外周动脉血流动力学机制的多普勒超声研究
发布时间：2018-07-14 07:59
【摘要】：目的 1.应用多普勒超声技术，观察健康成年人静息状态下肢体动脉血流速度曲线与心动周期间的关系，分析血流速度曲线上各主要波形产生的血流动力学原理，，为进一步研究加压实验可能产生的变化提供参照。 2.利用肢体加压实验模拟外周血管血流受阻，探讨不同程度血管血流受阻的情况下，多普勒血流速度曲线的变化规律及其流体力学原理并将之与外周动脉斑块形成病理状态下的多普勒血流速度曲线的变化对比，以期为外周动脉病变的超声诊断提供有用信息。 3.以前两项的研究观察结果为基础，以锁骨下动脉粥样硬化斑块形成患者为研究对象，探讨血流动力学变化在外周动脉血管病变超声诊断中的应用价值。 方法 1.40例健康志愿者，仪器采用意大利百胜公司的Mylabtwice彩色超声诊断仪及同步记录单向导联心电图。记录静息状态下肱动脉（BA）、桡动脉（RA）、股总动脉（CFA）和乆动脉（POA）的多普勒血流速度曲线（DFC）。连续测量3个心动周期的收缩期峰值流速（PSV）、舒张早期反向峰值流速（PRV）和阻力指数（RI），取平均值，结合流体力学原理分析其血流速度曲线形成原因。 2.受检者及超声仪器同前。记录肢体远端分级加压(20、40、60、80、100、120mmHg)下BA、RA、CFA和POA及近端分级加压(20、40、60、80、100、120mmHg)下BA、RA的多普勒血流速度曲线，连续测量3个心动周期的PSV、PRV及RI，取平均值并分析比较，结合流体力学原理进行血流速度曲线变化机制分析。 3.1例右侧锁骨下动脉粥样硬化斑块患者，经体检、实验室检查无高血压及糖尿病史，使用德国西门子公司的Acusons2000型彩色超声诊断仪，探查斑块二维及彩色多普勒血流状态，记录病变远端BA、RA的多普勒血流速度曲线，与健康成人及模拟加压试验后外周动脉血流动力学状态进行对比分析，结合流体力学原理分析其血流速度曲线变化原因。 4.1例先天性左侧双椎动脉畸形合并左侧锁骨下动脉粥样硬化斑块患者，使用德国西门子公司的Acusons2000型彩色超声诊断仪，探查两支椎动脉及锁骨下动脉的二维图像和彩色多普勒血流状态，应用流体力学原理分析血流状态产生的机制。 结果 1.健康成人静息状态下，外周动脉多普勒血流速度曲线呈高搏动性三相波形，即收缩期快速上升正向尖峰曲线，舒张期早期快速下降反向曲线，舒张中晚期正向低速小波。血流动力学参数PSV（BA：74.91±9.75cm/s，RA：45.43±5.45cm/s，CFA：116.32±14.87cm/s，POV：70.16±7.14cm/s），PRV（BA：9.23±0.81cm/s，RA：9.02±0.73cm/s，CFA：38.31±4.12cm/s，POA：16.62±2.39cm/s），RI（BA：1.07±0.03，RA：1.10±0.03，CFA：1.29±0.03，POA：1.22±0.04）。 2.远端及近端加压后，多普勒血流速度曲线随压力逐级升高出现规律性变化，表现为由三相波逐渐变化为两相波：收缩期血流峰值变化不显著，舒张期反向血流速度增大，舒张中晚期正向血流逐步减低至消失而后出现反向波。血流动力学参数比较：远端及近端加压0、40、80、120mmHg前后PRV变化显著（P0.005），PSV变化不显著（P0.05）；近端加压0、40、80、120mmHg后RI值变化不显著（P0.05），远端加压0、40、80、120mmHg后RI变化显著（P0.005）。 3.右侧锁骨下动脉粥样硬化斑块患者病变处二维图像显示局部狭窄，彩色多普勒示五彩样加速血流，远端BA、RA血流呈低速低阻改变，较正常人收缩及舒张中晚期血流速度下降，舒张期早期反向血流消失，阻力指数降低。 4.左侧锁骨下动脉粥样硬化斑块患者近端分支的椎动脉未出现“盗血现象”。远端分支椎动脉闭塞：二维图像显示管腔内稍低回声充填，彩色多普勒未见血流信号。 结论 1.由于心脏射血具有周期性，血液在动脉系统中的流动不是连续的，在舒张期同样血压的条件下，阻力小的组织和器官（例如脑组织）有连续的血流通过，而阻力大者（例如外周动脉）则没有。本实验从多普勒超声角度证实了血液在外周动脉内流动的模式。 2.肢体加压实验模拟了外周动脉阻力变化时引起的相应血管中血流动力学状态的改变。在遵守流体力学基本原理的前提下，随肢体加压后血流动力学呈现规律性变化。舒张早期反向血流伴随着压力逐级增加而增大、舒张中晚期正向血流从有到无直至反向，这些规律性的改变进一步验证了人体外周动脉的血流状态。 3.右侧锁骨下动脉斑块引起血管狭窄性病变，根据流体力学原理以及泊肃叶公式，狭窄后管腔压力降低，血液流速减低，从而引起远端动脉低压状态，再一次证明了流体力学原理在人体中的作用。 4.通过血流动力学原理分析得出，左侧锁骨下动脉斑块患者近端椎动脉血流方向正常的原因是远端椎动脉必然存在狭窄或闭塞，多普勒超声诊断验证了这一观点，说明多普勒超声检查结合血流动力学原理可以为临床外周动脉疾病的诊断提供帮助。
[Abstract]:objective
1. the relationship between the velocity curve of the arterial blood flow and the cardiac cycle in the resting state of the healthy adults was observed by Doppler ultrasound, and the hemodynamic principle of the main waveforms on the blood flow velocity curve was analyzed to provide reference for the further study of the possible changes in the pressure experiment.
