经阴道实时三维子宫输卵管造影中YZ-800造影剂注射装置的应用

发布时间：2018-01-13 17:44

  本文关键词：经阴道实时三维子宫输卵管造影中YZ-800造影剂注射装置的应用　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 造影剂 振动频率 逆流 峰值压力 不孕症 子宫输卵管超声造影

【摘要】：目的探讨经阴道实时三维子宫输卵管造影(transvaginal ultrasound real time three-dimensional hysterosalpingo-contrast sonography,TVS RT 3D-HyCoSy)中YZ-800造影剂注射装置的临床应用价值。材料与方法1.研究对象1.1实验研究选择24只健康新西兰兔,雌雄不限,体质量2.0～2.5 kg。实验动物的提供是广州军区广州总医院动物实验中心,动物许可证号码为SYXK(粤)2014-0100。实验的批准是广州军区广州总医院实验动物伦理委员会。健康新西兰兔被随机分为两组,一组是对照组(= 6),一组是实验组(= 18),实验组依不同振动频率分为3个亚组,分别是60 Hz、90 Hz、120 Hz,每组6只。1.2临床研究选择我院妇产科门诊及辅助生殖中心从2015年1月～2016年2月行TVS RT 3D-HyCoSy不孕症患者498例,年龄约20～44岁,平均约(29.8±4.5)岁。不孕时间约1～8年,平均约(3.3±2.7)年,其中原发性不孕214例,继发性不孕284例。所有入组患者根据中国超声医师协会的纳入标准及排除标准,于月经干净后3～7 d行TVS RT 3D-HyCoSy,全部入组患者签署子宫输卵管造影信息卡及子宫输卵管造影知情同意书。2.仪器与造影剂2.1仪器超声仪器:采用GE L0GIQ E9彩色多普勒超声诊断仪,9L-D线阵探头,中心频率6～9 MHz,机械指数0.14。GE Voluson E8彩色多普勒超声诊断仪,RIC 5-9-D经腔容积探头,中心频率5.0～9.0MHZ,179°扫描扇角、120°容积角,机械指数0.12～0.18。实验仪器:采用YZ-800造影剂注射装置,具有振动式卡座及实时振动和测压功能,振动频率范围为60Hz～120Hz,检测压力范围为0～90 kPa。2.2超声造影剂采用意大利Bracco公司SonoVue,内含有六氟化硫气体59mg,冻干粉末25mg,使用前注入5ml生理盐水配制震荡成微泡混悬液,配制完成后放置备用,造影时抽取20ml超声造影剂(由5ml微泡混悬液与生理盐水混合配制成)。3.研究方法3.1实验研究实验兔麻醉依据1 mL/kg静脉注入3%戊巴比妥钠,麻醉成功后并备皮,取其仰卧位固定,通过耳缘静脉置入24 G留置针,建立静脉注射通道。进入预先设置的实验兔条件,常规二维超声扫查兔肝脏,避开大血管,选择剑突下肝脏观察部位并标记。配制超声造影剂并将其置于YZ-800造影剂注射装置的振动卡座上,根据实验分组分别选择无振动和实验组,实验组分为60 Hz、90 Hz、120 Hz振动档位。启动二维灰阶造影键,对照组和60 Hz、90 Hz、120 Hz亚组分别在6个时间段(5、10、15、20、25、30 min)经兔耳缘静脉团注造影剂0.5 mg/kg,随后尾推1 mL 0.9%氯化钠溶液。全部造影数据存储于仪器硬盘,后期分析。造影图像的分析采用时间-强度曲线(time-intensity curve,TIC),将感兴趣区域(R0I)放置兔肝实质内,面积大概0.5～1.0 cm2,时间强度曲线采用伽马拟合方式,获得兔肝灌注TIC曲线。在图像进行分析时需连续3次检测峰值强度(peak-intensity,PI),取其平均值,分析过程中感兴趣区域的取样容积、取样部位、取样深度尽可能保持一致。3.2临床研究对498例不孕症妇女实施TVS RT 3D-HyCoSy,记录注入造影剂的量及停止注入时造影剂返流量、注入造影剂压力数据及患者疼痛程度,压力数据为TVSRT3D-HyCoSy时的峰值压力。结合子宫输卵管显影情况、造影剂溢出后盆腔内弥散、、注入造影剂量及返流量、造影剂有无逆流、注入造影剂时压力大小和造影过程中患者的疼痛度综合综合评估输卵管通畅度,分析不同输卵管通畅度的TVS RT 3D-HyCoSy时的峰值压力、逆流的发生率及造影过程中不良反应发生率,并比较峰值压力和逆流发生率差异。4.统计学方法应用SPSS 15.0医学统计学软件。计量资料用均数士标准差表示,方差不齐,采用采用welch检验;方差齐,采用多重因素方差分析。定性资料采用χ2检验。P0.05为差异具有统计学意义。结果1.实验兔:与对照组相比,90Hz亚组平均PI值差异有统计学意义(P0.05);120Hz亚组平均PI值差异有统计学意义(P0.05);60Hz亚组平均PI值比较,差异无统计学意义(P0.05)。与60Hz亚组相比,120Hz亚组平均PI值比较,差异有统计学意义(P0.05);90Hz亚组平均PI值比较,差异无统计学意义(P0.05)。与90Hz亚组相比,120Hz亚组平均PI值比较,差异有统计学意义(P0.05)。对照组和90Hz亚组中5、10、15、20 min之间PI值比较,差异无统计学意义(P0.05);对照组和90Hz亚组中25、30mim之间PI值比较,差异有统计学意义(P0.05)。2.不孕症患者中双侧输卵管通畅、双侧输卵管通而不畅、双侧输卵管阻塞的造影剂推注峰值压力分别为(22.47±5.96)kPa,(37.24土8.83)kPa,(44.64±7.73)kPa,三组间峰值压力比较差异有统计学意义(P0.01)。498例患者中,总的逆流发生率26.30%,其中双侧输卵管通畅、双侧输卵管通而不畅、双侧输卵管阻塞的逆流发生率分别为18.13%,30.21%,43.59%。无或轻、中、重度不良反应分别为88.80%,10.80%,0.40%。结论1.采用造影剂注射装置机械振动超声造影剂,在振动频率90 Hz、30 min内兔肝脏灌注PI值稳定,能维持较好的增强效果。2.在TVS RT 3D-HyCoSy中采用YZ-800造影剂注射装置监测并缓慢保持相对低压状态推注造影剂,量化子宫输卵管灌注压力,可减少造影中逆流的发生,便于连续性采集输卵管图像和后期观察分析图像;提高了患者检查的舒适度,有利于TVS RT 3D-HyCoSy顺利实施。该造影剂注射装置操作简单,临床实用性强,值得临床上推广使用。
[Abstract]:Objective to evaluate the value of transvaginal real-time three-dimensional hysterosalpingography (transvaginal ultrasound real time three-dimensional hysterosalpingo-contrast sonography, TVS RT 3D-HyCoSy) YZ-800 contrast agent injection device for clinical application. Materials and methods 1. subjects 1.1 experimental study of 24 healthy New Zealand rabbits, male or female, weighing 2 to 2.5 kg. experimental animal is to provide animal experimental center of Genenral Hospital of PLA Guangzhou Military Area, the animal license number for SYXK (Guangdong) 2014-0100. experiment is the experimental animal ethics committee approved the Genenral Hospital of PLA Guangzhou Military Area. Healthy New Zealand rabbits were randomly divided into two groups, one group is the