本文選題：超聲 + 助顯劑　； 參考：《泰山醫(yī)學(xué)院》2014年碩士論文

【摘要】：研究目的:觀察肝硬化患者門、脾靜脈內(nèi)徑、流速、流量,肝、脾動脈內(nèi)徑、阻力指數(shù)、搏動指數(shù)、門脈高壓指數(shù)等參數(shù)的變化特點,并經(jīng)腹胃充盈超聲觀察肝硬化食管胃壁厚度及曲張靜脈的內(nèi)徑,探討肝硬化門脈高壓患者以上各參數(shù)與食管胃靜脈曲張程度及破裂出血風(fēng)險的關(guān)系,以期找出預(yù)測肝硬化門脈高壓食管胃靜脈曲張破裂出血的簡單易行的方法。資料與方法:咸陽市中心醫(yī)院傳染科及消化內(nèi)科2013年4月至2014年3月住院及門診的肝硬化病人67例(均為乙肝后肝硬化),其中男性37例,女30例,年齡29~71歲,平均年齡47歲。根據(jù)有無食管靜脈曲張破裂出血病史分為出血組35例(52.2%),患者有一次或多次食管靜脈曲張破裂病史;未出血組32例(47.8%)。根據(jù)其食管靜脈曲張程度又分為無、輕度、中度和重度四組。隨機選擇經(jīng)臨床、實驗室及影像學(xué)檢查無任何肝病的健康志愿者20例,其中男性10例,女10例,年齡18~35歲,平均年齡25歲。采用PHILIPS i U22超聲診斷儀對所有受檢者行腹部超聲檢查,經(jīng)右肋緣下縱斜切掃查門靜脈主干(PV)及肝右動脈(HA),測量點在主干距左、右分支1~2cm處;右側(cè)臥位在左側(cè)第9~11肋間靠近腋后線上脾門處掃查脾靜脈(SV)及脾動脈(SA),測量點在距脾門0.5-1.0cm處測量。在平靜呼吸狀態(tài)下,分別測量門靜脈內(nèi)徑(Dpv)、時間平均最大流速(Vpv)、血流量(Qpv),肝動脈內(nèi)徑(Dha)、收縮期流速(HAmax)、舒張期流速(HAmin)、阻力指數(shù)(HARI)、搏動指數(shù)(HAPI),脾靜脈內(nèi)徑(Dsv)、時間平均最大流速(Vsv)、血流量(Qsv),脾動脈內(nèi)徑(Dsa)、收縮期流速(SAmax)、舒張期流速(SAmin)、阻力指數(shù)(SARI)、搏動指數(shù)(SAPI),以上參數(shù)均測量3次,取其平均值,并計算門脈高壓指數(shù)(PHI)。然后患者飲胃腸造影劑500ml(湖州東亞產(chǎn)胃腸超聲助顯劑),患者右側(cè)臥位,于腹部正中偏左顯示腹主動脈,再顯示食管下段及胃底,測量食管胃底壁厚度(Degw)及曲張靜脈內(nèi)徑(Degv)。超聲檢查前了解肝硬化患者的肝功能、血常規(guī)及有無肝性腦病等情況。患者行超聲檢查之前或之后都要進行胃鏡檢查,按食管胃靜脈曲張形態(tài)及出血危險程度分輕、中、重3級。應(yīng)用SPSS13.0軟件包進行統(tǒng)計分析,肝硬化組與正常對照組各測量參數(shù)的比較采用獨立樣本t檢驗,結(jié)果以均數(shù)±標準差(sx±)表示,各參數(shù)與胃鏡曲張程度分級的相關(guān)性分析采用Spearman等級相關(guān),各參數(shù)與超聲所測食管胃靜脈曲張程度的相關(guān)性分析采用Pearson相關(guān),食管胃曲張靜脈內(nèi)徑各等級劃分的截斷值及其敏感性和特異性運用受試者運籌特性曲線(ROC)求得,計數(shù)資料食管胃靜脈曲張不同程度組的出血率比較采用卡方檢驗。結(jié)果:1.肝硬化患者組的Dpv、Qpv、Dsv、Qsv、Degw、Degv、Dha、HARI、HAPI、Dsa、SARI、SAPI、PHI等參數(shù)明顯高于正常對照組,Vpv、HAmin明顯低于正常對照組,而肝硬化患者組Vsv、HAmax、SAmax、SAmin等參數(shù)與正常對照組比較均無明顯差異。2.肝硬化患者組Dpv、Dsv與胃鏡分級間有弱相關(guān)性,Degw、Degv有明顯相關(guān)性,而Vpv、Qpv、Vsv、Qsv、Dha、HAmax、HAmin、HARI、HAPI、Dsa、SAmax、SAmin、SARI、SAPI、Qsv/Qpv、PHI與胃鏡分級間均無明顯相關(guān)性。3.肝硬化患者組Dpv與Degv之間有弱相關(guān)性,Dsv、Degw與Degv之間有明顯相關(guān)性,而Vpv、Qpv、Vsv、Qsv、Dha、HAmax、HAmin、HARI、HAPI、Dsa、SAmax、SAmin、SARI、SAPI、Qsv/Qpv、PHI與Degv之間均無明顯相關(guān)性。4.根據(jù)內(nèi)鏡分度標準,將患者分為無、輕、中、重度四組,運用受試者運籌特性曲線(ROC)求出區(qū)分輕度與中度、中度與重度曲張靜脈內(nèi)徑的截斷值,以3.00mm和5.75mm分別作為劃分的截斷值,其敏感性和特異性分別為87.5%、91.7%和94.9%、89.3%。以超聲截斷值為標準將所有患者分為無、輕、中、重度四組,結(jié)果與內(nèi)鏡分度比較,得出超聲診斷食管胃靜脈曲張符合率分別為:66.7%、71.4%、78.6%、92.5%。5.肝硬化食管靜脈曲張重度組患者出血發(fā)生率為72.5%,明顯高于輕度及中度組。結(jié)論:1.肝硬化患者組的Dpv、Qpv、Dsv、Qsv、Degw、Degv、Dha、HARI、HAPI、Dsa、SARI、SAPI、PHI等參數(shù)可明顯增大,Vpv、、HAmin兩參數(shù)可明顯降低,而肝硬化患者組Vsv、HAmax、SAmax、SAmin等參數(shù)無明顯變化。肝硬化患者Degv與胃鏡分級有明顯相關(guān)性,Dpv、Dsv、Degw與Degv及胃鏡分級間也有相關(guān)性。2.超聲造影診斷食管胃靜脈曲張時,以3.00mm和5.75mm分別作為劃分輕度與中度、中度與重度曲張靜脈內(nèi)徑的截斷值,其敏感性和特異性分別為87.5%、91.7%和94.9%、89.3%。3.經(jīng)腹胃充盈超聲造影診斷食管胃靜脈曲張總體符合率為:85.1%。對于重度食管胃靜脈曲張的診斷準確率更是高達92.5%,重度組的出血率明顯高于其他兩組,達到72.5%,故經(jīng)腹胃充盈超聲造影對預(yù)測食管胃靜脈曲張破裂出血有一定的臨床價值,并可減少上消化道內(nèi)鏡的檢查,值得臨床推廣應(yīng)用。
[Abstract]:Objective: To observe the changes of the diameter, flow rate, flow rate, internal diameter of the liver, splenic artery, resistance index, pulsatile index and portal hypertension index, and to observe the thickness of the esophageal and gastric wall and the internal diameter of the varicose veins in the liver cirrhosis. The relationship between the degree of varicosity and the risk of rupture and hemorrhage in order to find out the simple and easy way to predict the bleeding of esophageal and gastric varices in the portal hypertension. Data and methods: 67 cases of liver cirrhosis in the hospital of