【作者】 柴亮；

【导师】 李越；

【作者基本信息】 中国人民解放军军医进修学院 ， 超声影像医学， 2008， 硕士

【摘要】 第一部分返流模型的建立及验证目的建立瓣膜反流的体外模型,实现实时三平面超声心动图对瓣膜反流定量测量的标准对照。原理利用经典力学液体压强原理p=ρgh,通过控制液面高度差h,实现对返流口压差的控制,进而得到稳定的流速v。通过时间继电器控制电磁阀门在给定的时间t开放。因此在给定反流孔口面积s前提下,流量q=vst保持恒定。材料方法1利用市售煤气管(内径1.5cm)连接水槽和自制量杯将二者之间的高度差固定在160cm,100cm,60cm三个水平。2利用台钻将60ml医用一次性注射器套桶顶端正中钻孔,孔径分别为2mm、3mm、4mm、5mm、6mm、7mm、8mm,9mm、10mm模拟圆形反流孔口,将其固定于水槽底部。3将电磁阀门(北京文达伟业机电设备有限公司生产,型号2w-15内径15mm)连入220v,50Hz普通照明电,用时间继电器(浙江泰华电器有限公司生产,型号JSS48A,时间精度0.01秒)控制电磁阀门的电流通断时间,以实现电磁阀门在给定时间的开放。4模拟反流液体:市售豆浆,温度控制在24-27°c。比重控制在3-4.5单位(约1.005-1.006)。5将GE VV7 DIMENSION 3V矩阵探头通过支架固定于水槽上方,并使其没入液体中,启动彩色多普勒实时三切面显像模式。结果1)时间继电器设置在0.4秒,连续多普勒显示反流的持续时间为(0.5±0.02)秒,大于时间继电器上所示读数。2)选择直径2mm、4mm、6mm、8mm孔口模拟返流,将时间继电器接通时间设定在0.4秒,压差固定在160cm,100cm,60cm液柱高度相互组合,通过自制量杯标出的容积刻度读取每次阀门开放实际通过孔口的流量,重复6次,测量结果误差在2.5ml以内。3)电磁阀门开放时间设置在0.4秒,当孔口内径大于8mm后,反流量保持在37ml不再增加,证明电磁阀门开度不大于8mm。4)实时三切面超声心动图显示反流柱可见呈纺锤形。结论我们通过自行设计建立了稳定可靠的适用于超声实验研究的瓣膜反流模型。实现了实时三平面超声心动图对模拟瓣膜反流定量检测的标准对照。第二部分彩色多普勒实时三切面体积法定量瓣膜反流的可行性研究目的探讨实时三维三切面成像模式下通过彩色多普勒反流信号体积定量瓣膜反流的可行性及影响因素。方法利用自制反流模型,用豆浆模拟反流液体,选择2mm,4mm,6mm,8mm圆形反流孔口,在160cm,100cm,60cm液柱压差下,通过设置不同仪器条件观测实时三维三切面成像模式下彩色多普勒反流信号的体积,将观测结果与实际反流量相比较。结果(1)在适当的仪器设置条件下,三维三切面显像法测得的反流彩色多普勒信号体积与实际流量无统计学差异(p＞0.05)。(2)实时三维三切面模式下反流的彩色多普勒信号体积受到仪器检查条件设置的影响,反流量测值随增益和能量输出的增加而增加,随着彩色速度标尺的降低而增大(p＜0.01,p＜0.01,p＜0.01)。(3)不同压差对三维三切面显像法测得的彩色多普勒信号体积的准确性有一定影响,低压差时提高增益结果更准确,测量值与真实值无统计学差异(P＞0.05)。结论实时三维三切面成像模式下利用彩色多普勒定量瓣膜反流可行,且方法简便,但前提是恰当的设定仪器的检查条件。第三部分缩流宽度与血流会聚法定量瓣膜反流的体外模型研究目的了解实时三切面成像模式利用缩流宽度和彩色血流会聚法定量瓣膜反流的准确性及其影响因素方法利用自制的体外返流模型,在实时三切面模式下对不同直径(2mm,4mm,6mm,8mm)圆形孔口,在不同压差及不同仪器检查条件设置下,选三切面中缩流和血流会聚区最清晰且较大者进行测量。结果1)对于4mm、6mm、8mm孔口,近端血流会聚法测量的反流流率受增益和速度标尺的影响不明显(p＞0.05),但压差对测量结果有显著影响(P＜0.01),测值随压差的增加而增加。对于2mm孔口而言,不同压差的反流流率无明显变化(p＞0.05)。2)利用PISA法得到的有效反流口面积(Efficient RegurigationOrifice Area EROA)与实际反流口面积相关性良好(r=0.9987)3)对于缩流宽度的研究在窄扫描角度的条件下2mm、4mm、6mm、8mm孔口反流的缩流均可显示,缩流口宽度主要受增益的影响(p＜0.01),而压差及速度标尺对缩流宽度的影响无统计学意义(p＞0.05,p＞0.05);增益-20db条件下缩流宽度与孔口相关系数为r=0.845。2mm孔口在低增益(-20db,-15db),宽扫描角度条件下未能显示,但在-13db,-7db两个增益条件下可以显示。采用宽的扫描角度的缩流宽度大于窄扫描角度下的缩流宽度(p＜0.01)。结论利用实时三切面超声心动图测量缩流宽度可以对瓣膜反流进行半定量评估,简便易行,不受压差影响,但须注意增益的恰当设置。在实时三切面模式下利用PISA法可精确定量瓣膜反流,但须注意压差对测值的影响。更多还原

