體位及誘發(fā)方式對(duì)超聲評(píng)價(jià)大隱靜脈反流影響的臨床研究
發(fā)布時(shí)間：2018-08-05 15:26
【摘要】：目的： 分析不同體位條件及不同誘發(fā)方式對(duì)超聲評(píng)價(jià)大隱靜脈不同節(jié)段反流的影響情況。 方法： 選取反流大隱靜脈50條（反流組）及健康志愿者大隱靜脈15條（對(duì)照組），在平臥位、整床傾斜20°頭高腳低位、整床傾斜40°頭高腳低位及站立位4種體位條件下，采用Valsalva動(dòng)作法及遠(yuǎn)端肢體袖帶充氣加壓法(對(duì)大隱靜脈小腿引流區(qū)施加100mmHg壓力)來誘發(fā)反流，分別在大隱靜脈隱股交界靜脈瓣下方約2cm處、大腿中段及小腿上段三處采集靜脈反流頻譜，記錄反流時(shí)間及最高反流速度。以站立位袖帶充氣加壓法誘發(fā)的反流時(shí)間大于0.5s作為診斷反流的標(biāo)準(zhǔn)，計(jì)算不同體位條件及不同誘發(fā)方式下大隱靜脈不同節(jié)段的反流誘發(fā)率，并進(jìn)一步比較不同體位及不同加壓方式誘發(fā)反流的反流時(shí)間及最高反流速度與標(biāo)準(zhǔn)檢查間的差異。 結(jié)果： （1）體位對(duì)遠(yuǎn)端肢體加壓法評(píng)估大隱靜脈反流的影響：在對(duì)照組中，平臥位、20°及40°體位均未出現(xiàn)假陽性病例。在反流組中，平臥位檢查大隱靜脈不同節(jié)段時(shí)均有假陰性病例出現(xiàn)，假陰性率分別為59%（19/32）、22%（11/50）、24%（12/50）；20°頭高腳低位、40°頭高腳低位時(shí)，大腿中段及小腿上段大隱靜脈反流誘發(fā)率與站立位一致，誘發(fā)率均為100%（50/50），但在大隱靜脈隱股交界下方約2cm處均出現(xiàn)一定假陰性率，分別為12%（4/32）、12%（4/32）。 （2）體位對(duì)Valsalva動(dòng)作法評(píng)估大隱靜脈反流的影響：對(duì)照組中，隱股交界下方約2cm處大隱靜脈在平臥位及20°頭高腳低位出現(xiàn)假陽性病例，假陽性率均為13.3%（2/15）。反流組中，在四種體位條件下SFJ處均存在假陰性和假陽性，以平臥位假陰性率及假陽性率最高，分別達(dá)到43.75%(14/32)、18.75%(6/32)，40°頭高腳低位的假陰性率及假陽性率最低，均為6.75%(2/32)。MGV及CGV段僅有假陰性病例，假陰性率分別為：MGV-14%(7/50)、8%(4/50)、8%(4/50)、8%(4/50)；CGV-48%(24/50)、52%(26/50)、34%(17/50)、34%(17/50)，無假陽性病例。 （3）體位對(duì)遠(yuǎn)端肢體袖帶充氣加壓法誘發(fā)的反流時(shí)間及最高反流速度的影響：反流組中大腿中段大隱靜脈在站立位、平臥位、20°頭高腳低位、40°頭高腳低位4種體位條件下反流時(shí)間分別為（7.75±3.23）s、（5.27±3.66）s、（8.67±3.72）s、（8.55±3.93）s，差異有統(tǒng)計(jì)學(xué)意義（F=56.9，P＜0.01）；20°及40°體位分別與站立位比較，，差異無統(tǒng)計(jì)學(xué)意義（q=1.51、1.33， P均＞0.05），而平臥位與站立位在反流時(shí)間上的差異有統(tǒng)計(jì)學(xué)意義（q=4.11，P＜0.01）。反流組大腿中段大隱靜脈在站立位、平臥位、20°頭高腳低位、40°腳頭高低位4種體位條件下最高反流速度分別為（55.26±22.24）cm/s、（22.87±12.03）cm/s、（38.46±16.30）cm/s、（45.13±19.21）cm/s，差異亦有統(tǒng)計(jì)學(xué)意義（F=13.7，P＜0.01）；平臥位、20°、40°頭高腳低位條件下的最高反流速度與站立位比較，差異均有統(tǒng)計(jì)學(xué)意義（q=12.71、6.59、3.98，P均＜0.01） 結(jié)論： （1）20°及40°頭高腳低位檢查大隱靜脈中下段反流的準(zhǔn)確性較高，適用于評(píng)估大隱靜脈反流。 （2）Valsalva法不宜作為大隱靜脈反流的誘發(fā)方式。 （3）評(píng)估大隱靜脈反流不宜采用平臥位檢查。 （4）取頭高腳低位遠(yuǎn)端肢體加壓法評(píng)價(jià)大腿中段大隱靜脈，其反流時(shí)間與站立位遠(yuǎn)端肢體加壓法結(jié)果相當(dāng)，最高反流速度雖有差異但有跡可循。
[Abstract]:Objective:
The effects of different postures and different ways of inducing different types of reflux on different segments of great saphenous vein were analyzed.
