【摘要】：目的：探討Syngo iFlow軟件評(píng)估下肢動(dòng)脈癥狀性缺血性疾病腔內(nèi)治療前后患肢血流動(dòng)力學(xué)改善情況的可行性和準(zhǔn)確性,及其與傳統(tǒng)臨床療效評(píng)估方法的相關(guān)性。方法：回顧性分析接受介入腔內(nèi)治療40例下肢動(dòng)脈慢化閉塞癥嚴(yán)重下肢缺血患者(男24例,女16例,年齡58-85歲,股胴動(dòng)脈TASC 11 B／C型病變)病歷資料。收集術(shù)前術(shù)后完整的忠肢循環(huán)狀況的評(píng)估資料,包括臨床癥狀體征(疼痛、冷感、跛行)評(píng)估、蹀肱指數(shù)(ABI)、經(jīng)皮氧分壓(TcPO2)測(cè)量等,評(píng)價(jià)手術(shù)療效。運(yùn)用Syngo iFlow對(duì)術(shù)前術(shù)后患肢足踝部TTP值進(jìn)行測(cè)量,評(píng)價(jià)肢端血流動(dòng)力學(xué)改善情況。采集術(shù)前和術(shù)后的股總動(dòng)脈分叉部、胭動(dòng)脈分叉部、踝關(guān)節(jié)水平TTP值以及胭動(dòng)脈分叉部股總動(dòng)脈分叉部、踝關(guān)節(jié)水平與胭動(dòng)脈分叉部之間TTP差值進(jìn)行統(tǒng)計(jì)學(xué)比較。由2名血管介入及影像診斷專科醫(yī)生采用比較評(píng)價(jià)DSAjfSyngo iFlow兩種方法顯示血流和灌注變化信息的質(zhì)量。分別采用t檢驗(yàn)、Wilcixin秩和檢驗(yàn)Spearman等級(jí)相關(guān)分析對(duì)資料進(jìn)行統(tǒng)計(jì)學(xué)分析,評(píng)價(jià)Syngo iFlow口傳統(tǒng)臨床評(píng)估方法對(duì)腔內(nèi)治療前后患肢循環(huán)改善評(píng)估的相關(guān)性及一致性。結(jié)果：40例患者通過(guò)腔內(nèi)治療成功修復(fù)股胭動(dòng)脈段重度狹窄及閉塞病變。術(shù)前傳統(tǒng)臨床方法評(píng)估：疼痛評(píng)分(1.88±1.62)、冷感評(píng)分(2.15±1.25)、跛行評(píng)分(2.90±0.84)、ABI(0.35±0.08)、TcPO2(27.39±5.26 )mmHg:術(shù)后1周內(nèi)評(píng)估：疼痛評(píng)分(0.22±0.42)、冷感評(píng)分(0.23±0.42)、跛行評(píng)分(0.63±0.59)、ABI(0.66±0.07)、TcP02(40.75±3.42)mmmHg,治療前后差異有統(tǒng)計(jì)學(xué)意義(P0.05),顯示患者下肢缺血癥狀均有顯著改善。SyngoiFlow評(píng)估：術(shù)前足踝水平點(diǎn)測(cè)量TTP值(14.54±1.89)s,術(shù)后足踝水平點(diǎn)測(cè)量TTP值(10.40±1.98)s；術(shù)前足踝水平區(qū)域測(cè)量TTP值(20.08±3.05)s,術(shù)后足踝水平區(qū)域測(cè)量TTP值(16.43±2.52)s,治療前后差異有統(tǒng)計(jì)學(xué)意義(P0.05),表明治療后足踝部區(qū)域血流灌注明顯改善。術(shù)前股胭動(dòng)脈TTP差值和胭踝動(dòng)脈TTP差值分別為(6.88±1.90)s、 (8.66±1.79)s,術(shù)后股胭動(dòng)脈TTP差值和胭踝動(dòng)脈TTP差值分別為(4.()5±1.25)、 (7.82±1.87)s,兩處TTP差值減小治療前后差異有統(tǒng)計(jì)學(xué)意義(P0.05),說(shuō)明治療后血流速度增快。Spearman相關(guān)性分析足躁部點(diǎn)測(cè)量ΔTTP和△ ABI、△TcP02之間呈正相關(guān)(r=0.53,0.33,P0.05)：區(qū)域測(cè)量△TTP和△ABI、△TcP02之問(wèn)呈正相關(guān)(r=0.63,0.41,P0.05)。運(yùn)用Syngo iFlowDSA兩種方法評(píng)判血流動(dòng)力學(xué)變化觀察結(jié)果比較,認(rèn)為Syngo Flow圖像觀察質(zhì)量較DSA圖像質(zhì)量?jī)?yōu)秀,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論：Syngo iFlow軟件可以用來(lái)實(shí)時(shí)量化分析下肢動(dòng)脈阻塞性疾病血管成形術(shù)前后的血流動(dòng)力學(xué)變化,其評(píng)估結(jié)果與傳統(tǒng)臨床療效評(píng)估方法具有一致性。
[Abstract]:Objective: to evaluate the feasibility and accuracy of Syngo iFlow software in evaluating hemodynamic improvement of affected limbs before and after endovascular treatment for lower extremity arterial symptomatic ischemic diseases and its correlation with traditional clinical evaluation methods. Methods: the medical records of 40 patients (24 males, 16 females, 58-85 years old with TASC 11 B / C lesions) with lower extremity slow occlusion treated by interventional intracavitary therapy were retrospectively analyzed. The preoperative and postoperative data were collected to evaluate the clinical symptoms and signs (pain, cold feeling, lameness), and the transcutaneous partial pressure of oxygen (TcPO2) to evaluate the outcome of the operation. Syngo iFlow was used to measure the TTP value of foot and ankle before and after