体位及诱发方式对超声评价大隐静脉反流影响的临床研究
发布时间：2018-08-05 15:26
【摘要】：目的： 分析不同体位条件及不同诱发方式对超声评价大隐静脉不同节段反流的影响情况。 方法： 选取反流大隐静脉50条（反流组）及健康志愿者大隐静脉15条（对照组），在平卧位、整床倾斜20°头高脚低位、整床倾斜40°头高脚低位及站立位4种体位条件下，采用Valsalva动作法及远端肢体袖带充气加压法(对大隐静脉小腿引流区施加100mmHg压力)来诱发反流，分别在大隐静脉隐股交界静脉瓣下方约2cm处、大腿中段及小腿上段三处采集静脉反流频谱，记录反流时间及最高反流速度。以站立位袖带充气加压法诱发的反流时间大于0.5s作为诊断反流的标准，计算不同体位条件及不同诱发方式下大隐静脉不同节段的反流诱发率，并进一步比较不同体位及不同加压方式诱发反流的反流时间及最高反流速度与标准检查间的差异。 结果： （1）体位对远端肢体加压法评估大隐静脉反流的影响：在对照组中，平卧位、20°及40°体位均未出现假阳性病例。在反流组中，平卧位检查大隐静脉不同节段时均有假阴性病例出现，假阴性率分别为59%（19/32）、22%（11/50）、24%（12/50）；20°头高脚低位、40°头高脚低位时，大腿中段及小腿上段大隐静脉反流诱发率与站立位一致，诱发率均为100%（50/50），但在大隐静脉隐股交界下方约2cm处均出现一定假阴性率，分别为12%（4/32）、12%（4/32）。 （2）体位对Valsalva动作法评估大隐静脉反流的影响：对照组中，隐股交界下方约2cm处大隐静脉在平卧位及20°头高脚低位出现假阳性病例，假阳性率均为13.3%（2/15）。反流组中，在四种体位条件下SFJ处均存在假阴性和假阳性，以平卧位假阴性率及假阳性率最高，分别达到43.75%(14/32)、18.75%(6/32)，40°头高脚低位的假阴性率及假阳性率最低，均为6.75%(2/32)。MGV及CGV段仅有假阴性病例，假阴性率分别为：MGV-14%(7/50)、8%(4/50)、8%(4/50)、8%(4/50)；CGV-48%(24/50)、52%(26/50)、34%(17/50)、34%(17/50)，无假阳性病例。 （3）体位对远端肢体袖带充气加压法诱发的反流时间及最高反流速度的影响：反流组中大腿中段大隐静脉在站立位、平卧位、20°头高脚低位、40°头高脚低位4种体位条件下反流时间分别为（7.75±3.23）s、（5.27±3.66）s、（8.67±3.72）s、（8.55±3.93）s，差异有统计学意义（F=56.9，P＜0.01）；20°及40°体位分别与站立位比较，，差异无统计学意义（q=1.51、1.33， P均＞0.05），而平卧位与站立位在反流时间上的差异有统计学意义（q=4.11，P＜0.01）。反流组大腿中段大隐静脉在站立位、平卧位、20°头高脚低位、40°脚头高低位4种体位条件下最高反流速度分别为（55.26±22.24）cm/s、（22.87±12.03）cm/s、（38.46±16.30）cm/s、（45.13±19.21）cm/s，差异亦有统计学意义（F=13.7，P＜0.01）；平卧位、20°、40°头高脚低位条件下的最高反流速度与站立位比较，差异均有统计学意义（q=12.71、6.59、3.98，P均＜0.01） 结论： （1）20°及40°头高脚低位检查大隐静脉中下段反流的准确性较高，适用于评估大隐静脉反流。 （2）Valsalva法不宜作为大隐静脉反流的诱发方式。 （3）评估大隐静脉反流不宜采用平卧位检查。 （4）取头高脚低位远端肢体加压法评价大腿中段大隐静脉，其反流时间与站立位远端肢体加压法结果相当，最高反流速度虽有差异但有迹可循。
[Abstract]:Objective:
The effects of different postures and different ways of inducing different types of reflux on different segments of great saphenous vein were analyzed.
Method:
50 cases of reflux great saphenous vein (reflux group) and 15 healthy volunteers' great saphenous vein (control group) were used in the supine position, the whole bed tilted 20 degrees head high foot low, the whole bed tilted 40 degrees head low position and the standing position 4 kinds of posture, using the Valsalva action method and the distal limb cuff inflatable pressure method (to apply 100mmHg to the drainage area of the great saphenous vein calf. The reaction time and the highest reflux velocity were recorded at about 2cm below the saphenous vein flap of the saphenous vein of the great saphenous vein and three parts of the middle thigh and upper leg. The reflux time induced by the standing cuff pressure method was greater than 0.5s as the criterion for the diagnosis of reflux, and the conditions of different body positions were calculated and the conditions were calculated. The reflux induced rate of different segments of the great saphenous vein was observed under different inducing modes, and the reflux time and the difference between the highest reflux velocity and the standard examination were further compared between the different body positions and the different compression methods.
