外周動(dòng)脈血流動(dòng)力學(xué)機(jī)制的多普勒超聲研究
發(fā)布時(shí)間：2018-07-14 07:59
【摘要】：目的 1.應(yīng)用多普勒超聲技術(shù)，觀察健康成年人靜息狀態(tài)下肢體動(dòng)脈血流速度曲線與心動(dòng)周期間的關(guān)系，分析血流速度曲線上各主要波形產(chǎn)生的血流動(dòng)力學(xué)原理，，為進(jìn)一步研究加壓實(shí)驗(yàn)可能產(chǎn)生的變化提供參照。 2.利用肢體加壓實(shí)驗(yàn)?zāi)M外周血管血流受阻，探討不同程度血管血流受阻的情況下，多普勒血流速度曲線的變化規(guī)律及其流體力學(xué)原理并將之與外周動(dòng)脈斑塊形成病理狀態(tài)下的多普勒血流速度曲線的變化對(duì)比，以期為外周動(dòng)脈病變的超聲診斷提供有用信息。 3.以前兩項(xiàng)的研究觀察結(jié)果為基礎(chǔ)，以鎖骨下動(dòng)脈粥樣硬化斑塊形成患者為研究對(duì)象，探討血流動(dòng)力學(xué)變化在外周動(dòng)脈血管病變超聲診斷中的應(yīng)用價(jià)值。 方法 1.40例健康志愿者，儀器采用意大利百勝公司的Mylabtwice彩色超聲診斷儀及同步記錄單向?qū)?lián)心電圖。記錄靜息狀態(tài)下肱動(dòng)脈（BA）、橈動(dòng)脈（RA）、股總動(dòng)脈（CFA）和乆動(dòng)脈（POA）的多普勒血流速度曲線（DFC）。連續(xù)測(cè)量3個(gè)心動(dòng)周期的收縮期峰值流速（PSV）、舒張?jiān)缙诜聪蚍逯盗魉伲≒RV）和阻力指數(shù)（RI），取平均值，結(jié)合流體力學(xué)原理分析其血流速度曲線形成原因。 2.受檢者及超聲儀器同前。記錄肢體遠(yuǎn)端分級(jí)加壓(20、40、60、80、100、120mmHg)下BA、RA、CFA和POA及近端分級(jí)加壓(20、40、60、80、100、120mmHg)下BA、RA的多普勒血流速度曲線，連續(xù)測(cè)量3個(gè)心動(dòng)周期的PSV、PRV及RI，取平均值并分析比較，結(jié)合流體力學(xué)原理進(jìn)行血流速度曲線變化機(jī)制分析。 3.1例右側(cè)鎖骨下動(dòng)脈粥樣硬化斑塊患者，經(jīng)體檢、實(shí)驗(yàn)室檢查無(wú)高血壓及糖尿病史，使用德國(guó)西門(mén)子公司的Acusons2000型彩色超聲診斷儀，探查斑塊二維及彩色多普勒血流狀態(tài)，記錄病變遠(yuǎn)端BA、RA的多普勒血流速度曲線，與健康成人及模擬加壓試驗(yàn)后外周動(dòng)脈血流動(dòng)力學(xué)狀態(tài)進(jìn)行對(duì)比分析，結(jié)合流體力學(xué)原理分析其血流速度曲線變化原因。 4.1例先天性左側(cè)雙椎動(dòng)脈畸形合并左側(cè)鎖骨下動(dòng)脈粥樣硬化斑塊患者，使用德國(guó)西門(mén)子公司的Acusons2000型彩色超聲診斷儀，探查兩支椎動(dòng)脈及鎖骨下動(dòng)脈的二維圖像和彩色多普勒血流狀態(tài)，應(yīng)用流體力學(xué)原理分析血流狀態(tài)產(chǎn)生的機(jī)制。 結(jié)果 1.健康成人靜息狀態(tài)下，外周動(dòng)脈多普勒血流速度曲線呈高搏動(dòng)性三相波形，即收縮期快速上升正向尖峰曲線，舒張期早期快速下降反向曲線，舒張中晚期正向低速小波。血流動(dòng)力學(xué)參數(shù)PSV（BA：74.91±9.75cm/s，RA：45.43±5.45cm/s，CFA：116.32±14.87cm/s，POV：70.16±7.14cm/s），PRV（BA：9.23±0.81cm/s，RA：9.02±0.73cm/s，CFA：38.31±4.12cm/s，POA：16.62±2.39cm/s），RI（BA：1.07±0.03，RA：1.10±0.03，CFA：1.29±0.03，POA：1.22±0.04）。 