa pool.In 184 cases,the probability of display from 1 to 11 +6 weeks was 93.33%, the probability of display from 12 to 12 +6 weeks was 97.20%,and the probability of display from 13 to 13 +6 weeks was 97.06%.Compared the display rates of CNS ultrasound examinations at different gestational weeks ,the difference was not statistically significant (χ2 ＝0.981,P＞0.05).Three cases of 6 cases of CNS malformation diagnosed in early pregnancy were combined with other malformations.One case considered Cantrell＇s hypothyroidism with CNS malformation,1 case with left iliac crest and right circumflex , 1 case with median cleft lip and palate , single atrioventricular with pulmonary atresia.The bilateral humerus was missing ,in addition,4 fetuses had an NT value more than 3 mm.The specificity of diagnosis of fetal CNS malformation in early pregnancy was 100.00%,the sensitivity was 85.71%,the specificity was 100.00%, and the positive predictive value was 99.46%.Conclusion Ultrasound imaging in the diagnosis of fetal CNS malformation in early pregnancy can improve the diagnosis rate and has high clinical value.
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Objective To observe the effects of acute normovolemic hemodilution(ANH) plus tranexamic acid on blood loss and blood transfusion in patients with total knee replacement.Methods 98 cases of patients with total knee replacement were divided into ANH group and combination group by computer randomization,49 cases in each group.ANH was performed in ANH group,and ANH plus tranexamic acid was given in combination group.The changes of hemoglobin(Hb),red blood cells deposited(Hct),platelet count(PLT) were observed before and after autologous blood transfusion in two group.The changes of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),D-dimer were observed at preoperative and postoperative in two group.The amount of blood loss and allogeneic blood infusion,the urine volume and the postoperative flow volume were recorded in two groups.Results The average levels of Hb,Hct after autologous blood transfusion in combination group were higher than those in ANH group,the differences were statistically significant(P<0.05).The average level of D-dimer at postoperative in combination group were higher than that in ANH group,the difference was statistically significant(P<0.05).The amounts of blood loss and allogeneic blood infusion,the postoperative flow volume were lower than those in ANH group,the differences were statistically significant(P<0.05).Conclusion The joint application of ANH and tranexamic acid can effectively reduce the amounts of blood loss and allogeneic blood infusion in patients with total knee replacement,and has a certain clinical value.
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Objective To explore the clinical advantages and curative effect of laparoscopic cholecystectomy for acute cholecystitis .Methods The clinical data of 178 cases with acute cholecystitis were retrospectively analyzed.82 cases underwent laparoscopic operation were selected as the laparoscopic group .96 patients underwent open operation treatment were selected as the open operation group .Results In the laparoscopic group ,82 cases were cured,78 cases were successfully completed laparoscopic cholecystectomy ,4 cases were converted to open surgery . The operation time,amount of bleeding,intestinal recovery time,bed time,hospitalization time in the laparoscopic group were (48.2 ±21.7)min,(55.3 ±10.3)mL,(3.2 ±1.4)d,(3.7 ±0.4)h,(6.7 ±0.4)d,which were signifi-cantly lower than (73.8 ±30.2)min,(97.8 ±19.4)mL,(5.4 ±1.3)d,(7.8 ±0.5)h,(11.8 ±1.5)d in the open operation group (t=3.307,2.806,2.582,3.203,2.931,all P<0.05).The incidence rate of complications in the laparoscopic group was 6.4%,which in the open operation group was 8.3%,the difference between the two groups was not statistically significant(χ2 =0.514,P=0.473).Conclusion Laparoscopic cholecystectomy in the treatment of acute cholecystitis is feasible ,safe,and effective,with a strong advantage .