本文選題：橈動(dòng)脈心內(nèi)膜下心肌活力率 + 頸動(dòng)脈心內(nèi)膜下心肌活力率　； 參考：《安徽醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的 首次提出一項(xiàng)無創(chuàng)評(píng)估心臟供血能力的新指標(biāo)：橈動(dòng)脈SEVR，并將從橈動(dòng)脈壓力波形直接獲取的心內(nèi)膜下心肌活力率（簡稱：橈動(dòng)脈SEVR）與從頸動(dòng)脈壓力波形直接獲取的心內(nèi)膜下心肌活力率（簡稱：頸動(dòng)脈SEVR）進(jìn)行相關(guān)性分析從而驗(yàn)證此指標(biāo)的有效性，而后進(jìn)一步評(píng)估橈動(dòng)脈心內(nèi)膜下心肌活力率的重復(fù)性，為臨床應(yīng)用與研究提供依據(jù)。 方法 橈動(dòng)脈SEVR的有效性研究中選擇200例20～74歲的健康人作為受試對(duì)象，其中男性99人，女性101人，將表面張力傳感器分別置于左側(cè)頸動(dòng)脈及橈動(dòng)脈動(dòng)脈搏動(dòng)最強(qiáng)處，連續(xù)記錄12s穩(wěn)定的橈動(dòng)脈及頸動(dòng)脈脈搏波，取所有波形的平均值，通過儀器自動(dòng)分析獲取頸動(dòng)脈SEVR和橈動(dòng)脈SEVR值；在橈動(dòng)脈SEVR的重復(fù)性研究中，選擇30名24～59歲的健康受試者，由兩名受過專業(yè)訓(xùn)練的操作人員分別對(duì)受試對(duì)象進(jìn)行橈動(dòng)脈SEVR的測量，24h后由第一操作者再次進(jìn)行一次測量，，獲取四次測量的橈動(dòng)脈SEVR值，并進(jìn)行橈動(dòng)脈SEVR的組內(nèi)重復(fù)性、組間重復(fù)性和day-to-day重復(fù)性分析。 結(jié)果 有效性研究中，盡管頸動(dòng)脈SEVR比橈動(dòng)脈SEVR更高，但是橈動(dòng)脈SEVR與頸動(dòng)脈SEVR仍然高度相關(guān)（r=0.81，P＜0.001）。男性的橈動(dòng)脈SEVR明顯比女性更高。多元線性逐步回歸分析顯示：心率、年齡、脈壓差、收縮壓是橈動(dòng)脈SEVR的獨(dú)立影響因素，其中心率與橈動(dòng)脈SEVR成負(fù)相關(guān)。重復(fù)性研究中，同一觀察者兩次測量、兩位觀察者以及day-to-day測量的兩次SEVR的平均不同（±2標(biāo)準(zhǔn)差）分別為：1.34±26.84，1.09±23.02，-0.15±41.52，Bland Altman圖顯示橈動(dòng)脈SEVR的組內(nèi)、組間、day-to-day測量值間均具有良好的一致性；組內(nèi)相關(guān)系數(shù)ICC值分別為0.898，0.929，0.775，均大于0.75，顯示具有很好的重復(fù)性；配對(duì)t檢驗(yàn)中P＞0.05，四次測量間差異無統(tǒng)計(jì)學(xué)意義。 結(jié)論 首次提出了橈動(dòng)脈SEVR這個(gè)指標(biāo)，并通過對(duì)不同年齡段健康人群進(jìn)行測量研究發(fā)現(xiàn)橈動(dòng)脈SEVR與頸動(dòng)脈SEVR具有高度相關(guān)性（r=0.81，P＜0.001），橈動(dòng)脈SEVR不需要任何轉(zhuǎn)換功能，可以直接用來評(píng)價(jià)頸動(dòng)脈SEVR，并且心率、性別、脈壓、收縮壓對(duì)于橈動(dòng)脈SEVR的影響幾乎與頸動(dòng)脈SEVR是一樣的，表明了橈動(dòng)脈SEVR與頸動(dòng)脈SEVR提供了相似的信息，橈動(dòng)脈SEVR可以替代頸動(dòng)脈SEVR用來進(jìn)行冠脈灌注的評(píng)估。橈動(dòng)脈SEVR的組內(nèi)、組間以及day-to-day重復(fù)性研究中均提示具有很好的重復(fù)性。因此橈動(dòng)脈SEVR可以作為評(píng)估心血管系統(tǒng)疾病的一項(xiàng)主要指標(biāo)，其易操作且有效性及重復(fù)性、可靠性好，可進(jìn)一步應(yīng)用到老年人以及心血管疾病患者的臨床試驗(yàn)中，從而為心血管疾病的早期發(fā)現(xiàn)、干預(yù)及治療進(jìn)行指導(dǎo)。
[Abstract]:Purpose For the first time, a new non-invasive index for evaluating cardiac blood supply capacity was proposed: SEVRR of radial artery, and the ratio of myocardial activity directly obtained from pressure waveform of radial artery (SEVRR) and carotid pressure waveform (SEVR) were obtained directly. In order to verify the validity of this index, the correlating analysis of the subendocardial myocardial viability rate (SEVR) of the carotid artery was carried out. The repeatability of myocardial activity under endocardium of radial artery was further evaluated to provide evidence for clinical application and research. Method In the study of the effectiveness of radial artery SEVR, 200 healthy subjects aged 20 to 74 years were selected as subjects, including 99 males and 101 females. The surface tension sensors were placed in the left carotid artery and radial artery to the strongest pulsatility, respectively. The pulse waves of the radial artery and the carotid