2. the changes in the blood flow velocity curve of Doppler and the principle of fluid mechanics were compared with the changes of the velocity curve of the Doppler blood flow in the pathological state of the peripheral arteries under different blood flow obstruction. Ultrasound diagnosis provides useful information.
3. the application value of hemodynamic changes in the ultrasonic diagnosis of peripheral artery vascular lesions was discussed based on the results of the previous two items and the patients with subclavian atherosclerotic plaque formation.
Method
1.40 healthy volunteers were used to record the Doppler blood flow velocity (DFC) of the humeral artery (BA), the radial artery (RA), the common femoral artery (CFA) and the artery (POA) in the resting state, using the Mylabtwice color ultrasonic diagnostic instrument of Baisheng company and the simultaneous recording of the unidirectional lead electrocardiogram. The peak systolic flow velocity of 3 cardiac cycles was continuously measured. PSV), the reverse peak flow velocity (PRV) and the resistance index (RI) in early diastole were taken, and the average value was calculated. Combined with the principle of fluid mechanics, the cause of the blood flow velocity curve was analyzed.
2. the subjects and ultrasonic instruments were in the same front. The Doppler blood flow velocity curves of BA, RA under BA, RA, CFA, POA and proximal graded compression (20,40,60,80100120mmHg) were recorded under the distal extremities compression (20,40,60,80100120mmHg), and the PSV, PRV and RI of 3 cardiac cycles were measured continuously. The mean values were compared and the blood flow was combined with the principle of fluid mechanics to carry out blood flow. Analysis of the mechanism of velocity curve change.
3.1 patients with right subclavian atherosclerotic plaques were examined without hypertension and diabetes, using the Acusons2000 color ultrasound diagnostic instrument of SIEMENS, Germany, to explore the two-dimensional and color Doppler flow status of plaque, and to record the Doppler velocity curve of the distal BA, RA, and the healthy adult and simulation. The hemodynamic state of peripheral artery after compression test was compared and analyzed, and the reasons for the change of blood flow velocity curve were analyzed combining with the principle of fluid mechanics.
4.1 cases of congenital left double vertebral artery malformation with left subclavian atherosclerotic plaque were used to detect the two-dimensional image of the two vertebral arteries and subclavian arteries and the color Doppler blood flow state by using the Acusons2000 color ultrasonic diagnostic instrument of German SIEMENS company. The mechanism of blood flow state was analyzed by the principle of fluid mechanics.
Result
1. at resting state of healthy adults, the Doppler flow velocity curve of the peripheral artery showed a high pulsating three phase waveform, that is, the rapid increase of the positive peak curve in the systole, the rapid descent of the reverse curve in the early diastolic phase, the low and middle late diastolic low velocity wavelets. The hemodynamic parameters PSV (BA: 74.91 + 9.75cm/s, RA:45.43 + 5.45cm/s, CFA:116.32 14.8) 7cm/s, POV:70.16 + 7.14cm/s), PRV (BA:9.23 + 0.81cm/s, RA:9.02 + 0.73cm/s, CFA:38.31 + 4.12cm/s, POA:16.62 + 2.39cm/s).