Xianyang Central Hospital and the Department of gastroenterology from April 2013 to March 2014 (all are post hepatitis B cirrhosis). There were 37 males and 30 females, aged 29~71 years, with an average age of 47 years old. According to the history of bleeding bleeding from esophageal varices, the bleeding group was divided into 35 cases (52.2%), the patient had a history of one or more esophageal varices rupture, 32 cases in the non bleeding group (47.8%). According to the degree of esophageal varices, the patients were divided into no, mild, moderate, and severe four groups. 20 healthy volunteers, including 10 males and 10 females, aged 18~35, with an average age of 25 years old, were selected by clinical, laboratory and imaging examination without any liver disease. All the subjects were examined by PHILIPS I U22 ultrasonic diagnostic apparatus, and the measured points were measured in the right rib of the portal vein (PV) and the right hepatic artery (HA) through the right rib margin. The trunk was located at the left and right branches at 1~2cm, and the right lateral position was detected in the splenic vein (SV) and the splenic artery (SA) at the splenic portal near the axillary line at the left 9~11 intercostal intercostal line. The measurement points were measured at the 0.5-1.0cm of the splenic portal. In the quiet breathing state, the portal vein diameter (Dpv), the time average maximum velocity (Vpv), the blood flow (Qpv), the hepatic artery diameter (Dha), and the contraction were measured. Phase flow velocity (HAmax), diastolic velocity (HAmin), resistance index (HARI), pulsatile index (HAPI), spleen vein diameter (Dsv), time average maximum velocity (Vsv), blood flow (Qsv), spleen artery diameter (Dsa), systolic flow velocity (SAmax), diastolic velocity (SAmin), resistance index (SARI), pulsatile index (SAPI)), the above parameters were measured 3 times, and the mean value was taken, and the mean value was measured, and the mean value was measured, and the mean value was measured, and the mean value was measured, and the mean value was measured, and the mean value was measured, and the mean value was taken, and the mean value was taken, and the mean value was taken, and the mean value was taken and counted The patient drank the portal hypertension index (PHI). Then the patient drank the gastrointestinal contrast agent 500ml (Huzhou East Asian gastrointestinal ultrasound AIDS), the right lateral position of the patient, the abdominal aorta in the middle of the abdomen, the lower esophagus and the fundus of the stomach, the thickness of the gastric fundus wall (Degw) and the variceal diameter (Degv). The liver function of the patients with liver cirrhosis before ultrasonic examination was understood. The patients had to undergo gastroscopy before or after ultrasound examination. According to the esophageal and gastric varices and the risk of bleeding, the patients were divided into 3 grades. The SPSS13.0 software package was used for statistical analysis. The independent sample t test was used for the comparison of the measured parameters of the liver cirrhosis group and the normal control group. Results the correlation analysis between the parameters and the degree of gastroscope varicosity was related to the correlation analysis between the