2.遠(yuǎn)端及近端加壓后，多普勒血流速度曲線隨壓力逐級(jí)升高出現(xiàn)規(guī)律性變化，表現(xiàn)為由三相波逐漸變化為兩相波：收縮期血流峰值變化不顯著，舒張期反向血流速度增大，舒張中晚期正向血流逐步減低至消失而后出現(xiàn)反向波。血流動(dòng)力學(xué)參數(shù)比較：遠(yuǎn)端及近端加壓0、40、80、120mmHg前后PRV變化顯著（P0.005），PSV變化不顯著（P0.05）；近端加壓0、40、80、120mmHg后RI值變化不顯著（P0.05），遠(yuǎn)端加壓0、40、80、120mmHg后RI變化顯著（P0.005）。 3.右側(cè)鎖骨下動(dòng)脈粥樣硬化斑塊患者病變處二維圖像顯示局部狹窄，彩色多普勒示五彩樣加速血流，遠(yuǎn)端BA、RA血流呈低速低阻改變，較正常人收縮及舒張中晚期血流速度下降，舒張期早期反向血流消失，阻力指數(shù)降低。 4.左側(cè)鎖骨下動(dòng)脈粥樣硬化斑塊患者近端分支的椎動(dòng)脈未出現(xiàn)“盜血現(xiàn)象”。遠(yuǎn)端分支椎動(dòng)脈閉塞：二維圖像顯示管腔內(nèi)稍低回聲充填，彩色多普勒未見(jiàn)血流信號(hào)。 結(jié)論 1.由于心臟射血具有周期性，血液在動(dòng)脈系統(tǒng)中的流動(dòng)不是連續(xù)的，在舒張期同樣血壓的條件下，阻力小的組織和器官（例如腦組織）有連續(xù)的血流通過(guò)，而阻力大者（例如外周動(dòng)脈）則沒(méi)有。本實(shí)驗(yàn)從多普勒超聲角度證實(shí)了血液在外周動(dòng)脈內(nèi)流動(dòng)的模式。 2.肢體加壓實(shí)驗(yàn)?zāi)M了外周動(dòng)脈阻力變化時(shí)引起的相應(yīng)血管中血流動(dòng)力學(xué)狀態(tài)的改變。在遵守流體力學(xué)基本原理的前提下，隨肢體加壓后血流動(dòng)力學(xué)呈現(xiàn)規(guī)律性變化。舒張?jiān)缙诜聪蜓靼殡S著壓力逐級(jí)增加而增大、舒張中晚期正向血流從有到無(wú)直至反向，這些規(guī)律性的改變進(jìn)一步驗(yàn)證了人體外周動(dòng)脈的血流狀態(tài)。 3.右側(cè)鎖骨下動(dòng)脈斑塊引起血管狹窄性病變，根據(jù)流體力學(xué)原理以及泊肅葉公式，狹窄后管腔壓力降低，血液流速減低，從而引起遠(yuǎn)端動(dòng)脈低壓狀態(tài)，再一次證明了流體力學(xué)原理在人體中的作用。 4.通過(guò)血流動(dòng)力學(xué)原理分析得出，左側(cè)鎖骨下動(dòng)脈斑塊患者近端椎動(dòng)脈血流方向正常的原因是遠(yuǎn)端椎動(dòng)脈必然存在狹窄或閉塞，多普勒超聲診斷驗(yàn)證了這一觀點(diǎn)，說(shuō)明多普勒超聲檢查結(jié)合血流動(dòng)力學(xué)原理可以為臨床外周動(dòng)脈疾病的診斷提供幫助。
[Abstract]:objective
1. the relationship between the velocity curve of the arterial blood flow and the cardiac cycle in the resting state of the healthy adults was observed by Doppler ultrasound, and the hemodynamic principle of the main waveforms on the blood flow velocity curve was analyzed to provide reference for the further study of the possible changes in the pressure experiment.
