本文關(guān)鍵詞：經(jīng)陰道實(shí)時(shí)三維子宮輸卵管造影中YZ-800造影劑注射裝置的應(yīng)用　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 造影劑 振動(dòng)頻率 逆流 峰值壓力 不孕癥 子宮輸卵管超聲造影

【摘要】：目的探討經(jīng)陰道實(shí)時(shí)三維子宮輸卵管造影(transvaginal ultrasound real time three-dimensional hysterosalpingo-contrast sonography,TVS RT 3D-HyCoSy)中YZ-800造影劑注射裝置的臨床應(yīng)用價(jià)值。材料與方法1.研究對(duì)象1.1實(shí)驗(yàn)研究選擇24只健康新西蘭兔,雌雄不限,體質(zhì)量2.0～2.5 kg。實(shí)驗(yàn)動(dòng)物的提供是廣州軍區(qū)廣州總醫(yī)院動(dòng)物實(shí)驗(yàn)中心,動(dòng)物許可證號(hào)碼為SYXK(粵)2014-0100。實(shí)驗(yàn)的批準(zhǔn)是廣州軍區(qū)廣州總醫(yī)院實(shí)驗(yàn)動(dòng)物倫理委員會(huì)。健康新西蘭兔被隨機(jī)分為兩組,一組是對(duì)照組(= 6),一組是實(shí)驗(yàn)組(= 18),實(shí)驗(yàn)組依不同振動(dòng)頻率分為3個(gè)亞組,分別是60 Hz、90 Hz、120 Hz,每組6只。1.2臨床研究選擇我院婦產(chǎn)科門(mén)診及輔助生殖中心從2015年1月～2016年2月行TVS RT 3D-HyCoSy不孕癥患者498例,年齡約20～44歲,平均約(29.8±4.5)歲。不孕時(shí)間約1～8年,平均約(3.3±2.7)年,其中原發(fā)性不孕214例,繼發(fā)性不孕284例。所有入組患者根據(jù)中國(guó)超聲醫(yī)師協(xié)會(huì)的納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),于月經(jīng)干凈后3～7 d行TVS RT 3D-HyCoSy,全部入組患者簽署子宮輸卵管造影信息卡及子宮輸卵管造影知情同意書(shū)。2.儀器與造影劑2.1儀器超聲儀器:采用GE L0GIQ E9彩色多普勒超聲診斷儀,9L-D線陣探頭,中心頻率6～9 MHz,機(jī)械指數(shù)0.14。GE Voluson E8彩色多普勒超聲診斷儀,RIC 5-9-D經(jīng)腔容積探頭,中心頻率5.0～9.0MHZ,179°掃描扇角、120°容積角,機(jī)械指數(shù)0.12～0.18。實(shí)驗(yàn)儀器:采用YZ-800造影劑注射裝置,具有振動(dòng)式卡座及實(shí)時(shí)振動(dòng)和測(cè)壓功能,振動(dòng)頻率范圍為60Hz～120Hz,檢測(cè)壓力范圍為0～90 kPa。2.2超聲造影劑采用意大利Bracco公司SonoVue,內(nèi)含有六氟化硫氣體59mg,凍干粉末25mg,使用前注入5ml生理鹽水配制震蕩成微泡混懸液,配制完成后放置備用,造影時(shí)抽取20ml超聲造影劑(由5ml微泡混懸液與生理鹽水混合配制成)。3.研究方法3.1實(shí)驗(yàn)研究實(shí)驗(yàn)兔麻醉依據(jù)1 mL/kg靜脈注入3%戊巴比妥鈉,麻醉成功后并備皮,取其仰臥位固定,通過(guò)耳緣靜脈置入24 G留置針,建立靜脈注射通道。進(jìn)入預(yù)先設(shè)置的實(shí)驗(yàn)兔條件,常規(guī)二維超聲掃查兔肝臟,避開(kāi)大血管,選擇劍突下肝臟觀察部位并標(biāo)記。配制超聲造影劑并將其置于YZ-800造影劑注射裝置的振動(dòng)卡座上,根據(jù)實(shí)驗(yàn)分組分別選擇無(wú)振動(dòng)和實(shí)驗(yàn)組,實(shí)驗(yàn)組分為60 Hz、90 Hz、120 Hz振動(dòng)檔位。啟動(dòng)二維灰階造影鍵,對(duì)照組和60 Hz、90 Hz、120 Hz亞組分別在6個(gè)時(shí)間段(5、10、15、20、25、30 min)經(jīng)兔耳緣靜脈團(tuán)注造影劑0.5 mg/kg,隨后尾推1 mL 0.9%氯化鈉溶液。全部造影數(shù)據(jù)存儲(chǔ)于儀器硬盤(pán),后期分析。造影圖像的分析采用時(shí)間-強(qiáng)度曲線(time-intensity curve,TIC),將感興趣區(qū)域(R0I)放置兔肝實(shí)質(zhì)內(nèi),面積大概0.5～1.0 cm2,時(shí)間強(qiáng)度曲線采用伽馬擬合方式,獲得兔肝灌注TIC曲線。在圖像進(jìn)行分析時(shí)需連續(xù)3次檢測(cè)峰值強(qiáng)度(peak-intensity,PI),取其平均值,分析過(guò)程中感興趣區(qū)域的取樣容積、取樣部位、取樣深度盡可能保持一致。3.2臨床研究對(duì)498例不孕癥婦女實(shí)施TVS RT 3D-HyCoSy,記錄注入造影劑的量及停止注入時(shí)造影劑返流量、注入造影劑壓力數(shù)據(jù)及患者疼痛程度,壓力數(shù)據(jù)為T(mén)VSRT3D-HyCoSy時(shí)的峰值壓力。結(jié)合子宮輸卵管顯影情況、造影劑溢出后盆腔內(nèi)彌散、、注入造影劑量及返流量、造影劑有無(wú)逆流、注入造影劑時(shí)壓力大小和造影過(guò)程中患者的疼痛度綜合綜合評(píng)估輸卵管通暢度,分析不同輸卵管通暢度的TVS RT 3D-HyCoSy時(shí)的峰值壓力、逆流的發(fā)生率及造影過(guò)程中不良反應(yīng)發(fā)生率,并比較峰值壓力和逆流發(fā)生率差異。4.統(tǒng)計(jì)學(xué)方法應(yīng)用SPSS 15.0醫(yī)學(xué)統(tǒng)計(jì)學(xué)軟件。計(jì)量資料用均數(shù)士標(biāo)準(zhǔn)差表示,方差不齊,采用采用welch檢驗(yàn);方差齊,采用多重因素方差分析。定性資料采用χ2檢驗(yàn)。P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果1.實(shí)驗(yàn)兔:與對(duì)照組相比,90Hz亞組平均PI值差異有統(tǒng)計(jì)學(xué)意義(P0.05);120Hz亞組平均PI值差異有統(tǒng)計(jì)學(xué)意義(P0.05);60Hz亞組平均PI值比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。