parameters and the degree of gastroscope varicosity (SX +). The correlation between the parameters and the degree of esophageal gastric varices measured by ultrasound was related to the correlation of Pearson, the truncated values of each grade of the internal diameter of the esophagogastric varicose veins, and the sensitivity and specific use of the esophagogastric varicose veins. The bleeding rate of different degree group of esophageal and gastric varices in counting data was compared with chi square test. Results: the parameters of Dpv, Qpv, Dsv, Qsv, Degw, Degv, Dha, HARI, HAPI, Dsa, SARI, Qpv in the 1. cirrhosis patients were significantly higher than those in the normal control group, and the liver cirrhosis patients were significantly lower than those of the normal control group. The parameters of Vsv, HAmax, SAmax, SAmin were not significantly different from those in the normal control group, and there was no significant correlation between the Dpv in the patients with.2. liver cirrhosis, and there was a weak correlation between the Dsv and the gastroscopy. There is a weak correlation between Dpv and Degv, and there is a significant correlation between Dsv, Degw and Degv, while Vpv, Qpv, Vsv, Qsv, Dha, HAmax, there are no obvious correlations between them. The patients are divided into no, light, medium, and severe groups according to the standard of endoscopy. ROC was used to distinguish between mild and moderate, moderate to severe varicose veins, with 3.00mm and 5.75mm as truncated values respectively. The sensitivity and specificity were 87.5%, 91.7% and 94.9% respectively. 89.3%. was divided into four groups: No, light, medium, severe, and the results were compared with the endoscopy, and the results were compared with the endoscopy. The coincidence rate of ultrasonic diagnosis of esophageal and gastric varices was 66.7%, 71.4%, 78.6%, and the incidence of hemorrhage in the severe esophageal varices of 92.5%.5. cirrhosis was 72.5%, which was significantly higher than that of the mild and moderate groups. Conclusion: 1. liver cirrhosis patients' Dpv, Qpv, Dsv, Qsv, Degw, Degv, Dha, HARI, HAPI, Dsa, SARI, etc. The two parameters could be significantly reduced, while the parameters of Vsv, HAmax, SAmax, and SAmin were not significantly changed in the patients with liver cirrhosis. There was a significant correlation between Degv and gastroscope classification in the patients with liver cirrhosis. Dpv, Dsv, Degw and Degv and gastroscopy were also associated with.2. ultrasonography in the diagnosis of esophageal and gastric varices, and 3.00mm and 5.75mm were used as mild and moderate respectively. The sensitivity and specificity of degrees and severe varicose veins were 87.5%, 91.7% and 94.9% respectively. The total coincidence rate of 89.3%.3. for the diagnosis of esophagogastric varices was as high as 92.5% for severe esophageal varices, and the bleeding rate in severe group was significantly higher than that of the other two groups. It is 72.5%, so it has certain clinical value to predict esophageal and gastric variceal bleeding, and can reduce the examination of upper gastrointestinal endoscopy. It is worthy of clinical application.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2;R445.1

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