瞬時波強技術在腎移植患者心血管功能評價中的應用研究
發(fā)布時間：2018-11-08 12:10
【摘要】：目的： 1．應用瞬時波強(Wave Intensity，WI)[1]技術評價腎移植患者心臟與頸動脈血流動力學變化。 2．瞬時波強技術在腎移植患者心臟及頸動脈血流動力學變化無創(chuàng)估測中的價值。 材料和方法： 1.選擇2012年6月至2013年12月期間，在我院腎病內科就診的門診及住院復查腎移植患者32例，男17例，女15例，年齡為19~68歲，平均(43.16士2.32)歲，均為腎移植術后病情穩(wěn)定患者。依據(jù)術后有無并發(fā)癥分為兩組，即有并發(fā)癥組（其中血壓異常7例，血壓＞140/90mmHg；血糖異常6例，空腹血糖≥7.0mmol/l）和無并發(fā)癥組（19例）。正常對照組32例,男性16例，女性16例，年齡為20~65歲，平均(41.22士2.18)歲，經(jīng)檢查均無高血壓、糖尿病、高血脂等。 2.首先選取彩超儀器，要選取裝有WI軟件的α10型彩色多普勒超聲診斷儀，由日本ALOKA公司生產(chǎn)，選擇Adult Heart程序，進行常規(guī)超聲心動圖檢查，于左室長軸切面測量獲得反映左室結構及收縮功能的參數(shù)：收縮末期的左室內徑(LVEDS)、舒張末期的左室內徑(LVEDd)、室間隔舒張末期的厚度(IVST)、左室后壁厚度(PWT)，左室的射血分數(shù)（EF)、左室短軸的縮短率(FS)、每搏量(SV)、心輸出量(CO)；并通過心尖的四腔心切面獲得左室舒張功能相應值（舒張早期與晚期峰值速度E峰、A峰）及E/A。上述所有參數(shù)，要分別測量三次，然后計算平均數(shù)，并記錄數(shù)據(jù)和存儲圖像。進入WI程序后，描記獲得隨心動周期運動的右側頸總動脈管壁的軌跡，，進而得到WI參數(shù)：瞬時加速度波強(Wl， AcceleratingWave Intensity)、負向波面積(NA，NnegativeArea)、瞬時減速度波強(W2，Decelerating Wave Intensity)、動脈彈性參數(shù)—頸動脈僵硬度（β，Stiffness）、血管的壓力-應變彈性系數(shù)（Ep，Contingency coefficient of Pressure）、頸動脈順應性（AC，Compliance）、增大指數(shù)（AI， Augmentation index）、脈搏波傳導速度（PWVβ，Pulse Wave Velocity）等多項WI曲線參數(shù)，分析腎移植患者的WI曲線特征及表現(xiàn)規(guī)律，探討WI技術在無創(chuàng)性評價腎移植患者心臟和動脈系統(tǒng)的血流動力學表現(xiàn)和相互關系方面的應用價值。 結果: (1).一般資料比較:腎移植術后有并發(fā)癥組、腎移植術后無并發(fā)癥組、正常對照組的年齡、身高、體重、體表面積及身體質量指數(shù)差異比較，p0.05，均無統(tǒng)計學意義；腎移植術后有并發(fā)癥組分別與腎移植術后無并發(fā)癥組和正常對照組收縮壓、舒張壓、平均壓的差異比較，p均0.01有顯著意義。 (2).常規(guī)超聲心動圖檢查參數(shù)比較：腎移植術后有并發(fā)癥組分別與腎移植術后無并發(fā)癥組、正常對照組的LVEDS、LVEDd、I VST、PWT指標差異比較，p0.05有統(tǒng)計學意義；腎移植無并發(fā)癥組與正常對照組的LVEDS、LVEDd、I VST、P WT指標差異比較，p0.05無統(tǒng)計學意義；腎移植有并發(fā)癥組、腎移植無并發(fā)癥組、正常對照組EF、FS、SV、CO差異分別比較，p0.05無統(tǒng)計學意義；腎移植有并發(fā)癥組、腎移植無并發(fā)癥組與正常對照組E峰差異比較，p0.05有統(tǒng)計學意義；三組間E/A比值、A峰的差異比較，p0.05無統(tǒng)計學意義。 (3).WI技術各參數(shù)比較：腎移植術后有并發(fā)癥組與腎移植術后無并發(fā)癥組β、Ep、PWVβ均高于對照組,差異有統(tǒng)計學意義(p 0.05)；腎移植術后有并發(fā)癥組W1、W2、NA明顯高于無并發(fā)癥組和對照組,差異有統(tǒng)計學意義(p 0.05)；三組間AC和AI無明顯差異。 結論： WI系統(tǒng)通過實時測量動脈管徑和動脈內血流速度變化，可以在動脈硬化早期，綜合評估動脈管壁的柔韌性和心臟功能，WI技術具有原始數(shù)據(jù)的實時采集、重復性好、無創(chuàng)性、精確度高等優(yōu)點，為臨床篩查、隨訪和評價治療效果提供定量、WI相關數(shù)據(jù)進而得到關于心臟和頸動脈系統(tǒng)之間的相關性，是一種研究腎移植患者客觀的有利依據(jù)，進而為臨床治療提供指導；本文經(jīng)過統(tǒng)計、研究腎移植患者的頸動脈的心功能的全新方法。
[Abstract]:Purpose: 1. The hemodynamics of the heart and the carotid artery in the patients with renal transplantation was evaluated by the wave intensity (WI)[1] technique. changes of the dynamic changes of blood flow in the heart and carotid artery in the patients with renal transplantation The value in the test. Materials and Methods: 1. During the period from June 2012 to December 2013, 32 cases of renal transplantation were reviewed in the clinic and in-hospital of the nephrology department of our hospital. There were 17 males and 15 females. The age ranged from 19 to 68 years. The average was 43. 16 (2. 32) years. The patients with stable condition after renal transplantation were divided into two groups according to the postoperative complications, namely, the complication group (in which the blood pressure was abnormal in 7 cases, the blood pressure was more than 140/ 90mmHg, the blood glucose was abnormal in 6 cases, and the fasting blood glucose was 7.0mmol/ l). and there were no complications (19 cases). The normal control group (n = 32), male (16), female (16), age (20-65), average (41. 22 + 18) years, no high examination. Blood pressure, diabetes, hyperlipidemia, and the like. First, select the color Doppler ultrasound instrument, select the color Doppler ultrasonic diagnostic instrument with the WI software, select the Ault Heart procedure by the Japanese ALOHKA company, conduct routine echocardiogram, and obtain the measurement of the long axis section of the left chamber. Parameters reflecting the structure and contraction function of the left chamber: the left ventricular diameter (LVEDS) at the end of the contraction, the left ventricular diameter (LVEDd) at the end of the diastole, the thickness (IVST) at the end of the interventricular septum, the thickness of the posterior wall of the left chamber (PWT), the ejection fraction (EF) of the left chamber, the shortening of the short axis of the left chamber (FS), each stroke Volume (SV), cardiac output (CO); and the corresponding value of the left ventricular diastolic function (early and late diastolic) is obtained through the four-lumen heart-cut surface of the apex Peak speed E (peak, peak A) and E/ A. All of the above parameters are measured three times and then calculated The average number and the recorded data and