医用光纤压力传感器用于测量食管曲张静脉压力的实验及临床研究

发布时间：2018-05-12 01:26

本文选题：食管和胃静脉曲张 + 测压法　；参考：《安徽医科大学》2016年博士论文

【摘要】：研究背景食管曲张静脉压力增高是导致门脉高压食管静脉曲张破裂出血的关键因素,测量食管曲张静脉压力对于预测曲张静脉出血风险以及评估药物治疗效果具有重要意义。现有的无创性食管曲张静脉测压方法,包括普通压力探头测压法、气囊测压法以及超声内镜引导测压法都是依据血管被刚刚压陷时,血管腔内外压力平衡的原理进行测压。操作者按照自己的经验判断曲张静脉被压陷时刻,计算曲张血管压力,存在主观性,同时由于对设备要求较高,操作过程复杂,因此没有得到大规模应用。近年来,随着光纤技术的发展,光纤压力传感器已经大规模应用于临床进行器官和组织的压力检测,光纤压力传感器具有传统压力传感器所不可比的优点:灵敏度高、响应速度快、重量轻、机械强度高。如果能建立一种基于光纤技术的食管曲张静脉测压技术,利用光纤压力传感器所具备的操作简便,灵敏度高,可靠性强等特点进行食管曲张静脉的贴壁测压,可以提高食管曲张静脉无创测压技术的精确性。目的1.建立碰触式医用光纤食管曲张静脉测压技术;2.通过模拟食管曲张静脉的体外测压实验,验证该项测压技术指标的准确性和可靠性;3.通过杂交犬肠系膜上静脉(等同于门静脉)和下腔静脉的体内测压实验,与有创血压监护仪测量的实际压力值相对照,验证该项测压技术的可操作性和可靠性;4.通过门脉高压症食管静脉曲张患者的体内测压验证,与TIPS术中测量的门静脉压力梯度相对照,评估体内测压的可行性和准确性。材料与方法1.建立碰触式医用光纤食管曲张静脉测压技术,由光纤压力探头、光纤传感器接收装置、电子胃镜图像采集单元以及数据处理终端组成,将光纤压力探头贴壁放置在曲张静脉上能实时记录曲张静脉压力变化曲线图,并能通过软件计算出曲张静脉压力。2.通过体外实验验证医用光纤静脉测压仪的准确性:将光纤压力探头通过胃镜活检通道放置在模拟曲张静脉表面进行贴壁测压。模拟曲张静脉模型有两种不同直径(4 mm,8 mm),分别模拟小、中大食管曲张静脉,模拟血管内充满水并与玻璃水柱相连,通过调节水柱的高度而改变模拟血管内压力。由两名操作者分别进行测压,操作者不知道模拟血管内压力的实际值和测量值,两种不同直径模拟血管的实际压力值范围均在6∽40 mm Hg之间。3.通过动物实验验证医用光纤静脉测压仪的可操作性:在10只杂交犬中选择肠系膜上静脉(压力等同于门静脉)和下腔静脉作为测量血管,将光纤压力传感器测压结果与有创血压监护仪测量的实际压力值相对照,由两名操作者分别进行测压,操作者不知道被测血管压力的实际值和测量值,以验证医用光纤静脉测压仪测压的可操作性和可靠性。通过门脉高压症食管静脉曲张患者的体内测压验证医用光纤静脉测压仪的可行性和准确性:在81例门脉高压症食管静脉曲张患者中,将食道曲张静脉无创测压结果与TIPS术中测量的门静脉压力梯度相对照,同时与有无腹水、不同食管曲张静脉直径以及肝功能Child-Pugh分级相对照,以验证医用光纤静脉测压仪测压的可行性和准确性。结果1.碰触式医用光纤食管曲张静脉测压技术运行稳定,在体外实验、动物实验和体内验证中均顺利完成压力检测;2.体外实验发现,不同直径模拟血管的测压值与实际值之间具有良好相关性(r≥0.998,P0.001),两名操作者分别测量的压力值之间具有良好相关性(r≥0.998,P0.001),模拟血管的直径大小和经验不同的操作者均不影响测压结果;3.动物实验发现,医用光纤静脉测压仪测量的肠系膜上静脉压力值与有创血压测量的实际值之间具有良好相关性(r=0.731,P0.001),两名操作者分别测量的压力值之间具有良好相关性(r=0.757,P0.001),下腔静脉的测量值与有创血压实际值之间具有良好相关性(r=0.862,P0.001),两名操作者分别测量的压力值之间具有良好相关性(r=0.778,P0.001),医用光纤静脉测压仪测量的数值较有创血压监护仪更为精确;4.检测81例门脉高压症患者的食管曲张静脉压力,全部病例均测压成功,没有胸骨后疼痛、食管曲张静脉出血、难以控制的咳嗽及呼吸困难等严重副作用。平均食管曲张静脉压(22.9±4.0 mm Hg)低于TIPS术中测量的门静脉压力梯度(38.0±6.4mm Hg),回归分析表明,食管曲张静脉压力与门静脉压力梯度间具有良好的相关性(r=0.932,P0.001)。有腹水患者(n=56)的食管曲张静脉压力明显高于无腹水患者(n=25)(24.56±4.36 mm Hg vs 15.74±3.92 mm Hg,P0.05),F3粗大血管(n=71)的食道曲张静脉压力值较F2(n=10)的高(23.6±4.8mm Hg vs 19.5±3.7 mm Hg,P0.05)。Child-Pugh分级与食管曲张静脉压力无相关性,Child A级(n=15)患者平均压力为23.5±3.4 mm Hg,Child B+C级(n=66)患者平均压力为22.2±4.1 mm Hg(t=1.09,P=0.28)。结论我们的研究显示,碰触式医用光纤食管曲张静脉测压技术具有较高的准确性与可行性,据此测定的食管曲张静脉压力是预测食管曲张静脉破裂出血的主要危险因素,具有进一步开发应用的潜在价值。
[Abstract]:Background esophageal variceal pressure is the key factor in the bleeding of portal hypertensive esophageal varices. The measurement of esophageal variceal pressure is important for predicting the risk of variceal bleeding and the evaluation of the effect of drug treatment. The existing noninvasive esophageal Zhang Jingmai pressure measurement, including the common pressure probe Pressure measurement, balloon pressure measurement and endoscopic ultrasound guided pressure measurement are all based on the principle of pressure balance between the intravascular cavity and the intravascular pressure when the blood vessel is just pressed. The operator determines the pressure of the varicose veins in the time of the compression of the varicose veins according to his own experience. In recent years, with the development of optical fiber technology, optical fiber pressure sensors have been widely used in clinical organ and tissue pressure detection. Fiber pressure sensors have the advantages of traditional pressure sensors: high sensitivity, quick response, light weight, high mechanical strength. A kind