Result:
(1) the effect of postural pressure on the large saphenous venous reflux in the distal limb: in the control group, there were no false positive cases in the supine position, 20 degrees and 40 degrees. In the reflux group, false negative cases were found in the different segments of the great saphenous vein, the false negative rate was divided into 59% (19/32), 22% (11/50), 24% (12/50), and 20 degree head low feet. The rate of reflux induced by great saphenous vein in the middle thigh and upper leg of the thigh was the same as that of the standing position, and the induced rate was 100% (50/50), but there were some false negative rates at about 2cm below the saphenous junction of the great saphenous vein, 12% (4/32) and 12% (4/32), respectively.
(2) the effect of the body position on the Valsalva action method to evaluate the reflux of great saphenous vein: in the control group, there were false positive cases in the supine position and 20 degree head low position below the saphenous junction, and the false positive rate was 13.3% (2/15). In the reflux group, there were false negative and false positive in the SFJ position under the four position conditions, and the false negative was negative in the supine position. The rate and false positive rate were the highest, 43.75% (14/32), 18.75% (6/32), the lowest false negative rate and false positive rate in the lower head of the head, all 6.75% (2/32).MGV and CGV only false negative cases, the false negative rates were MGV-14% (7/50), 8% (4/50), 8% (4/50), 8% (4/50), CGV-48% (24/50), 52% (34%), 34% (34%), no false positive. Case.
(3) the effect of body position on the reflux time and the highest reflux velocity induced by the inflatable pressure method of the distal limb cuff: in the reflux group, the great saphenous vein of the middle thigh in the standing position, the supine position, the 20 degree head low position and the 40 degree head low position, the reflux time is (7.75 + 3.23) s, (5.27 + 3.66) s, (8.67 + 3.72) s, (8.55 + 3.93), the difference. There were statistical significance (F=56.9, P < 0.01); there was no statistically significant difference between the position of 20 and 40 degrees (q=1.51,1.33, P > 0.05), while the difference between the horizontal and standing positions was statistically significant (q=4.11, P < 0.01). The large saphenous vein in the middle thigh of the reflux group was in the standing position, the supine position, the 20 [degree head high foot], 40 degrees. The highest reflux velocity was (55.26 + 22.24) cm/s, (22.87 + 12.03) cm/s, (38.46 + 16.30) cm/s and (45.13 + 19.21) cm/s, respectively (F=13.7, P < 0.01), respectively (F=13.7, P < 0.01), and the difference of the highest reflux rate under the lower position of the flat, 40 [degree] height foot was statistically significant (q=12 .71,6.59,3.98, P < 0.01)
Conclusion:
(1) 20 degree and 40 degree head high and low position examination of the middle and lower segment of the great saphenous vein is more accurate, and is suitable for evaluating the great saphenous vein reflux.
(2) the Valsalva method is not suitable for inducing the reflux of the great saphenous vein.
(3) evaluation of great saphenous vein reflux is not suitable for supine position examination.
(4) the great saphenous vein of the middle thigh was evaluated by the compression method of the distal extremities of the lower head of the high foot. The reflux time was equivalent to the result of the pressure method of the distal limb of the standing position, although the highest reflux velocity was different, but there was a trace to follow.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R543.6
[Abstract]:Objective:
The effects of different postures and different ways of inducing different types of reflux on different segments of great saphenous vein were analyzed.
Method:
50 cases of reflux great saphenous vein (reflux group) and 15 healthy volunteers' great saphenous vein (control group) were used in the supine position, the whole bed tilted 20 degrees head high foot low, the whole bed tilted 40 degrees head low position and the standing position 4 kinds of posture, using the Valsalva action method and the distal limb cuff inflatable pressure method (to apply 100mmHg to the drainage area of the great saphenous vein calf. The reaction time and the highest reflux velocity were recorded at about 2cm below the saphenous vein flap of the saphenous vein of the great saphenous vein and three parts of the middle thigh and upper leg. The reflux time induced by the standing cuff pressure method was greater than 0.5s as the criterion for the diagnosis of reflux, and the conditions of different body positions were calculated and the conditions were calculated. The reflux induced rate of different segments of the great saphenous vein was observed under different inducing modes, and the reflux time and the difference between the highest reflux velocity and the standard examination were further compared between the different body positions and the different compression methods.