2. the changes in the blood flow velocity curve of Doppler and the principle of fluid mechanics were compared with the changes of the velocity curve of the Doppler blood flow in the pathological state of the peripheral arteries under different blood flow obstruction. Ultrasound diagnosis provides useful information.
3. the application value of hemodynamic changes in the ultrasonic diagnosis of peripheral artery vascular lesions was discussed based on the results of the previous two items and the patients with subclavian atherosclerotic plaque formation.
Method
1.40 healthy volunteers were used to record the Doppler blood flow velocity (DFC) of the humeral artery (BA), the radial artery (RA), the common femoral artery (CFA) and the artery (POA) in the resting state, using the Mylabtwice color ultrasonic diagnostic instrument of Baisheng company and the simultaneous recording of the unidirectional lead electrocardiogram. The peak systolic flow velocity of 3 cardiac cycles was continuously measured. PSV), the reverse peak flow velocity (PRV) and the resistance index (RI) in early diastole were taken, and the average value was calculated. Combined with the principle of fluid mechanics, the cause of the blood flow velocity curve was analyzed.
2. the subjects and ultrasonic instruments were in the same front. The Doppler blood flow velocity curves of BA, RA under BA, RA, CFA, POA and proximal graded compression (20,40,60,80100120mmHg) were recorded under the distal extremities compression (20,40,60,80100120mmHg), and the PSV, PRV and RI of 3 cardiac cycles were measured continuously. The mean values were compared and the blood flow was combined with the principle of fluid mechanics to carry out blood flow. Analysis of the mechanism of velocity curve change.
3.1 patients with right subclavian atherosclerotic plaques were examined without hypertension and diabetes, using the Acusons2000 color ultrasound diagnostic instrument of SIEMENS, Germany, to explore the two-dimensional and color Doppler flow status of plaque, and to record the Doppler velocity curve of the distal BA, RA, and the healthy adult and simulation. The hemodynamic state of peripheral artery after compression test was compared and analyzed, and the reasons for the change of blood flow velocity curve were analyzed combining with the principle of fluid mechanics.
4.1 cases of congenital left double vertebral artery malformation with left subclavian atherosclerotic plaque were used to detect the two-dimensional image of the two vertebral arteries and subclavian arteries and the color Doppler blood flow state by using the Acusons2000 color ultrasonic diagnostic instrument of German SIEMENS company. The mechanism of blood flow state was analyzed by the principle of fluid mechanics.
Result
1. at resting state of healthy adults, the Doppler flow velocity curve of the peripheral artery showed a high pulsating three phase waveform, that is, the rapid increase of the positive peak curve in the systole, the rapid descent of the reverse curve in the early diastolic phase, the low and middle late diastolic low velocity wavelets. The hemodynamic parameters PSV (BA: 74.91 + 9.75cm/s, RA:45.43 + 5.45cm/s, CFA:116.32 14.8) 7cm/s, POV:70.16 + 7.14cm/s), PRV (BA:9.23 + 0.81cm/s, RA:9.02 + 0.73cm/s, CFA:38.31 + 4.12cm/s, POA:16.62 + 2.39cm/s).
2. after the compression of the distal and proximal end, the velocity curve of Doppler's blood flow velocity changes regularly with the pressure step by step, showing that the three phase waves gradually change into two phase waves: the change of the peak blood flow peak is not significant, the velocity of the reverse blood flow in the diastolic phase increases, and the middle and late diastolic blood flow is reduced to the reverse wave. The PRV changes were significant (P0.005) before and after the compression of 0,40,80120mmHg (P0.005), and the changes of PSV were not significant (P0.05). The RI value of the proximal 0,40,80120mmHg was not significant (P0.05), and the RI changed significantly (P0.005) after the distal compression of 0,40,80120mmHg.
3. the two-dimensional image of the lesions of the right subclavicular atherosclerotic plaque showed local stenosis, color Doppler showed five color accelerated blood flow, the distal BA, RA blood flow showed low velocity and low resistance change, compared with the normal and the middle and late diastolic blood flow velocity, the early diastolic reverse blood flow disappeared, and the resistance index decreased.