of esophageal variceal pressure measurement technique based on fiber optic technology is established. It is easy to operate, with high sensitivity and high reliability, which can improve the accuracy of esophageal variceal noninvasive pressure measurement technology. Objective 1. to establish touch type medical fiber esophageal varices. Intravenous pressure measurement; 2. the accuracy and reliability of the pressure measurement technique were verified by an in vitro pressure test of a esophageal varicose vein. (3.) the pressure measurement of the superior mesenteric vein (equivalent to the portal vein) and the inferior vena cava in a hybrid dog was compared with the actual pressure measured by a invasive blood pressure monitoring instrument to verify the pressure measurement technique. The maneuverability and reliability of the operation; 4. to evaluate the feasibility and accuracy of the body pressure measurement in the body of the portal hypertensive patients with esophageal varices, compared with the pressure gradient of the portal vein measured in TIPS. Material and method 1. a touch type medical optical fiber esophagus Zhang Jingmai pressure measurement technique was established by the optical fiber pressure probe and fiber. The sensor receiving device, the electronic gastroscope image acquisition unit and the data processing terminal are composed of the optical fiber pressure probe placed on the varicose vein to record the curve of the varicose vein pressure in real time, and the veracity of the varicose vein pressure.2. can be calculated through the software to verify the accuracy of the medical optical fiber vein piezometer through in vitro experiment: The optical fiber pressure probe is placed on the surface of the analogue varicose vein by a gastroscope biopsy channel. The simulated varicose vein model has two different diameters (4 mm, 8 mm), which simulate small, medium and large esophageal varicose veins, simulate the water filled with water in the blood vessel and connect with the glass water column, and change the simulated intravascular pressure by adjusting the height of the water column. Two operators were measured separately, the operator did not know the actual value of the simulated intravascular pressure and the measured values. The actual pressure range of the two different diameters was between 6 and 40 mm Hg.3. through animal experiments to verify the operability of the medical optical fiber vein piezometer. In 10 hybrid dogs, the superior mesenteric vein was selected (pressure). The force is equal to the portal vein) and the inferior vena cava as the measuring blood vessel. The pressure measurement results of the optical fiber pressure sensor are compared with the actual pressure values measured by the invasive blood pressure monitor. The pressure is measured by two operators respectively. The operator does not know the actual value and the measured value of the measured vascular pressure, so as to verify the availability of the pressure measuring instrument of the medical optical fiber venous pressure measuring instrument. Practicality and reliability. The feasibility and accuracy of the medical fiber-optic venous piezometer in patients with esophageal varicose portal hypertension: in 81 patients with portal hypertensive esophageal varices, the results of the esophageal variceal