桡动脉心内膜下心肌活力率的有效性和重复性研究

发布时间：2018-05-14 12:21

本文选题：桡动脉心内膜下心肌活力率 + 颈动脉心内膜下心肌活力率　；参考：《安徽医科大学》2012年硕士论文

【摘要】：目的首次提出一项无创评估心脏供血能力的新指标：桡动脉SEVR，并将从桡动脉压力波形直接获取的心内膜下心肌活力率（简称：桡动脉SEVR）与从颈动脉压力波形直接获取的心内膜下心肌活力率（简称：颈动脉SEVR）进行相关性分析从而验证此指标的有效性，而后进一步评估桡动脉心内膜下心肌活力率的重复性，为临床应用与研究提供依据。方法桡动脉SEVR的有效性研究中选择200例20～74岁的健康人作为受试对象，其中男性99人，女性101人，将表面张力传感器分别置于左侧颈动脉及桡动脉动脉搏动最强处，连续记录12s稳定的桡动脉及颈动脉脉搏波，取所有波形的平均值，通过仪器自动分析获取颈动脉SEVR和桡动脉SEVR值；在桡动脉SEVR的重复性研究中，选择30名24～59岁的健康受试者，由两名受过专业训练的操作人员分别对受试对象进行桡动脉SEVR的测量，24h后由第一操作者再次进行一次测量，，获取四次测量的桡动脉SEVR值，并进行桡动脉SEVR的组内重复性、组间重复性和day-to-day重复性分析。结果有效性研究中，尽管颈动脉SEVR比桡动脉SEVR更高，但是桡动脉SEVR与颈动脉SEVR仍然高度相关（r=0.81，P＜0.001）。男性的桡动脉SEVR明显比女性更高。多元线性逐步回归分析显示：心率、年龄、脉压差、收缩压是桡动脉SEVR的独立影响因素，其中心率与桡动脉SEVR成负相关。重复性研究中，同一观察者两次测量、两位观察者以及day-to-day测量的两次SEVR的平均不同（±2标准差）分别为：1.34±26.84，1.09±23.02，-0.15±41.52，Bland Altman图显示桡动脉SEVR的组内、组间、day-to-day测量值间均具有良好的一致性；组内相关系数ICC值分别为0.898，0.929，0.775，均大于0.75，显示具有很好的重复性；配对t检验中P＞0.05，四次测量间差异无统计学意义。结论首次提出了桡动脉SEVR这个指标，并通过对不同年龄段健康人群进行测量研究发现桡动脉SEVR与颈动脉SEVR具有高度相关性（r=0.81，P＜0.001），桡动脉SEVR不需要任何转换功能，可以直接用来评价颈动脉SEVR，并且心率、性别、脉压、收缩压对于桡动脉SEVR的影响几乎与颈动脉SEVR是一样的，表明了桡动脉SEVR与颈动脉SEVR提供了相似的信息，桡动脉SEVR可以替代颈动脉SEVR用来进行冠脉灌注的评估。桡动脉SEVR的组内、组间以及day-to-day重复性研究中均提示具有很好的重复性。因此桡动脉SEVR可以作为评估心血管系统疾病的一项主要指标，其易操作且有效性及重复性、可靠性好，可进一步应用到老年人以及心血管疾病患者的临床试验中，从而为心血管疾病的早期发现、干预及治疗进行指导。
[Abstract]:Purpose For the first time, a new non-invasive index for evaluating cardiac blood supply capacity was proposed: SEVRR of radial artery, and the ratio of myocardial activity directly obtained from pressure waveform of radial artery (SEVRR) and carotid pressure waveform (SEVR) were obtained directly. In order to verify the validity of this index, the correlating analysis of the subendocardial myocardial viability rate (SEVR) of the carotid artery was carried out. The repeatability of myocardial activity under endocardium of radial artery was further evaluated to provide evidence for clinical application and research. Method In the study of the effectiveness of radial artery SEVR, 200 healthy subjects aged 20 to 74 years were selected as subjects, including 99 males and 101 females. The surface tension sensors were placed in the left carotid artery and radial artery to the strongest pulsatility, respectively. The pulse waves of the radial artery and the carotid artery were recorded continuously for 12 s, and the mean values of all the waveforms were taken, and the SEVR and SEVR values of the radial artery were obtained by automatic instrument analysis. In the repetitive study of radial SEVR, 30 healthy subjects aged 24 to 59 years were selected. After 24 hours of measurement of radial artery SEVR, the first operator again measured the radial artery SEVR value four times by two trained operators, and performed intra-group repeatability of radial artery SEVR. Analysis of repeatability and day-to-day repeatability between groups. Result In the effectiveness study, although carotid SEVR was higher than radial SEVR, radial SEVR was still highly correlated with carotid SEVR (P < 0.001). Radial artery SEVR was significantly higher in men than in women. Multiple linear stepwise regression analysis showed that heart rate, age, pulse pressure difference and systolic pressure were independent influencing factors of radial artery SEVR, in which heart rate was negatively correlated with radial artery SEVR. In the reproducible study, the average difference (卤2 standard deviation) of SEVR between the two observers and the two day-to-day measurements was 1. 34 卤26. 84 卤1. 09 卤23. 02 卤0. 15 卤41. 52 and 1. 9 卤23. 02 卤41. 52 Bland / Altman, respectively. There was good agreement between the two groups in the measurement of SEVR in radial artery. The correlation coefficient (ICC) in the group was 0.8980.290.775, which was more than 0.75, which showed good repeatability, but there was no significant difference between the four measurements in the paired t test (P > 0.05). Conclusion The index of radial artery SEVR was put forward for the first time, and it was found that radial artery SEVR was highly correlated with carotid artery SEVR (P < 0.001), and radial artery SEVR did not need any conversion function. It can be directly used to evaluate carotid SEVRs, and the effects of heart rate, sex, pulse pressure, systolic pressure on radial SEVR are almost the same as those on carotid SEVR, suggesting that radial SEVR and carotid SEVR provide similar information. Radial SEVR can be used to evaluate coronary perfusion in place of carotid SEVR. The reproducibility of radial artery SEVR in group, inter-group and day-to-day was demonstrated to be very good. Therefore, radial artery SEVR can be used as a major index for the evaluation of cardiovascular diseases. It is easy to operate, effective and reproducible, and can be further applied to clinical trials in the elderly and patients with cardiovascular disease. So as to the early detection of cardiovascular disease, intervention and treatment of guidance.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R87

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