4. left subclavicular atherosclerotic plaques had no "blood theft" in the proximal branch of the vertebral artery. The distal branch of the vertebral artery occlusion: a two-dimensional image showed a slightly hypoechoic filling in the lumen, and no blood flow signals were found in color Doppler.
conclusion
1. the flow of blood in the arterial system is not continuous because of the circulation of the blood in the arterial system. In the condition of the same blood pressure in the diastolic phase, the small resistance tissues and organs (such as the brain tissue) have continuous flow of blood, while the large resistance (such as the peripheral artery) is not. This experiment confirmed the blood in the peripheral artery from the Doppler ultrasound angle. Internal flow pattern.
The 2. limb pressure experiment simulated the changes of the hemodynamic state in the corresponding blood vessels caused by the change of the peripheral arterial resistance. Under the premise of complying with the basic principle of fluid mechanics, the hemodynamics changes regularly with the pressure of the limbs. The early diastolic blood flow increased with the pressure step by step, and the middle and late diastolic blood flow was diastolic blood. From the flow to the opposite and the reverse, these regular changes further verify the peripheral blood flow of the human body.
3. the atherosclerotic plaque of the right subclavian artery causes vascular stenosis. According to the principle of hydrodynamics and Poisson's formula, the pressure of the lumen is reduced and the blood flow velocity is reduced after the stenosis, which causes the low pressure of the distal artery, and again proves the role of the principle of hydrodynamics in the human body.
4. through the analysis of the principle of hemodynamics, the reason for the normal flow direction of the proximal vertebral artery in the left subclavian artery plaque patients is the inevitable stenosis or occlusion of the distal vertebral artery. The Doppler ultrasound diagnosis confirms this view, indicating that the Doppler ultrasound examination combined with the principle of blood flow mechanics can be used for the diagnosis of clinical peripheral artery disease. The break provides help.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R445.1;R543.5
本文編號(hào)：2120992
[Abstract]:objective
1. the relationship between the velocity curve of the arterial blood flow and the cardiac cycle in the resting state of the healthy adults was observed by Doppler ultrasound, and the hemodynamic principle of the main waveforms on the blood flow velocity curve was analyzed to provide reference for the further study of the possible changes in the pressure experiment.
2. the changes in the blood flow velocity curve of Doppler and the principle of fluid mechanics were compared with the changes of the velocity curve of the Doppler blood flow in the pathological state of the peripheral arteries under different blood flow obstruction. Ultrasound diagnosis provides useful information.
3. the application value of hemodynamic changes in the ultrasonic diagnosis of peripheral artery vascular lesions was discussed based on the results of the previous two items and the patients with subclavian atherosclerotic plaque formation.
Method
1.40 healthy volunteers were used to record the Doppler blood flow velocity (DFC) of the humeral artery (BA), the radial artery (RA), the common femoral artery (CFA) and the artery (POA) in the resting state, using the Mylabtwice color ultrasonic diagnostic instrument of Baisheng company and the simultaneous recording of the unidirectional lead electrocardiogram. The peak systolic flow velocity of 3 cardiac cycles was continuously measured. PSV), the reverse peak flow velocity (PRV) and the resistance index (RI) in early diastole were taken, and the average value was calculated. Combined with the principle of fluid mechanics, the cause of the blood flow velocity curve was analyzed.
2. the subjects and ultrasonic instruments were in the same front. The Doppler blood flow velocity curves of BA, RA under BA, RA, CFA, POA and proximal graded compression (20,40,60,80100120mmHg) were recorded under the distal extremities compression (20,40,60,80100120mmHg), and the PSV, PRV and RI of 3 cardiac cycles were measured continuously. The mean values were compared and the blood flow was combined with the principle of fluid mechanics to carry out blood flow. Analysis of the mechanism of velocity curve change.
3.1 patients with right subclavian atherosclerotic plaques were examined without hypertension and diabetes, using the Acusons2000 color ultrasound diagnostic instrument of SIEMENS, Germany, to explore the two-dimensional and color Doppler flow status of plaque, and to record the Doppler velocity curve of the distal BA, RA, and the healthy adult and simulation. The hemodynamic state of peripheral artery after compression test was compared and analyzed, and the reasons for the change of blood flow velocity curve were analyzed combining with the principle of fluid mechanics.