Method:
50 cases of reflux great saphenous vein (reflux group) and 15 healthy volunteers' great saphenous vein (control group) were used in the supine position, the whole bed tilted 20 degrees head high foot low, the whole bed tilted 40 degrees head low position and the standing position 4 kinds of posture, using the Valsalva action method and the distal limb cuff inflatable pressure method (to apply 100mmHg to the drainage area of the great saphenous vein calf. The reaction time and the highest reflux velocity were recorded at about 2cm below the saphenous vein flap of the saphenous vein of the great saphenous vein and three parts of the middle thigh and upper leg. The reflux time induced by the standing cuff pressure method was greater than 0.5s as the criterion for the diagnosis of reflux, and the conditions of different body positions were calculated and the conditions were calculated. The reflux induced rate of different segments of the great saphenous vein was observed under different inducing modes, and the reflux time and the difference between the highest reflux velocity and the standard examination were further compared between the different body positions and the different compression methods.
Result:
(1) the effect of postural pressure on the large saphenous venous reflux in the distal limb: in the control group, there were no false positive cases in the supine position, 20 degrees and 40 degrees. In the reflux group, false negative cases were found in the different segments of the great saphenous vein, the false negative rate was divided into 59% (19/32), 22% (11/50), 24% (12/50), and 20 degree head low feet. The rate of reflux induced by great saphenous vein in the middle thigh and upper leg of the thigh was the same as that of the standing position, and the induced rate was 100% (50/50), but there were some false negative rates at about 2cm below the saphenous junction of the great saphenous vein, 12% (4/32) and 12% (4/32), respectively.
(2) the effect of the body position on the Valsalva action method to evaluate the reflux of great saphenous vein: in the control group, there were false positive cases in the supine position and 20 degree head low position below the saphenous junction, and the false positive rate was 13.3% (2/15). In the reflux group, there were false negative and false positive in the SFJ position under the four position conditions, and the false negative was negative in the supine position. The rate and false positive rate were the highest, 43.75% (14/32), 18.75% (6/32), the lowest false negative rate and false positive rate in the lower head of the head, all 6.75% (2/32).MGV and CGV only false negative cases, the false negative rates were MGV-14% (7/50), 8% (4/50), 8% (4/50), 8% (4/50), CGV-48% (24/50), 52% (34%), 34% (34%), no false positive. Case.
(3) the effect of body position on the reflux time and the highest reflux velocity induced by the inflatable pressure method of the distal limb cuff: in the reflux group, the great saphenous vein of the middle thigh in the standing position, the supine position, the 20 degree head low position and the 40 degree head low position, the reflux time is (7.75 + 3.23) s, (5.27 + 3.66) s, (8.67 + 3.72) s, (8.55 + 3.93), the difference. There were statistical significance (F=56.9, P < 0.01); there was no statistically significant difference between the position of 20 and 40 degrees (q=1.51,1.33, P > 0.05), while the difference between the horizontal and standing positions was statistically significant (q=4.11, P < 0.01). The large saphenous vein in the middle thigh of the reflux group was in the standing position, the supine position, the 20 [degree head high foot], 40 degrees. The highest reflux velocity was (55.26 + 22.24) cm/s, (22.87 + 12.03) cm/s, (38.46 + 16.30) cm/s and (45.13 + 19.21) cm/s, respectively (F=13.7, P < 0.01), respectively (F=13.7, P < 0.01), and the difference of the highest reflux rate under the lower position of the flat, 40 [degree] height foot was statistically significant (q=12 .71,6.59,3.98, P < 0.01)
Conclusion:
(1) 20 degree and 40 degree head high and low position examination of the middle and lower segment of the great saphenous vein is more accurate, and is suitable for evaluating the great saphenous vein reflux.
(2) the Valsalva method is not suitable for inducing the reflux of the great saphenous vein.
(3) evaluation of great saphenous vein reflux is not suitable for supine position examination.
