超声粒子图像测速技术检测左室血流动力学的可行性研究

发布时间：2018-05-29 00:44

本文选题：速度粒子图像测速技术 + 微泡造影　；参考：《中南大学》2014年硕士论文

【摘要】：研究背景：涡流在自然界中无处不在,是流体运动所特有的存在形式。近几十年来流体力学中关于涡流的研究有了较快的发展,使得人类能够模拟显示和测量涡流运动。心腔内的血流运动,因为心脏所特有的电生理和室壁心肌的收缩、舒张等影响,可以表现为复杂的涡流形式。心血管疾病的产生与心腔及动脉血流的流动状况密切相关,其血流动力学改变与失调可以引起心血管系统功能紊乱和各种心血管疾病。目前临床上所使用的常规超声心动图是通过评价室壁运动来反映心脏功能,而对于心腔内的血流动力学变化研究还很少。伴随各种测量技术和观测手段的不断更新发展,心脏的血流动力学研究再次成为研究热点。因此,心血管内血流动力学的研究,对心血管疾病形成的认识有重大意义。目的：探讨超声粒子图像测速技术在左室血流动力学研究中的可行性与可重复性。对象及方法：2013年10月至2014年4月健康体检发现二尖瓣口轻微狭窄患者20例,按照性别、年龄与之相匹配的健康志愿者20例。应用GE LOGIQ E9具备组织谐波、局部放大、电影回放、动态储存功能,能对图像进行自动优化,达到最佳图像。使用4VIC探头,其频率为2.75-4.25MHz。对所选对象进行基础超声心动图检查。并行静脉造影,获取左室三腔心切面血流动态图。使用]hyperflow软件进行脱机分析。每个参数均取三个心动周期平均值。结果：实验组各房室内径与正常组无明显统计学差异,EF、FS、收缩及舒张末期内径与正常组不存在明显统计学差异。其左室涡流参数相对正常组,长度比(涡流长度与左室腔长度的比值)增加,宽度比(涡流宽度与左室腔长度的比值)减小,证明其左室腔内涡流形态较正常组更为扁长,存在统计学差异,深度比(涡流中心相对于左室长轴的位置)增加,即涡流位置更远离二尖瓣口,而更靠近左室中心,存在统计学差异,舒张早期充盈血流峰速加快,消耗的能量更多。结论：通过超声粒子图像测速技术来定量分析正常人与二尖瓣轻微狭窄患者的左室血流状态是可行的。能够在二尖瓣狭窄尚处于功能代偿期、未出现明显临床症状及体征时就检测出血流动力学的改变,并且,这项技术是一种新的无创的、可靠的定量工具,涡流成像可以生动的描述左室血流情况,其对血流动力学的监测分析是传统多普勒超声心动图等技术所无法做到的,这项技术可广泛运用于临床诊断、评价及普查工作中。
[Abstract]:Background: swirl is ubiquitous in nature and is a unique form of fluid motion. The research on eddy current in hydrodynamics has developed rapidly in recent decades, which makes it possible to simulate and measure eddy current motion. The flow of blood in the heart chamber is characterized by electrophysiology and the effects of contraction and relaxation of the ventricular wall, which can be characterized by complex eddy current. The occurrence of cardiovascular diseases is closely related to the flow status of the heart cavity and arterial blood flow, and its hemodynamic changes and disorders can lead to the dysfunction of the cardiovascular system and various cardiovascular diseases. At present, conventional echocardiography is used to evaluate ventricular wall motion to reflect cardiac function, but there are few studies on the changes of intracardiac hemodynamics. With the continuous development of various measurement techniques and observation methods, the research of heart hemodynamics has become a hot topic again. Therefore, the study of cardiovascular hemodynamics has great significance in understanding the formation of cardiovascular disease. Objective: to investigate the feasibility and reproducibility of particle image velocimetry in the study of left ventricular hemodynamics. Participants and methods: from October 2013 to April 2014, 20 patients with mild stenosis of mitral orifice and 20 healthy volunteers matched by gender and age were found. GE LOGIQ E9 has the functions of tissue harmonic, local amplification, movie playback and dynamic storage. It can automatically optimize the image and achieve the best image. The frequency of 4VIC probe is 2.75-4.25MHz. The selected subjects were examined by basic echocardiography. Venography was performed to obtain three-chamber hemodynamic images of left ventricle. Use] hyperflow software for offline analysis. The mean values of three cardiac cycles were taken for each parameter. Results: there was no significant difference in the atrioventricular diameter between the experimental group and the normal group, but there was no significant difference in the systolic and diastolic diameter between the experimental group and the normal group. Compared with the normal group, the length ratio (the ratio of eddy current length to left ventricular cavity length) increased and the width ratio (the ratio of eddy current width to left ventricular cavity length) decreased. There was a statistical difference, and the depth ratio (the vortex center relative to the left ventricular long axis) increased, that is, the eddy current position was farther away from the mitral orifice, and closer to the left ventricular center, there was a statistical difference, and the peak velocity of early diastolic filling was faster. More energy is consumed. Conclusion: it is feasible to quantitatively analyze the left ventricular blood flow in normal subjects and patients with mild mitral stenosis by particle image velocimetry. To be able to detect changes in bleeding dynamics when mitral stenosis is still in a functional compensatory phase, without obvious clinical symptoms and signs, and this technique is a new, noninvasive and reliable quantitative tool. Eddy current imaging can vividly describe the left ventricular blood flow, and its monitoring and analysis of hemodynamics can not be achieved by traditional Doppler echocardiography, which can be widely used in clinical diagnosis, evaluation and general survey.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R541

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