artery were recorded continuously for 12 s, and the mean values of all the waveforms were taken, and the SEVR and SEVR values of the radial artery were obtained by automatic instrument analysis. In the repetitive study of radial SEVR, 30 healthy subjects aged 24 to 59 years were selected. After 24 hours of measurement of radial artery SEVR, the first operator again measured the radial artery SEVR value four times by two trained operators, and performed intra-group repeatability of radial artery SEVR. Analysis of repeatability and day-to-day repeatability between groups. Result In the effectiveness study, although carotid SEVR was higher than radial SEVR, radial SEVR was still highly correlated with carotid SEVR (P < 0.001). Radial artery SEVR was significantly higher in men than in women. Multiple linear stepwise regression analysis showed that heart rate, age, pulse pressure difference and systolic pressure were independent influencing factors of radial artery SEVR, in which heart rate was negatively correlated with radial artery SEVR. In the reproducible study, the average difference (鹵2 standard deviation) of SEVR between the two observers and the two day-to-day measurements was 1. 34 鹵26. 84 鹵1. 09 鹵23. 02 鹵0. 15 鹵41. 52 and 1. 9 鹵23. 02 鹵41. 52 Bland / Altman, respectively. There was good agreement between the two groups in the measurement of SEVR in radial artery. The correlation coefficient (ICC) in the group was 0.8980.290.775, which was more than 0.75, which showed good repeatability, but there was no significant difference between the four measurements in the paired t test (P > 0.05). Conclusion The index of radial artery SEVR was put forward for the first time, and it was found that radial artery SEVR was highly correlated with carotid artery SEVR (P < 0.001), and radial artery SEVR did not need any conversion function. It can be directly used to evaluate carotid SEVRs, and the effects of heart rate, sex, pulse pressure, systolic pressure on radial SEVR are almost the same as those on carotid SEVR, suggesting that radial SEVR and carotid SEVR provide similar information. Radial SEVR can be used to evaluate coronary perfusion in place of carotid SEVR. The reproducibility of radial artery SEVR in group, inter-group and day-to-day was demonstrated to be very good. Therefore, radial artery SEVR can be used as a major index for the evaluation of cardiovascular diseases. It is easy to operate, effective and reproducible, and can be further applied to clinical trials in the elderly and patients with cardiovascular disease. So as to the early detection of cardiovascular disease, intervention and treatment of guidance.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R87

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相關(guān)期刊論文 前1條

1 譚靜;華琦;聞靜;邢繡榮;劉榮坤;楊崢;;代謝綜合征與動(dòng)脈僵硬度的關(guān)系[J];中國動(dòng)脈硬化雜志;2006年02期

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