(4) the great saphenous vein of the middle thigh was evaluated by the compression method of the distal extremities of the lower head of the high foot. The reflux time was equivalent to the result of the pressure method of the distal limb of the standing position, although the highest reflux velocity was different, but there was a trace to follow.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R543.6
[Abstract]:Objective:
The effects of different postures and different ways of inducing different types of reflux on different segments of great saphenous vein were analyzed.
Method:
50 cases of reflux great saphenous vein (reflux group) and 15 healthy volunteers' great saphenous vein (control group) were used in the supine position, the whole bed tilted 20 degrees head high foot low, the whole bed tilted 40 degrees head low position and the standing position 4 kinds of posture, using the Valsalva action method and the distal limb cuff inflatable pressure method (to apply 100mmHg to the drainage area of the great saphenous vein calf. The reaction time and the highest reflux velocity were recorded at about 2cm below the saphenous vein flap of the saphenous vein of the great saphenous vein and three parts of the middle thigh and upper leg. The reflux time induced by the standing cuff pressure method was greater than 0.5s as the criterion for the diagnosis of reflux, and the conditions of different body positions were calculated and the conditions were calculated. The reflux induced rate of different segments of the great saphenous vein was observed under different inducing modes, and the reflux time and the difference between the highest reflux velocity and the standard examination were further compared between the different body positions and the different compression methods.
Result:
(1) the effect of postural pressure on the large saphenous venous reflux in the distal limb: in the control group, there were no false positive cases in the supine position, 20 degrees and 40 degrees. In the reflux group, false negative cases were found in the different segments of the great saphenous vein, the false negative rate was divided into 59% (19/32), 22% (11/50), 24% (12/50), and 20 degree head low feet. The rate of reflux induced by great saphenous vein in the middle thigh and upper leg of the thigh was the same as that of the standing position, and the induced rate was 100% (50/50), but there were some false negative rates at about 2cm below the saphenous junction of the great saphenous vein, 12% (4/32) and 12% (4/32), respectively.
(2) the effect of the body position on the Valsalva action method to evaluate the reflux of great saphenous vein: in the control group, there were false positive cases in the supine position and 20 degree head low position below the saphenous junction, and the false positive rate was 13.3% (2/15). In the reflux group, there were false negative and false positive in the SFJ position under the four position conditions, and the false negative was negative in the supine position. The rate and false positive rate were the highest, 43.75% (14/32), 18.75% (6/32), the lowest false negative rate and false positive rate in the lower head of the head, all 6.75% (2/32).MGV and CGV only false negative cases, the false negative rates were MGV-14% (7/50), 8% (4/50), 8% (4/50), 8% (4/50), CGV-48% (24/50), 52% (34%), 34% (34%), no false positive. Case.
(3) the effect of body position on the reflux time and the highest reflux velocity induced by the inflatable pressure method of the distal limb cuff: in the reflux group, the great saphenous vein of the middle thigh in the standing position, the supine position, the 20 degree head low position and the 40 degree head low position, the reflux time is (7.75 + 3.23) s, (5.27 + 3.66) s, (8.67 + 3.72) s, (8.55 + 3.93), the difference. There were statistical significance (F=56.9, P < 0.01); there was no statistically significant difference between the position of 20 and 40 degrees (q=1.51,1.33, P > 0.05), while the difference between the horizontal and standing positions was statistically significant (q=4.11, P < 0.01). The large saphenous vein in the middle thigh of the reflux group was in the standing position, the supine position, the 20 [degree head high foot], 40 degrees. The highest reflux velocity was (55.26 + 22.24) cm/s, (22.87 + 12.03) cm/s, (38.46 + 16.30) cm/s and (45.13 + 19.21) cm/s, respectively (F=13.7, P < 0.01), respectively (F=13.7, P < 0.01), and the difference of the highest reflux rate under the lower position of the flat, 40 [degree] height foot was statistically significant (q=12 .71,6.59,3.98, P < 0.01)
Conclusion:
(1) 20 degree and 40 degree head high and low position examination of the middle and lower segment of the great saphenous vein is more accurate, and is suitable for evaluating the great saphenous vein reflux.
(2) the Valsalva method is not suitable for inducing the reflux of the great saphenous vein.
(3) evaluation of great saphenous vein reflux is not suitable for supine position examination.
(4) the great saphenous vein of the middle thigh was evaluated by the compression method of the distal extremities of the lower head of the high foot. The reflux time was equivalent to the result of the pressure method of the distal limb of the standing position, although the highest reflux velocity was different, but there was a trace to follow.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R543.6
【共引文獻(xiàn)】
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