stored images were recorded. After entering the WI procedure, the trace of the right neck total artery wall with the motion of the cardiac cycle was obtained, and the WI parameters were obtained: the instantaneous acceleration wave intensity (Wl, the Acceleration Wave Intensity), the negative-to-wave area (NA, NnegativeArea), the instantaneous deceleration wave (W2, Decelerating). Wave Intensity, arterial elasticity parameters, carotid stiffness, arterial compliance (Ep, Conforming efficiency of Pressure), carotid compliance (AC, Compliance), augmentation index (AI, Augmentation index), pulse wave conduction velocity (PWV), Pulse Wave Velo The characteristics of the WI curve and the performance of the kidney transplantation were analyzed, and the blood flow dynamics of the heart and the arterial system in the patients with renal transplantation were evaluated by using the WI technique. performance and mutual relationship The results were as follows: (1): (1) There were no complications after renal transplantation, no complication group after renal transplantation, age, height, body weight, body surface area and body mass of normal control group. There was no significant difference in the index difference and p0.05, and there was no significant difference between the postoperative complication group and the normal control group after the kidney transplantation. average pressure (2) There were no complications after renal transplantation, LVEDS, LVEDd, I VST and PWT in the normal control group were significantly different. Compared with LVEDS, LVEDd, I VST and P WT in the normal control group, there was no statistical significance in p0.05. There were no complications in renal transplantation, no complication group in kidney transplantation, EF, FS, SV and CO in the normal control group, respectively. There was no statistical significance in p0.05. There was no significant difference between the two groups of renal transplantation and the normal control group, and p0.05 was of statistical significance. There was no significant difference in the ratio of A and A. (3) There was no statistical significance in p0.05. (3) Compared with the control group, there was no complication group after renal transplantation, and the difference of Ep and PWV was higher than that in the control group (p <0.05). The incidence of W1, W2 and NA in the complication group was significantly higher than that of the non-complication group and the control group. statistics Conclusion: WI system can evaluate the flexibility and heart function of the arterial wall in the early stage of arteriosclerosis by measuring the arterial diameter and the velocity of the blood flow in the artery in real time. The WI technology has the advantages of real-time acquisition of raw data, good repeatability, no invasive, high accuracy and the like, and provides quantitative and WI-related data for clinical screening, follow-up and evaluation of the treatment effect, so as to obtain the correlation between the heart and the carotid artery system, and is a research and development method. To investigate the objective and beneficial basis of renal transplantation, and to provide clinical treatment
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.2;R54
本文編號：2318468
[Abstract]:Purpose: 1. The hemodynamics of the heart and the carotid artery in the patients with renal transplantation was evaluated by the wave intensity (WI)[1] technique. changes of the dynamic changes of blood flow in the heart and carotid artery in the patients with renal transplantation The value in the test. Materials and Methods: 1. During the period from June 2012 to December 2013, 32 cases of renal transplantation were reviewed in the clinic and in-hospital of the nephrology department of our hospital. There were 17 males and 15 females. The age ranged from 19 to 68 years. The average was 43. 16 (2. 32) years. The patients with stable condition after renal transplantation were divided into two groups according to the postoperative complications, namely, the complication group (in which the blood pressure was abnormal in 7 cases, the blood pressure was more than 140/ 90mmHg, the blood glucose was abnormal in 6 cases, and the fasting blood glucose was 7.0mmol/ l). and there were no complications (19 cases). The normal control group (n = 32), male (16), female (16), age (20-65), average (41. 