Syngo iFlow评估症状性下肢动脉缺血介入腔内成形术前后循环变化的初步研究
发布时间：2018-10-10 16:46
【摘要】：目的：探讨Syngo iFlow软件评估下肢动脉症状性缺血性疾病腔内治疗前后患肢血流动力学改善情况的可行性和准确性,及其与传统临床疗效评估方法的相关性。方法：回顾性分析接受介入腔内治疗40例下肢动脉慢化闭塞症严重下肢缺血患者(男24例,女16例,年龄58-85岁,股胴动脉TASC 11 B／C型病变)病历资料。收集术前术后完整的忠肢循环状况的评估资料,包括临床症状体征(疼痛、冷感、跛行)评估、蹀肱指数(ABI)、经皮氧分压(TcPO2)测量等,评价手术疗效。运用Syngo iFlow对术前术后患肢足踝部TTP值进行测量,评价肢端血流动力学改善情况。采集术前和术后的股总动脉分叉部、胭动脉分叉部、踝关节水平TTP值以及胭动脉分叉部股总动脉分叉部、踝关节水平与胭动脉分叉部之间TTP差值进行统计学比较。由2名血管介入及影像诊断专科医生采用比较评价DSAjfSyngo iFlow两种方法显示血流和灌注变化信息的质量。分别采用t检验、Wilcixin秩和检验Spearman等级相关分析对资料进行统计学分析,评价Syngo iFlow口传统临床评估方法对腔内治疗前后患肢循环改善评估的相关性及一致性。结果：40例患者通过腔内治疗成功修复股胭动脉段重度狭窄及闭塞病变。术前传统临床方法评估：疼痛评分(1.88±1.62)、冷感评分(2.15±1.25)、跛行评分(2.90±0.84)、ABI(0.35±0.08)、TcPO2(27.39±5.26 )mmHg:术后1周内评估：疼痛评分(0.22±0.42)、冷感评分(0.23±0.42)、跛行评分(0.63±0.59)、ABI(0.66±0.07)、TcP02(40.75±3.42)mmmHg,治疗前后差异有统计学意义(P0.05),显示患者下肢缺血症状均有显著改善。SyngoiFlow评估：术前足踝水平点测量TTP值(14.54±1.89)s,术后足踝水平点测量TTP值(10.40±1.98)s；术前足踝水平区域测量TTP值(20.08±3.05)s,术后足踝水平区域测量TTP值(16.43±2.52)s,治疗前后差异有统计学意义(P0.05),表明治疗后足踝部区域血流灌注明显改善。术前股胭动脉TTP差值和胭踝动脉TTP差值分别为(6.88±1.90)s、 (8.66±1.79)s,术后股胭动脉TTP差值和胭踝动脉TTP差值分别为(4.()5±1.25)、 (7.82±1.87)s,两处TTP差值减小治疗前后差异有统计学意义(P0.05),说明治疗后血流速度增快。Spearman相关性分析足躁部点测量ΔTTP和△ ABI、△TcP02之间呈正相关(r=0.53,0.33,P0.05)：区域测量△TTP和△ABI、△TcP02之问呈正相关(r=0.63,0.41,P0.05)。运用Syngo iFlowDSA两种方法评判血流动力学变化观察结果比较,认为Syngo Flow图像观察质量较DSA图像质量优秀,差异有统计学意义。结论：Syngo iFlow软件可以用来实时量化分析下肢动脉阻塞性疾病血管成形术前后的血流动力学变化,其评估结果与传统临床疗效评估方法具有一致性。
[Abstract]:Objective: to evaluate the feasibility and accuracy of Syngo iFlow software in evaluating hemodynamic improvement of affected limbs before and after endovascular treatment for lower extremity arterial symptomatic ischemic diseases and its correlation with traditional clinical evaluation methods. Methods: the medical records of 40 patients (24 males, 16 females, 58-85 years old with TASC 11 B / C lesions) with lower extremity slow occlusion treated by interventional intracavitary therapy were retrospectively analyzed. The preoperative and postoperative data were collected to evaluate the clinical symptoms and signs (pain, cold feeling, lameness), and the transcutaneous partial pressure of oxygen (TcPO2) to evaluate the outcome of the operation. Syngo iFlow was used to measure the TTP value of foot and ankle before and after operation to evaluate the improvement of hemodynamics. The TTP values of common femoral artery bifurcation, popliteal artery bifurcation, ankle joint level and popliteal artery bifurcation were collected before and after operation. The TTP difference between the common femoral artery bifurcation and popliteal artery bifurcation was statistically compared between the ankle level and the popliteal artery bifurcation. The quality of blood flow and perfusion information was compared and evaluated by two vascular interventional and imaging diagnostics specialists. T test, Wilcixin rank sum test and Spearman grade correlation analysis were used to evaluate the correlation and consistency of the traditional clinical evaluation method of Syngo iFlow mouth in evaluating the improvement of limb circulation before and after intracavitary treatment. Results: 40 patients successfully repaired severe femoral artery stenosis and occlusion by endovascular treatment. Preoperative evaluation of traditional clinical methods: pain score (1.88 卤1.62), cold sensation score (2.15 卤1.25), lameness score (2.90 卤0.84), ABI (, 0.35 卤0.08), TcPO2 (27.39 卤5.26) mmHg:, 1 week after operation: pain score (0.22 卤0.42), cold feeling score (0.23 卤0.42), limping score (0.63 卤0.59), ABI (0.66 卤0.07), TcP02 (40.75 卤3.42) mmmHg, before and after treatment (P0.05). SyngoiFlow evaluation showed that TTP value was (14.54 卤1.89) s at ankle level before operation and TTP was (10.40 卤1.98) s at ankle level after operation. The TTP value in the ankle area before operation was (20.08 卤3.05) s, and the TTP value in the ankle area after operation was (16.43 卤2.52) s. The difference before and after treatment was statistically significant (P0.05), which indicated that the blood perfusion in the ankle area was improved significantly after treatment. Preoperative TTP difference of popliteal artery and popliteal artery TTP difference were (6.88 卤1.90) s, (8.66 卤1.79) s, postoperatively, TTP difference of popliteal artery and popliteal artery TTP difference were (4.5 卤1.25), (7.82 卤1.87) s, respectively. There was significant difference between the two TTP differences before and after treatment (P0.05). Spearman correlation analysis showed that there was a positive correlation between 螖 TTP and ABI, TcP02 (r = 0.53P = 0.33) and a positive correlation between TTP and ABI, TcP02 (r = 0.63n 0.41 P 0.05). The observation results of hemodynamic changes were evaluated by Syngo iFlowDSA, and the results showed that the quality of Syngo Flow images was better than that of DSA images, and the difference was statistically significant. Conclusion: Syngo iFlow software can be used to quantify the hemodynamic changes before and after angioplasty in patients with lower extremity arterial obstructive disease. The evaluation results are consistent with the traditional clinical evaluation methods.
