彩色多普勒超声对下肢动脉闭塞性疾病血流动力学变化研究

Haemodynamics study on arterial occlusion in lower extremities by color doppler ultrasonography

目的:探讨下肢动脉闭塞性疾病闭塞前段的血流动力学变化规律,研究彩色多普勒超声(CDU)在下肢动脉闭塞性疾病中的临床应用价值。方法:对35例下肢股-腘动脉型闭塞的患者进行彩色多普勒超声检查,分析其二维图像、彩色多普勒血流表现及脉冲多普勒血流动力学特征,并与正常参考值作对比分析。结果:二维灰阶显像可清晰显示血管腔内充填的中高回声硬化斑块或中低回声实质性血栓结构,彩色多普勒血流成像(CDFI)显示血流中断,闭塞段血流信号消失,闭塞前段可见红色血流内间有小股蓝色血流,脉冲多普勒(Paulse waveform, PW)频谱分析得出血流动力学的变化情况为:收缩期峰值流速(PSV)为(54．66±22．43)cm／s,较正常值明显减低 (P<0．001);收缩期加速时间(AT)为(0．12±0．03)s,较正常值明显延长(P<0．001);阻力指数(RI)为0．92± 0．21,较正常值增大(P<0．005);搏动指数(PI)为6．38±3．24,较正常值增大(P<0．005)。结论:彩色多普勒超声成像作为一种无刨性的检查方法应用于下肢动脉闭塞性疾病,具有操作简便、可重复性强及诊断准确的特点。通过对受累血管的直观显示、频谱形态的分析,以及血流动力学参数的测定,可为下肢动脉闭塞性疾病提供充分的诊断依据,动态评价临床治疗效果。

Objective： To study the haemodynamic characteristics of lumen proximal after getting arterial occlusive disease in the lower extremities, and assessing the clinical diagnostic value of color Doppler ultrasonography （CDU）. Methods： Thirty-five cases of arterial occlusion in the femoral artery and popliteal artery were examined with CDU. Parameters for blood flow and two-dimensional sonography imaging were collected and compared with normal criteria. Results： For the disease atheromatous plaque and median to low sound substance thrombus in lumen were clearly displayed by CDU. The color Doppler flow imaging showed interruption of the blood flow, the flow signal disappearance in the occlusion part. The analysis of pulse waveforms showed peak systolic velocity （PSV） decreased sharply（PSV was 54.66 ± 22.43cm/s, P 〈0.001）, along with the resistive index （RI） and pulsitive index （PI） apparently increased （RI was 0.92±0.21, P 〈0.005; PI was 6.38_±3.24, P 〈0.005）. The systolic acceleration time （AT） prolonged significantly （AT was 0.12± 0.03s, P 〈0. 001 ）. Compared with the normal standard, the deviation of all four indexes showed significant differences. Conclusion： The method of color Doppler ultrasonography for arterial occlusion as a non invasive examination tool is easy to practice and demonstrates good accuracy and repeated. This method can be used in the disease for parameters of haemodynamics caused by thrombus, CDU can provide fully evidences for clinic diagnosis. CDU has the potential to be an important way in examination and follow-up for limb＇s arterial disease.