operation to evaluate the improvement of hemodynamics. The TTP values of common femoral artery bifurcation, popliteal artery bifurcation, ankle joint level and popliteal artery bifurcation were collected before and after operation. The TTP difference between the common femoral artery bifurcation and popliteal artery bifurcation was statistically compared between the ankle level and the popliteal artery bifurcation. The quality of blood flow and perfusion information was compared and evaluated by two vascular interventional and imaging diagnostics specialists. T test, Wilcixin rank sum test and Spearman grade correlation analysis were used to evaluate the correlation and consistency of the traditional clinical evaluation method of Syngo iFlow mouth in evaluating the improvement of limb circulation before and after intracavitary treatment. Results: 40 patients successfully repaired severe femoral artery stenosis and occlusion by endovascular treatment. Preoperative evaluation of traditional clinical methods: pain score (1.88 鹵1.62), cold sensation score (2.15 鹵1.25), lameness score (2.90 鹵0.84), ABI (, 0.35 鹵0.08), TcPO2 (27.39 鹵5.26) mmHg:, 1 week after operation: pain score (0.22 鹵0.42), cold feeling score (0.23 鹵0.42), limping score (0.63 鹵0.59), ABI (0.66 鹵0.07), TcP02 (40.75 鹵3.42) mmmHg, before and after treatment (P0.05). SyngoiFlow evaluation showed that TTP value was (14.54 鹵1.89) s at ankle level before operation and TTP was (10.40 鹵1.98) s at ankle level after operation. The TTP value in the ankle area before operation was (20.08 鹵3.05) s, and the TTP value in the ankle area after operation was (16.43 鹵2.52) s. The difference before and after treatment was statistically significant (P0.05), which indicated that the blood perfusion in the ankle area was improved significantly after treatment. Preoperative TTP difference of popliteal artery and popliteal artery TTP difference were (6.88 鹵1.90) s, (8.66 鹵1.79) s, postoperatively, TTP difference of popliteal artery and popliteal artery TTP difference were (4.5 鹵1.25), (7.82 鹵1.87) s, respectively. There was significant difference between the two TTP differences before and after treatment (P0.05). Spearman correlation analysis showed that there was a positive correlation between 螖 TTP and ABI, TcP02 (r = 0.53P = 0.33) and a positive correlation between TTP and ABI, TcP02 (r = 0.63n 0.41 P 0.05). The observation results of hemodynamic changes were evaluated by Syngo iFlowDSA, and the results showed that the quality of Syngo Flow images was better than that of DSA images, and the difference was statistically significant. Conclusion: Syngo iFlow software can be used to quantify the hemodynamic changes before and after angioplasty in patients with lower extremity arterial obstructive disease. The evaluation results are consistent with the traditional clinical evaluation methods.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R654.4;R816.2

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