【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R654.4;R816.2
本文编号：2262524
[Abstract]:Objective: to evaluate the feasibility and accuracy of Syngo iFlow software in evaluating hemodynamic improvement of affected limbs before and after endovascular treatment for lower extremity arterial symptomatic ischemic diseases and its correlation with traditional clinical evaluation methods. Methods: the medical records of 40 patients (24 males, 16 females, 58-85 years old with TASC 11 B / C lesions) with lower extremity slow occlusion treated by interventional intracavitary therapy were retrospectively analyzed. The preoperative and postoperative data were collected to evaluate the clinical symptoms and signs (pain, cold feeling, lameness), and the transcutaneous partial pressure of oxygen (TcPO2) to evaluate the outcome of the operation. Syngo iFlow was used to measure the TTP value of foot and ankle before and after operation to evaluate the improvement of hemodynamics. The TTP values of common femoral artery bifurcation, popliteal artery bifurcation, ankle joint level and popliteal artery bifurcation were collected before and after operation. The TTP difference between the common femoral artery bifurcation and popliteal artery bifurcation was statistically compared between the ankle level and the popliteal artery bifurcation. The quality of blood flow and perfusion information was compared and evaluated by two vascular interventional and imaging diagnostics specialists. T test, Wilcixin rank sum test and Spearman grade correlation analysis were used to evaluate the correlation and consistency of the traditional clinical evaluation method of Syngo iFlow mouth in evaluating the improvement of limb circulation before and after intracavitary treatment. Results: 40 patients successfully repaired severe femoral artery stenosis and occlusion by endovascular treatment. Preoperative evaluation of traditional clinical methods: pain score (1.88 卤1.62), cold sensation score (2.15 卤1.25), lameness score (2.90 卤0.84), ABI (, 0.35 卤0.08), TcPO2 (27.39 卤5.26) mmHg:, 1 week after operation: pain score (0.22 卤0.42), cold feeling score (0.23 卤0.42), limping score (0.63 卤0.59), ABI (0.66 卤0.07), TcP02 (40.75 卤3.42) mmmHg, before and after treatment (P0.05). SyngoiFlow evaluation showed that TTP value was (14.54 卤1.89) s at ankle level before operation and TTP was (10.40 卤1.98) s at ankle level after operation. The TTP value in the ankle area before operation was (20.08 卤3.05) s, and the TTP value in the ankle area after operation was (16.43 卤2.52) s. The difference before and after treatment was statistically significant (P0.05), which indicated that the blood perfusion in the ankle area was improved significantly after treatment. Preoperative TTP difference of popliteal artery and popliteal artery TTP difference were (6.88 卤1.90) s, (8.66 卤1.79) s, postoperatively, TTP difference of popliteal artery and popliteal artery TTP difference were (4.5 卤1.25), (7.82 卤1.87) s, respectively. There was significant difference between the two TTP differences before and after treatment (P0.05). Spearman correlation analysis showed that there was a positive correlation between 螖 TTP and ABI, TcP02 (r = 0.53P = 0.33) and a positive correlation between TTP and ABI, TcP02 (r = 0.63n 0.41 P 0.05). The observation results of hemodynamic changes were evaluated by Syngo iFlowDSA, and the results showed that the quality of Syngo Flow images was better than that of DSA images, and the difference was statistically significant. Conclusion: Syngo iFlow software can be used to quantify the hemodynamic changes before and after angioplasty in patients with lower extremity arterial obstructive disease. The evaluation results are consistent with the traditional clinical evaluation methods.
【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R654.4;R816.2
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