與60Hz亞組相比,120Hz亞組平均PI值比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);90Hz亞組平均PI值比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。與90Hz亞組相比,120Hz亞組平均PI值比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)照組和90Hz亞組中5、10、15、20 min之間PI值比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)照組和90Hz亞組中25、30mim之間PI值比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.不孕癥患者中雙側(cè)輸卵管通暢、雙側(cè)輸卵管通而不暢、雙側(cè)輸卵管阻塞的造影劑推注峰值壓力分別為(22.47±5.96)kPa,(37.24土8.83)kPa,(44.64±7.73)kPa,三組間峰值壓力比較差異有統(tǒng)計(jì)學(xué)意義(P0.01)。498例患者中,總的逆流發(fā)生率26.30%,其中雙側(cè)輸卵管通暢、雙側(cè)輸卵管通而不暢、雙側(cè)輸卵管阻塞的逆流發(fā)生率分別為18.13%,30.21%,43.59%。無(wú)或輕、中、重度不良反應(yīng)分別為88.80%,10.80%,0.40%。結(jié)論1.采用造影劑注射裝置機(jī)械振動(dòng)超聲造影劑,在振動(dòng)頻率90 Hz、30 min內(nèi)兔肝臟灌注PI值穩(wěn)定,能維持較好的增強(qiáng)效果。2.在TVS RT 3D-HyCoSy中采用YZ-800造影劑注射裝置監(jiān)測(cè)并緩慢保持相對(duì)低壓狀態(tài)推注造影劑,量化子宮輸卵管灌注壓力,可減少造影中逆流的發(fā)生,便于連續(xù)性采集輸卵管圖像和后期觀察分析圖像;提高了患者檢查的舒適度,有利于TVS RT 3D-HyCoSy順利實(shí)施。該造影劑注射裝置操作簡(jiǎn)單,臨床實(shí)用性強(qiáng),值得臨床上推廣使用。
[Abstract]:Objective to evaluate the value of transvaginal real-time three-dimensional hysterosalpingography (transvaginal ultrasound real time three-dimensional hysterosalpingo-contrast sonography, TVS RT 3D-HyCoSy) YZ-800 contrast agent injection device for clinical application. Materials and methods 1. subjects 1.1 experimental study of 24 healthy New Zealand rabbits, male or female, weighing 2 to 2.5 kg. experimental animal is to provide animal experimental center of Genenral Hospital of PLA Guangzhou Military Area, the animal license number for SYXK (Guangdong) 2014-0100. experiment is the experimental animal ethics committee approved the Genenral Hospital of PLA Guangzhou Military Area. Healthy New Zealand rabbits were randomly divided into two groups, one group is the control group (n = 6), a group of experimental group (n = 18), experimental group according to different vibration frequency 3 sub groups were 60 Hz, 90 Hz, 120 Hz, 6 rats in each group.1.2 clinical study in our hospital obstetrics and gynecology clinic and assisted reproductive center from 2 015 years from January to February 2016 for TVS RT 3D-HyCoSy in 498 cases of infertility, age about 20 to 44 years old, an average of about (29.8 + 4.5) years old. The duration of infertility is about 1 ~ 8 years, an average of about (3.3 + 2.7) years, including 214 cases of primary infertility and secondary infertility in 284 cases. All groups the patients according to the inclusion Chinese Association sonographer criteria and exclusion criteria, in menstrual clean after 3 ~ 7 d TVS RT 3D-HyCoSy, all the patients signed the hysterosalpingography information card and hysterosalpingography informed consent.2. instrument and contrast 2.1 instrument using GE L0GIQ ultrasonic instrument: E9 color Doppler ultrasound diagnostic instrument 9L-D, linear array probe, a center frequency of 6 MHz to 9 Voluson, mechanical index 0.14.GE E8 color Doppler ultrasound