noninvasive pressure are compared with the pressure gradient of the portal vein measured during the TIPS operation, with the presence of the abdomen. Water, the diameter of different esophageal varices and the Child-Pugh classification of liver function, to verify the feasibility and accuracy of the medical optical fiber venous pressure measuring instrument. Results 1. touch type medical fiber-optic esophageal variceal pressure measurement technique was stable, and the pressure detection was successfully completed in the experiment in vitro, in animal experiments and in the body, and 2. in vitro. It was found that there was a good correlation between the measured values of the simulated blood vessels of different diameters and the actual values (r > 0.998, P0.001). The pressure values measured by the two operators had good correlation (r > 0.998, P0.001). The diameter of the simulated blood vessels and the experience of different experience did not affect the results of the pressure measurement; 3. animal experiments found that the medical light was used for medical light. There was a good correlation between the value of the superior mesenteric vein pressure measured by the fibrinometer and the actual value of the invasive blood pressure measurement (r=0.731, P0.001). There was a good correlation between the pressure values measured by two operators (r=0.757, P0.001). There was a good correlation between the measured values of the inferior vena cava and the actual value of invasive blood pressure (r=0.862, P 0.001) there was a good correlation between the pressure values measured by two operators (r=0.778, P0.001), and the value of the medical fiber venous piezometer was more accurate than that of the invasive blood pressure monitor; 4. the esophageal variceal pressure of 81 patients with portal hypertension was detected. All cases were successfully measured, without post sternal pain and esophageal variceal vein. Severe side effects such as bleeding, uncontrollable cough and dyspnea. Average esophageal variceal venous pressure (22.9 + 4 mm Hg) was lower than that measured in TIPS (38 + 6.4mm Hg). Regression analysis showed a good correlation between the esophageal variceal pressure and the pressure gradient of the portal vein (r=0.932, P0.001). Patients with ascites (n=5). 6) the venous pressure of esophageal varices was significantly higher than that of the patients without ascites (n=25) (24.56 + 4.36 mm Hg vs 15.74 + 3.92 mm Hg, P0.05). The value of the esophageal variceal pressure in F3 large vessels (n=71) was higher than that of F2 (n=10) (23.6 + 4.8mm 19.5 + 3.7), and there was no correlation between the esophageal variceal pressure and the esophageal variceal pressure. The average pressure was 23.5 + 3.4 mm Hg and the average pressure of Child B+C (n=66) patients was 22.2 + 4.1 mm Hg (t=1.09, P=0.28). Conclusion our study showed that the touch type medical fiber-optic esophageal variceal pressure measurement technique has high accuracy and feasibility. The esophageal variceal Zhang Jingmai pressure measured accordingly is the main prediction of the bleeding of esophageal variceal rupture. Risk factors are of potential value for further development and application.

【学位授予单位】：安徽医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R575.2;TP212

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