Result:
(1) the effect of postural pressure on the large saphenous venous reflux in the distal limb: in the control group, there were no false positive cases in the supine position, 20 degrees and 40 degrees. In the reflux group, false negative cases were found in the different segments of the great saphenous vein, the false negative rate was divided into 59% (19/32), 22% (11/50), 24% (12/50), and 20 degree head low feet. The rate of reflux induced by great saphenous vein in the middle thigh and upper leg of the thigh was the same as that of the standing position, and the induced rate was 100% (50/50), but there were some false negative rates at about 2cm below the saphenous junction of the great saphenous vein, 12% (4/32) and 12% (4/32), respectively.
(2) the effect of the body position on the Valsalva action method to evaluate the reflux of great saphenous vein: in the control group, there were false positive cases in the supine position and 20 degree head low position below the saphenous junction, and the false positive rate was 13.3% (2/15). In the reflux group, there were false negative and false positive in the SFJ position under the four position conditions, and the false negative was negative in the supine position. The rate and false positive rate were the highest, 43.75% (14/32), 18.75% (6/32), the lowest false negative rate and false positive rate in the lower head of the head, all 6.75% (2/32).MGV and CGV only false negative cases, the false negative rates were MGV-14% (7/50), 8% (4/50), 8% (4/50), 8% (4/50), CGV-48% (24/50), 52% (34%), 34% (34%), no false positive. Case.
(3) the effect of body position on the reflux time and the highest reflux velocity induced by the inflatable pressure method of the distal limb cuff: in the reflux group, the great saphenous vein of the middle thigh in the standing position, the supine position, the 20 degree head low position and the 40 degree head low position, the reflux time is (7.75 + 3.23) s, (5.27 + 3.66) s, (8.67 + 3.72) s, (8.55 + 3.93), the difference. There were statistical significance (F=56.9, P < 0.01); there was no statistically significant difference between the position of 20 and 40 degrees (q=1.51,1.33, P > 0.05), while the difference between the horizontal and standing positions was statistically significant (q=4.11, P < 0.01). The large saphenous vein in the middle thigh of the reflux group was in the standing position, the supine position, the 20 [degree head high foot], 40 degrees. The highest reflux velocity was (55.26 + 22.24) cm/s, (22.87 + 12.03) cm/s, (38.46 + 16.30) cm/s and (45.13 + 19.21) cm/s, respectively (F=13.7, P < 0.01), respectively (F=13.7, P < 0.01), and the difference of the highest reflux rate under the lower position of the flat, 40 [degree] height foot was statistically significant (q=12 .71,6.59,3.98, P < 0.01)
Conclusion:
(1) 20 degree and 40 degree head high and low position examination of the middle and lower segment of the great saphenous vein is more accurate, and is suitable for evaluating the great saphenous vein reflux.
(2) the Valsalva method is not suitable for inducing the reflux of the great saphenous vein.
(3) evaluation of great saphenous vein reflux is not suitable for supine position examination.
(4) the great saphenous vein of the middle thigh was evaluated by the compression method of the distal extremities of the lower head of the high foot. The reflux time was equivalent to the result of the pressure method of the distal limb of the standing position, although the highest reflux velocity was different, but there was a trace to follow.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R543.6
【共引文献】
相关期刊论文 前10条
1 郭晓音;;肠系膜上动脉彩色多普勒超声在腹痛患者病因诊断中的价值[J];临床医学;2014年07期
2 黄慧芹;汪萍;陈硕;范丽琴;;彩色多普勒超声在产后并发下肢静脉血栓防治中的应用[J];当代医学;2014年36期
3 罗丽敏;;颈动脉粥样硬化斑块与脑梗死相互关系的临床研究[J];泰山医学院学报;2013年12期
4 李红梅;肖化石;蔡忠凤;;彩色多普勒超声对下肢深静脉血栓的诊断价值[J];临床合理用药杂志;2014年05期
5 唐敏;滕继军;王敏;孙晓敏;张晨;;急性多发性脑梗死形态与其供血动脉狭窄的关系[J];齐鲁医学杂志;2014年02期
6 胡远英;雷鸣;汤兰桂;张泓鑫;向攀;杨丽;;彩超检测脑梗死患者颈动脉粥样硬化及其与幽门螺杆菌感染的关系[J];临床和实验医学杂志;2014年13期
7 王金荣;;彩超诊断下肢动脉硬化性闭塞症的应用体会[J];山西职工医学院学报;2014年06期
8 周鹭;姚芳;;60例糖尿病下肢深静脉血栓形成临床分析[J];现代诊断与治疗;2013年19期
9 刘秋云;陈明;;剪应力在颈动脉粥样硬化性疾病中作用的研究进展[J];肿瘤影像学;2014年01期
10 赖桂兰;郭宗琳;邓勇均;屈_忱
本文编号：2166207
本文链接：https://www.wllwen.com/yixuelunwen/fangshe/2166207.html