diagnostic instrument, RIC 5-9-D by volume probe, the center frequency of 5 ~ 9.0MHZ, 179 ~ 120 DEG volume scanning fan angle, angle, mechanical index of 0.12 ~ 0.18. experimental instrument using YZ-800 The contrast agent injection device with vibration type deck and real-time vibration and pressure, vibration frequency range is 60Hz ~ 120Hz, pressure detection range is 0 ~ 90 kPa.2.2 ultrasound contrast agent used in Italy Bracco company SonoVue, containing six sulfur hexafluoride gas 59mg, freeze-dried powder 25mg, before using injection of 5ml saline solution into micro shock bubble suspension, prepared after placed standby, angiography extraction of 20ml ultrasound contrast agents (by 5ml microbubbles suspension and normal saline was prepared by mixing.3.) research methods experimental study 3.1 anesthetized rabbits on the basis of the 1 mL/kg intravenous injection of 3% pentobarbital sodium, after the success of anesthesia and skin preparation, the supine fixed. Through the ear vein inserted 24 G intravenous indwelling needle, a set of experimental rabbits. The channel condition into conventional two-dimensional ultrasound scan of rabbit liver, avoid large vessels, select the xiphoid and labeled with liver observation site. Preparation of ultrasound contrast agent and its vibration card is placed in the YZ-800 contrast agent injection device, on the basis of the experimental group were selected without vibration and experimental group. The experimental group was divided into 60 Hz, 90 Hz, 120 Hz vibration gear. Two dimensional gray-scale contrast start button, the control group and 60 Hz, 90 Hz, 120 Hz sub group in 6 time periods (5,10,15,20,25,30 min) by rabbit ear vein bolus 0.5 mg/kg 1 mL 0.9%, then push the tail Sodium Chloride Solution. All the data stored on the hard disk imaging instrument, post analysis. Analysis of angiographic images by time intensity curve (time-intensity, curve, TIC), the region of interest (R0I) placed in the hepatic parenchyma, an area of about 0.5 ~ 1 cm2, time intensity curve with gamma curve fitting method, to obtain rabbit liver perfusion TIC curve. 3 consecutive detection in image analysis of peak intensity (peak-intensity, PI), the average value of interest in the process of analysis The sample volume, the sampling position, sampling depth as far as possible to maintain the consistent implementation of TVS RT 3D-HyCoSy.3.2 clinical study on 498 cases of infertile women, record injection of contrast quantity and injection of contrast agent to stop backflow, contrast agent injection pressure data and pain degree, peak pressure data is TVSRT3D-HyCoSy. Combined with uterine tube development. Dispersion of pelvic contrast overflow after injection of contrast dose and return flow, contrast agents have no current, injected contrast agent comprehensive syndrome pressure and the pain degree during the examination and assessment of tubal patency, analysis of the peak