2. after the compression of the distal and proximal end, the velocity curve of Doppler's blood flow velocity changes regularly with the pressure step by step, showing that the three phase waves gradually change into two phase waves: the change of the peak blood flow peak is not significant, the velocity of the reverse blood flow in the diastolic phase increases, and the middle and late diastolic blood flow is reduced to the reverse wave. The PRV changes were significant (P0.005) before and after the compression of 0,40,80120mmHg (P0.005), and the changes of PSV were not significant (P0.05). The RI value of the proximal 0,40,80120mmHg was not significant (P0.05), and the RI changed significantly (P0.005) after the distal compression of 0,40,80120mmHg.
3. the two-dimensional image of the lesions of the right subclavicular atherosclerotic plaque showed local stenosis, color Doppler showed five color accelerated blood flow, the distal BA, RA blood flow showed low velocity and low resistance change, compared with the normal and the middle and late diastolic blood flow velocity, the early diastolic reverse blood flow disappeared, and the resistance index decreased.
4. left subclavicular atherosclerotic plaques had no "blood theft" in the proximal branch of the vertebral artery. The distal branch of the vertebral artery occlusion: a two-dimensional image showed a slightly hypoechoic filling in the lumen, and no blood flow signals were found in color Doppler.
conclusion
1. the flow of blood in the arterial system is not continuous because of the circulation of the blood in the arterial system. In the condition of the same blood pressure in the diastolic phase, the small resistance tissues and organs (such as the brain tissue) have continuous flow of blood, while the large resistance (such as the peripheral artery) is not. This experiment confirmed the blood in the peripheral artery from the Doppler ultrasound angle. Internal flow pattern.
The 2. limb pressure experiment simulated the changes of the hemodynamic state in the corresponding blood vessels caused by the change of the peripheral arterial resistance. Under the premise of complying with the basic principle of fluid mechanics, the hemodynamics changes regularly with the pressure of the limbs. The early diastolic blood flow increased with the pressure step by step, and the middle and late diastolic blood flow was diastolic blood. From the flow to the opposite and the reverse, these regular changes further verify the peripheral blood flow of the human body.
3. the atherosclerotic plaque of the right subclavian artery causes vascular stenosis. According to the principle of hydrodynamics and Poisson's formula, the pressure of the lumen is reduced and the blood flow velocity is reduced after the stenosis, which causes the low pressure of the distal artery, and again proves the role of the principle of hydrodynamics in the human body.
4. through the analysis of the principle of hemodynamics, the reason for the normal flow direction of the proximal vertebral artery in the left subclavian artery plaque patients is the inevitable stenosis or occlusion of the distal vertebral artery. The Doppler ultrasound diagnosis confirms this view, indicating that the Doppler ultrasound examination combined with the principle of blood flow mechanics can be used for the diagnosis of clinical peripheral artery disease. The break provides help.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R543.5
本文编号：2120992
[Abstract]:objective
1. the relationship between the velocity curve of the arterial blood flow and the cardiac cycle in the resting state of the healthy adults was observed by Doppler ultrasound, and the hemodynamic principle of the main waveforms on the blood flow velocity curve was analyzed to provide reference for the further study of the possible changes in the pressure experiment.
2. the changes in the blood flow velocity curve of Doppler and the principle of fluid mechanics were compared with the changes of the velocity curve of the Doppler blood flow in the pathological state of the peripheral arteries under different blood flow obstruction. Ultrasound diagnosis provides useful information.
3. the application value of hemodynamic changes in the ultrasonic diagnosis of peripheral artery vascular lesions was discussed based on the results of the previous two items and the patients with subclavian atherosclerotic plaque formation.
Method
1.40 healthy volunteers were used to record the Doppler blood flow velocity (DFC) of the humeral artery (BA), the radial artery (RA), the common femoral artery (CFA) and the artery (POA) in the resting state, using the Mylabtwice color ultrasonic diagnostic instrument of Baisheng company and the simultaneous recording of the unidirectional lead electrocardiogram. The peak systolic flow velocity of 3 cardiac cycles was continuously measured. PSV), the reverse peak flow velocity (PRV) and the resistance index (RI) in early diastole were taken, and the average value was calculated. Combined with the principle of fluid mechanics, the cause of the blood flow velocity curve was analyzed.
2. the subjects and ultrasonic instruments were in the same front. The Doppler blood flow velocity curves of BA, RA under BA, RA, CFA, POA and proximal graded compression (20,40,60,80100120mmHg) were recorded under the distal extremities compression (20,40,60,80100120mmHg), and the PSV, PRV and RI of 3 cardiac cycles were measured continuously. The mean values were compared and the blood flow was combined with the principle of fluid mechanics to carry out blood flow. Analysis of the mechanism of velocity curve change.