4.1 cases of congenital left double vertebral artery malformation with left subclavian atherosclerotic plaque were used to detect the two-dimensional image of the two vertebral arteries and subclavian arteries and the color Doppler blood flow state by using the Acusons2000 color ultrasonic diagnostic instrument of German SIEMENS company. The mechanism of blood flow state was analyzed by the principle of fluid mechanics.
Result
1. at resting state of healthy adults, the Doppler flow velocity curve of the peripheral artery showed a high pulsating three phase waveform, that is, the rapid increase of the positive peak curve in the systole, the rapid descent of the reverse curve in the early diastolic phase, the low and middle late diastolic low velocity wavelets. The hemodynamic parameters PSV (BA: 74.91 + 9.75cm/s, RA:45.43 + 5.45cm/s, CFA:116.32 14.8) 7cm/s, POV:70.16 + 7.14cm/s), PRV (BA:9.23 + 0.81cm/s, RA:9.02 + 0.73cm/s, CFA:38.31 + 4.12cm/s, POA:16.62 + 2.39cm/s).
2. after the compression of the distal and proximal end, the velocity curve of Doppler's blood flow velocity changes regularly with the pressure step by step, showing that the three phase waves gradually change into two phase waves: the change of the peak blood flow peak is not significant, the velocity of the reverse blood flow in the diastolic phase increases, and the middle and late diastolic blood flow is reduced to the reverse wave. The PRV changes were significant (P0.005) before and after the compression of 0,40,80120mmHg (P0.005), and the changes of PSV were not significant (P0.05). The RI value of the proximal 0,40,80120mmHg was not significant (P0.05), and the RI changed significantly (P0.005) after the distal compression of 0,40,80120mmHg.
3. the two-dimensional image of the lesions of the right subclavicular atherosclerotic plaque showed local stenosis, color Doppler showed five color accelerated blood flow, the distal BA, RA blood flow showed low velocity and low resistance change, compared with the normal and the middle and late diastolic blood flow velocity, the early diastolic reverse blood flow disappeared, and the resistance index decreased.
4. left subclavicular atherosclerotic plaques had no "blood theft" in the proximal branch of the vertebral artery. The distal branch of the vertebral artery occlusion: a two-dimensional image showed a slightly hypoechoic filling in the lumen, and no blood flow signals were found in color Doppler.
conclusion
1. the flow of blood in the arterial system is not continuous because of the circulation of the blood in the arterial system. In the condition of the same blood pressure in the diastolic phase, the small resistance tissues and organs (such as the brain tissue) have continuous flow of blood, while the large resistance (such as the peripheral artery) is not. This experiment confirmed the blood in the peripheral artery from the Doppler ultrasound angle. Internal flow pattern.
The 2. limb pressure experiment simulated the changes of the hemodynamic state in the corresponding blood vessels caused by the change of the peripheral arterial resistance. Under the premise of complying with the basic principle of fluid mechanics, the hemodynamics changes regularly with the pressure of the limbs. The early diastolic blood flow increased with the pressure step by step, and the middle and late diastolic blood flow was diastolic blood. From the flow to the opposite and the reverse, these regular changes further verify the peripheral blood flow of the human body.
3. the atherosclerotic plaque of the right subclavian artery causes vascular stenosis. According to the principle of hydrodynamics and Poisson's formula, the pressure of the lumen is reduced and the blood flow velocity is reduced after the stenosis, which causes the low pressure of the distal artery, and again proves the role of the principle of hydrodynamics in the human body.
4. through the analysis of the principle of hemodynamics, the reason for the normal flow direction of the proximal vertebral artery in the left subclavian artery plaque patients is the inevitable stenosis or occlusion of the distal vertebral artery. The Doppler ultrasound diagnosis confirms this view, indicating that the Doppler ultrasound examination combined with the principle of blood flow mechanics can be used for the diagnosis of clinical peripheral artery disease. The break provides help.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R445.1;R543.5
【參考文獻(xiàn)】
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本文編號(hào)：2120992
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