pressure of different tubal patency of the TVS RT 3D-HyCoSy. The incidence rate of adverse reactions and imaging process countercurrent, and compare the peak pressure and reflux incidence differences of.4. statistical methods using SPSS 15 software. The measurement of medical statistics With the mean + standard deviation, homogeneity of variance, by using Welch test; variance analysis, the multiple factor variance. Qualitative data using.P0.05 2 test for the difference was statistically significant. Results of the 1. experimental rabbits: compared with control group, 90Hz subgroup average PI value difference was statistically significant (P0.05); 120Hz subgroup average PI value difference was statistically significant (P0.05); 60Hz group average PI value comparison, no statistically significant difference (P0.05). Compared with 60Hz subgroup, 120Hz subgroup average PI value comparison, the difference was statistically significant (P0.05); 90Hz group average PI value comparison, the difference was not statistically significant (P0.05). Compared with 90Hz subgroup, 120Hz subgroup average PI value comparison, the difference was statistically significant (P0.05). Group 90Hz and subgroup 5,10,15,20 min between the PI value comparison, no statistically significant difference (P0.05) between 90Hz and 25,30mim group; subgroup PI value comparison, difference There was statistical significance (P0.05). The.2. of bilateral tubal infertility patients, bilateral salpingitis, bilateral fallopian tube obstruction contrast agent bolus peak pressure respectively (22.47 + 5.96) kPa, (37.24 + 8.83) kPa, (44.64 + 7.73) kPa, the three groups have significant peak the pressure difference (P0.01) of.498 patients, the total reflux incidence 26.30%, including bilateral tubal patency, bilateral salpingitis, bilateral fallopian tube obstruction, reflux incidence were 18.13%, 30.21%, 43.59%. or light, respectively, the severe adverse reaction was 88.80%, 10.80%, 0.40%. conclusion 1. by contrast agent injection device of mechanical vibration in the vibration frequency of ultrasound contrast agent, 90 Hz, 30 min in rabbit liver perfusion PI value is stable and can maintain good strengthening effect of.2. in TVS RT 3D-HyCoSy using YZ-800 contrast agent injection device monitoring and maintain a relatively low state pushed slowly Injection of contrast agent, quantification of uterus and fallopian tube perfusion pressure, can reduce the contrast in the flow reversal, and later to facilitate image observation and analysis of the continuity of image acquisition fallopian tube; improve patient comfort, is conducive to the smooth implementation of TVS RT 3D-HyCoSy. The contrast agent injection device has simple operation, clinical practicability, and is worthy of promotion the use of clinical practice.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R711.6;R445.1
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本文編號(hào)：1419900