3.1 patients with right subclavian atherosclerotic plaques were examined without hypertension and diabetes, using the Acusons2000 color ultrasound diagnostic instrument of SIEMENS, Germany, to explore the two-dimensional and color Doppler flow status of plaque, and to record the Doppler velocity curve of the distal BA, RA, and the healthy adult and simulation. The hemodynamic state of peripheral artery after compression test was compared and analyzed, and the reasons for the change of blood flow velocity curve were analyzed combining with the principle of fluid mechanics.
4.1 cases of congenital left double vertebral artery malformation with left subclavian atherosclerotic plaque were used to detect the two-dimensional image of the two vertebral arteries and subclavian arteries and the color Doppler blood flow state by using the Acusons2000 color ultrasonic diagnostic instrument of German SIEMENS company. The mechanism of blood flow state was analyzed by the principle of fluid mechanics.
Result
1. at resting state of healthy adults, the Doppler flow velocity curve of the peripheral artery showed a high pulsating three phase waveform, that is, the rapid increase of the positive peak curve in the systole, the rapid descent of the reverse curve in the early diastolic phase, the low and middle late diastolic low velocity wavelets. The hemodynamic parameters PSV (BA: 74.91 + 9.75cm/s, RA:45.43 + 5.45cm/s, CFA:116.32 14.8) 7cm/s, POV:70.16 + 7.14cm/s), PRV (BA:9.23 + 0.81cm/s, RA:9.02 + 0.73cm/s, CFA:38.31 + 4.12cm/s, POA:16.62 + 2.39cm/s).
2. after the compression of the distal and proximal end, the velocity curve of Doppler's blood flow velocity changes regularly with the pressure step by step, showing that the three phase waves gradually change into two phase waves: the change of the peak blood flow peak is not significant, the velocity of the reverse blood flow in the diastolic phase increases, and the middle and late diastolic blood flow is reduced to the reverse wave. The PRV changes were significant (P0.005) before and after the compression of 0,40,80120mmHg (P0.005), and the changes of PSV were not significant (P0.05). The RI value of the proximal 0,40,80120mmHg was not significant (P0.05), and the RI changed significantly (P0.005) after the distal compression of 0,40,80120mmHg.
3. the two-dimensional image of the lesions of the right subclavicular atherosclerotic plaque showed local stenosis, color Doppler showed five color accelerated blood flow, the distal BA, RA blood flow showed low velocity and low resistance change, compared with the normal and the middle and late diastolic blood flow velocity, the early diastolic reverse blood flow disappeared, and the resistance index decreased.
4. left subclavicular atherosclerotic plaques had no "blood theft" in the proximal branch of the vertebral artery. The distal branch of the vertebral artery occlusion: a two-dimensional image showed a slightly hypoechoic filling in the lumen, and no blood flow signals were found in color Doppler.
conclusion
1. the flow of blood in the arterial system is not continuous because of the circulation of the blood in the arterial system. In the condition of the same blood pressure in the diastolic phase, the small resistance tissues and organs (such as the brain tissue) have continuous flow of blood, while the large resistance (such as the peripheral artery) is not. This experiment confirmed the blood in the peripheral artery from the Doppler ultrasound angle. Internal flow pattern.
The 2. limb pressure experiment simulated the changes of the hemodynamic state in the corresponding blood vessels caused by the change of the peripheral arterial resistance. Under the premise of complying with the basic principle of fluid mechanics, the hemodynamics changes regularly with the pressure of the limbs. The early diastolic blood flow increased with the pressure step by step, and the middle and late diastolic blood flow was diastolic blood. From the flow to the opposite and the reverse, these regular changes further verify the peripheral blood flow of the human body.
3. the atherosclerotic plaque of the right subclavian artery causes vascular stenosis. According to the principle of hydrodynamics and Poisson's formula, the pressure of the lumen is reduced and the blood flow velocity is reduced after the stenosis, which causes the low pressure of the distal artery, and again proves the role of the principle of hydrodynamics in the human body.
4. through the analysis of the principle of hemodynamics, the reason for the normal flow direction of the proximal vertebral artery in the left subclavian artery plaque patients is the inevitable stenosis or occlusion of the distal vertebral artery. The Doppler ultrasound diagnosis confirms this view, indicating that the Doppler ultrasound examination combined with the principle of blood flow mechanics can be used for the diagnosis of clinical peripheral artery disease. The break provides help.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R543.5
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相关期刊论文 前3条
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2 段云友,刘禧,袁丽君,曹铁生,杨炳昂,李群,张勇;二维及多普勒超声在锁骨下动脉盗血综合征诊断中的应用[J];中国超声医学杂志;2001年08期
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