control group (n = 6), a group of experimental group (n = 18), experimental group according to different vibration frequency 3 sub groups were 60 Hz, 90 Hz, 120 Hz, 6 rats in each group.1.2 clinical study in our hospital obstetrics and gynecology clinic and assisted reproductive center from 2 015 years from January to February 2016 for TVS RT 3D-HyCoSy in 498 cases of infertility, age about 20 to 44 years old, an average of about (29.8 + 4.5) years old. The duration of infertility is about 1 ~ 8 years, an average of about (3.3 + 2.7) years, including 214 cases of primary infertility and secondary infertility in 284 cases. All groups the patients according to the inclusion Chinese Association sonographer criteria and exclusion criteria, in menstrual clean after 3 ~ 7 d TVS RT 3D-HyCoSy, all the patients signed the hysterosalpingography information card and hysterosalpingography informed consent.2. instrument and contrast 2.1 instrument using GE L0GIQ ultrasonic instrument: E9 color Doppler ultrasound diagnostic instrument 9L-D, linear array probe, a center frequency of 6 MHz to 9 Voluson, mechanical index 0.14.GE E8 color Doppler ultrasound diagnostic instrument, RIC 5-9-D by volume probe, the center frequency of 5 ~ 9.0MHZ, 179 ~ 120 DEG volume scanning fan angle, angle, mechanical index of 0.12 ~ 0.18. experimental instrument using YZ-800 The contrast agent injection device with vibration type deck and real-time vibration and pressure, vibration frequency range is 60Hz ~ 120Hz, pressure detection range is 0 ~ 90 kPa.2.2 ultrasound contrast agent used in Italy Bracco company SonoVue, containing six sulfur hexafluoride gas 59mg, freeze-dried powder 25mg, before using injection of 5ml saline solution into micro shock bubble suspension, prepared after placed standby, angiography extraction of 20ml ultrasound contrast agents (by 5ml microbubbles suspension and normal saline was prepared by mixing.3.) research methods experimental study 3.1 anesthetized rabbits on the basis of the 1 mL/kg intravenous injection of 3% pentobarbital sodium, after the success of anesthesia and skin preparation, the supine fixed. Through the ear vein inserted 24 G intravenous indwelling needle, a set of experimental rabbits. The channel condition into conventional two-dimensional ultrasound scan of rabbit liver, avoid large vessels, select the xiphoid and labeled with liver observation site. Preparation of ultrasound contrast agent and its vibration card is placed in the YZ-800 contrast agent injection device, on the basis of the experimental group were selected without vibration and experimental group. The experimental group was divided into 60 Hz, 90 Hz, 120 Hz vibration gear. Two dimensional gray-scale contrast start button, the control group and 60 Hz, 90 Hz, 120 Hz sub group in 6 time periods (5,10,15,20,25,30 min) by rabbit ear vein bolus 0.5 mg/kg 1 mL 0.9%, then push the tail Sodium Chloride Solution. All the data stored on the hard disk imaging instrument, post analysis. Analysis of angiographic images by time intensity curve (time-intensity, curve, TIC), the region of interest (R0I) placed in the hepatic parenchyma, an area of about 0.5 ~ 1 cm2, time intensity curve with gamma curve fitting method, to obtain rabbit liver perfusion TIC curve. 