22 + 18) years, no high examination. Blood pressure, diabetes, hyperlipidemia, and the like. First, select the color Doppler ultrasound instrument, select the color Doppler ultrasonic diagnostic instrument with the WI software, select the Ault Heart procedure by the Japanese ALOHKA company, conduct routine echocardiogram, and obtain the measurement of the long axis section of the left chamber. Parameters reflecting the structure and contraction function of the left chamber: the left ventricular diameter (LVEDS) at the end of the contraction, the left ventricular diameter (LVEDd) at the end of the diastole, the thickness (IVST) at the end of the interventricular septum, the thickness of the posterior wall of the left chamber (PWT), the ejection fraction (EF) of the left chamber, the shortening of the short axis of the left chamber (FS), each stroke Volume (SV), cardiac output (CO); and the corresponding value of the left ventricular diastolic function (early and late diastolic) is obtained through the four-lumen heart-cut surface of the apex Peak speed E (peak, peak A) and E/ A. All of the above parameters are measured three times and then calculated The average number and the recorded data and stored images were recorded. After entering the WI procedure, the trace of the right neck total artery wall with the motion of the cardiac cycle was obtained, and the WI parameters were obtained: the instantaneous acceleration wave intensity (Wl, the Acceleration Wave Intensity), the negative-to-wave area (NA, NnegativeArea), the instantaneous deceleration wave (W2, Decelerating). Wave Intensity, arterial elasticity parameters, carotid stiffness, arterial compliance (Ep, Conforming efficiency of Pressure), carotid compliance (AC, Compliance), augmentation index (AI, Augmentation index), pulse wave conduction velocity (PWV), Pulse Wave Velo The characteristics of the WI curve and the performance of the kidney transplantation were analyzed, and the blood flow dynamics of the heart and the arterial system in the patients with renal transplantation were evaluated by using the WI technique. performance and mutual relationship The results were as follows: (1): (1) There were no complications after renal transplantation, no complication group after renal transplantation, age, height, body weight, body surface area and body mass of normal control group. There was no significant difference in the index difference and p0.05, and there was no significant difference between the postoperative complication group and the normal control group after the kidney transplantation. average pressure (2) There were no complications after renal transplantation, LVEDS, LVEDd, I VST and PWT in the normal control group were significantly different. Compared with LVEDS, LVEDd, I VST and P WT in the normal control group, there was no statistical significance in p0.05. There were no complications in renal transplantation, no complication group in kidney transplantation, EF, FS, SV and CO in the normal control group, respectively. There was no statistical significance in p0.05. There was no significant difference between the two groups of renal transplantation and the normal control group, and p0.05 was of statistical significance. There was no significant difference in the ratio of A and A. (3) There was no statistical significance in p0.05. (3) Compared with the control group, there was no complication group after renal transplantation, and the difference of Ep and PWV was higher than that in the control group (p <0.05). The incidence of W1, W2 and NA in the complication group was significantly higher than that of the non-complication group and the control group. statistics Conclusion: WI system can evaluate the flexibility and heart function of the arterial wall in the early stage of arteriosclerosis by measuring the arterial diameter and the velocity of the blood flow in the artery in real time. The WI technology has the advantages of real-time acquisition of raw data, good repeatability, no invasive, high accuracy and the like, and provides quantitative and WI-related data for clinical screening, follow-up and evaluation of the treatment effect, so as to obtain the correlation between the heart and the carotid artery system, and is a research and development method. To investigate the objective and beneficial basis of renal transplantation, and to provide clinical treatment
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.2;R54
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