健康成人上肢肱动脉-指端微循环的血流动力学梯度变化研究

Hemodynamic gradient changes of upper extremity arteries from the brachial artery to fingertip microcirculation in healthy adults

目的探讨健康成人上肢动脉从肱动脉至指端微循环的血流动力学特点及变化趋势。方法纳入2019年8月至2019年11月川北医学院健康管理中心体检健康成人205例,其中男88例,女117例,年龄20~80(49±15)岁,各年龄段男女比例相当。采用常规高频彩色多普勒超声结合平面波超敏感血流显像技术(Angio PLUS)探查右手臂的肱动脉、尺动脉、桡动脉、指掌侧固有动脉、指背动脉弓及甲床三级动脉弓,获取各动脉的解剖学及血流动力学参数,并分析动脉间各项参数的差异及变化趋势。结果上肢动脉血流频谱主要表现为单相波形、典型三相波形、非典型三相波及其他少见波形4种类型。由肱动脉至指掌侧固有动脉血流频谱中单相波形占比逐渐增多(Mantel-Haenszel趋势检验χ2=139.457,Spearman's R=-0.477,P<0.001),至指端动脉水平血流频谱均表现为单相波形。当肱动脉血流频谱表现为单相波形时,其分支动脉均表现为单相波形。由肱动脉至甲床三级动脉弓的血管内径、收缩期峰值血流速度、阻力指数、搏动指数、血流容积速度、收缩期血流加速度差异有统计学意义(多组动脉间Cruskal-Wallis检验H=898.478、802.719、613.528、656.745、836.189、868.450,均P<0.01),上述参数均与动脉解剖位置相关并呈递减趋势(Spearman's R=-0.930、-0.871、-0.768、-0.793、-0.891、-0.921,均P<0.01)。结论正常成人上肢由近心端至远心端动脉管腔内径及血流动力学参数呈现规律梯度变化。常规高频彩色多普勒超声结合Angio PLUS技术可用于监测上肢动脉及指端微循环的不同水平血流动力学状态。

Objective To investigate the hemodynamic characteristics and change trend of upper extremity arteries from the brachial artery to ipsilateral fingertip microcirculation in healthy adults.Methods A total of 205 healthy adults from the Health Management Center of North Sichuan Medical College were enrolled in this study from August 2019 to November 2019.There were 88 males and 117 females,aged 20-80(mean,49±15)years,with no significant difference in sex ratio among different age groups.The right brachial artery,ulnar artery,radial artery,palmar proper digital artery,dorsal digital artery arch,and third grade artery arch of fingernail bed(FN3 AA)were detected by color Doppler flow imaging(CDFI)and Angio PLUS.The anatomical and hemodynamic parameters were obtained to analyze the differences and trends of the parameters among the arteries.Results The Doppler spectrum of the upper extremity artery mainly showed four types:monophasic waveform,typical triphasic waveform,atypical triphasic waveform,and other rare waveforms.The proportion of monophasic waveform increased gradually from the brachial artery to the palmar proper digital artery(Mantel-Haenszelχ2=139.457,Spearman’s R=-0.477,P<0.001).The waveform of fingertip arteries was monophasic.When the brachial artery showed the monophasic waveform,its branches also showed the same waveform.There were statistically significant differences in vessel diameter,peak systolic flow velocity(PSV),resistance index(RI),pulsatility index(PI),blood flow volume velocity,and systolic blood flow acceleration from the brachial artery to FN3 AA(CruskalWallis H=898.478,802.719,613.528,656.745,836.189,and 868.450,respectively;P<0.01 for all),and these parameters showed a decreasing trend related to the anatomical position of arteries(Spearman’s R=-0.930,-0.871,-0.768,-0.793,-0.891,and-0.921,respectively;P<0.01 for all).Conclusion The vessel diameter and hemodynamic parameters present regular gradient changes among upper extremity arteries.Conventional high-frequency color Doppler combined with Angio PLUS could be used to monitor the hemodynamic status of upper extremity arteries at different levels.