3 consecutive detection in image analysis of peak intensity (peak-intensity, PI), the average value of interest in the process of analysis The sample volume, the sampling position, sampling depth as far as possible to maintain the consistent implementation of TVS RT 3D-HyCoSy.3.2 clinical study on 498 cases of infertile women, record injection of contrast quantity and injection of contrast agent to stop backflow, contrast agent injection pressure data and pain degree, peak pressure data is TVSRT3D-HyCoSy. Combined with uterine tube development. Dispersion of pelvic contrast overflow after injection of contrast dose and return flow, contrast agents have no current, injected contrast agent comprehensive syndrome pressure and the pain degree during the examination and assessment of tubal patency, analysis of the peak pressure of different tubal patency of the TVS RT 3D-HyCoSy. The incidence rate of adverse reactions and imaging process countercurrent, and compare the peak pressure and reflux incidence differences of.4. statistical methods using SPSS 15 software. The measurement of medical statistics With the mean + standard deviation, homogeneity of variance, by using Welch test; variance analysis, the multiple factor variance. Qualitative data using.P0.05 2 test for the difference was statistically significant. Results of the 1. experimental rabbits: compared with control group, 90Hz subgroup average PI value difference was statistically significant (P0.05); 120Hz subgroup average PI value difference was statistically significant (P0.05); 60Hz group average PI value comparison, no statistically significant difference (P0.05). Compared with 60Hz subgroup, 120Hz subgroup average PI value comparison, the difference was statistically significant (P0.05); 90Hz group average PI value comparison, the difference was not statistically significant (P0.05). Compared with 90Hz subgroup, 120Hz subgroup average PI value comparison, the difference was statistically significant (P0.05). Group 90Hz and subgroup 5,10,15,20 min between the PI value comparison, no statistically significant difference (P0.05) between 90Hz and 25,30mim group; subgroup PI value comparison, difference There was statistical significance (P0.05). The.2. of bilateral tubal infertility patients, bilateral salpingitis, bilateral fallopian tube obstruction contrast agent bolus peak pressure respectively (22.47 + 5.96) kPa, (37.24 + 8.83) kPa, (44.64 + 7.73) kPa, the three groups have significant peak the pressure difference (P0.01) of.498 patients, the total reflux incidence 26.30%, including bilateral tubal patency, bilateral salpingitis, bilateral fallopian tube obstruction, reflux incidence were 18.13%, 30.21%, 43.59%. or light, respectively, the severe adverse reaction was 88.80%, 10.80%, 0.40%. conclusion 1. by contrast agent injection device of mechanical vibration in the vibration frequency of ultrasound contrast agent, 90 Hz, 30 min in rabbit liver perfusion PI value is stable and can maintain good strengthening effect of.2. in TVS RT 3D-HyCoSy using YZ-800 contrast agent injection device monitoring and maintain a relatively low state pushed slowly Injection of contrast agent, quantification of uterus and fallopian tube perfusion pressure, can reduce the contrast in the flow reversal, and later to facilitate image observation and analysis of the continuity of image acquisition fallopian tube; improve patient comfort, is conducive to the smooth implementation of TVS RT 3D-HyCoSy. The contrast agent injection device has simple operation, clinical practicability, and is worthy of promotion the use of clinical practice.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.6;R445.1
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本文编号：1419900