【Abstract】 Part 1Objective To set up a vitro mode to imitate the valve regurigtation and to establish the true control of the quantification assessment of the valve regurgation by real-time tri-plane echocardiography.Mehtods and principle Basing the principle of pressure of fluid p=ρgh, to keep a stabilizaed gradient through the orification by keep a given altitude of the fluid.Control the open time of the electromagnetically operated valve by using a timer.1)The water tank and self-made measuring glass was connected by a gas pipe which inner diameter is 1.5cm.And keep in the three difference height between the water tank and the measuring glass.2)A hole was drilled in the center at the top of the casing of single-use syringes with different diameters 2mm、3mm、4mm、5mm、6mm 7mm、8mm、9mm、10mm to imitate regurgitation orific.3)Bean milk which temperature was at 24-27°c and specific density was controled at 1.005-1.006. 4)The real-time three-dimensional transducer of 4V(GE VV7 DIMENSION)was fixed above the water tank by a bracket to detect the color Doppler flow image of imitated valve regurgitation.Results 1)The lasting time of imitated regurgitation was longer(0.5±0.02s) than the set time(0.4s)by the timer.2)Lasting time of imitated regurgitation set at 0.4s,the gradient through the orification set at 160cm,100cm,60cm of the height of fluid,the error volumes of imitation regurgitation through orifics(inner diameter 2mm,4mm,6mm,8mm)were not more than 2.5 ml.3)Volumes of imitation regurgitation through orifics was not increase when the diameter of the orfic was over 8mm,demonstrating the size of orfic of the electromagnetically operated valve not more than 8ram.4)The shape of the volume of the reguigitatin was a spindle observed in real-time tri-plane color doppler echocardiography.Conclusions The self-made vitro mode can imitate the valve regurgitation. Using the mode,the control can be established between the volume measured in the real-time tri-plane echocardiography and the real volume through orific.Part 2The feasibility study on valve regurgitation quantification with real-time three dimensional echocardiograph in tri-plane color doppler mode____vitro studyObjective To validate the feasibility of mitral quantification with real-time three-dimensional echocardiography(RT-3DE)in tri-plane color doppler mode.Mehtods The volumes of color doppler of imitation regurgitation were observed and measured in real-time three-dimensional echocardiograph in tri-plane color doppler mode using self-made regurgitation mode with the different instrument condition.The diameter of regurgitation orifice were selected with 2mm,4mm,6mm, 8mm.The gradient of pressure was controled under the height of water at 160cm, 100cm,60cm.Result The regurgitant flow volume measured with 3D color doppler imaging were increased with the increase of gain and power and lower of the color bar. However there were no difference between the volume measured with 3D color doppler imaging and the real volume under the appropriate instrument condition.Conclusions It is feasible to quantify the mitral regurgitation with real-time three-dimensional echocardiography(RT-3DE)in three-section color doppler mode. But the accuracy of the quantification is influenced by the instrument condition. Part 3vena contracta width and the flow convergence method in the quantitive assessment of valvular reguigitation by real -time tri-plane echocardiography____vitro studyObjective To evaluate the accuracy and effect factor in the quantiation of valve regurgitation with vena contracta width and the flow convergence method by real -time tri-plane echocardiography.Methds The vena contracta width and the flow convergen of different diameter orifice(2mm,4mm,6mm,8mm)were observed and measured in different gradient and different instrument condition by real -time tri-plane echocardiography.Results flow rate that measured by the convergence method.The vena contracta width did not vary with the transvalvular gradient and color bar(P＞0.05,p＞0.05),but it was correlated with the gain(p＜0.05).The vena contracta width was signdficantly correlated with the diameter of the orifice,r=0.854 when gain was set at -20db.The width increased with the increase of gain.While the transvalvular gradient influenced the flow rate measured by the flow convergence significantly(p＜0.05).Conclusion Vena contracta widthes are easy to measure and can be used to assess the valvular regurgitation and do not vary with the transalvular gradient but the gain of color doppler influences the width.The flow convergence method is a accurate method to quantitive assess valvular reguigitation and corelated to the transvalvular gradient.更多还原