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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (04) : 346 -349. doi: 10.3877/cma.j.issn.2095-5782.2020.04.010

所属专题： 专题评论； 文献；

影像诊断

超声造影无创性评估下肢浅静脉血流阻断的初步研究
卢吴柱1, 陈慧1, 黄涌泉1, 张晶晶2, 梁艳2, 苏中振1, 白雪玲3,†()   
  1. 1. 519000　广东珠海，中山大学附属第五医院超声科
    2. 519000　广东珠海，中山大学附属第五医院介入医学中心
    3. 519000　广东珠海，中山大学附属第五医院消毒供应中心
  • 收稿日期:2020-07-09 出版日期:2020-11-25
  • 通信作者: 白雪玲
  • 基金资助:
    中山大学附属第五医院护理科研基金(31019905030501)

A preliminary study of noninvasive evaluation of blocking superficial veins of lower limb by contrast-enhanced ultrasonography

Wuzhu Lu1, Hui Chen1, Yongquan Huang1, Jingjing Zhang2, Yan Liang2, Zhongzhen Su1, Xueling Bai3,†()   

  1. 1. Department of Ultrasonic, the Fifth Affiliated Hospital of Sun Yat-sen University, Guangdong Zhuhai 519000, China
    2. Department of Interventional Medicine, the Fifth Affiliated Hospital of Sun Yat-sen University, Guangdong Zhuhai 519000, China
    3. Department of Central Sterile Supply, the Fifth Affiliated Hospital of Sun Yat-sen University, Guangdong Zhuhai 519000, China
  • Received:2020-07-09 Published:2020-11-25
  • Corresponding author: Xueling Bai
  • About author:
    Corresponding author: Bai Xueling, Email:
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卢吴柱, 陈慧, 黄涌泉, 张晶晶, 梁艳, 苏中振, 白雪玲. 超声造影无创性评估下肢浅静脉血流阻断的初步研究[J/OL]. 中华介入放射学电子杂志, 2020, 08(04): 346-349.

Wuzhu Lu, Hui Chen, Yongquan Huang, Jingjing Zhang, Yan Liang, Zhongzhen Su, Xueling Bai. A preliminary study of noninvasive evaluation of blocking superficial veins of lower limb by contrast-enhanced ultrasonography[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(04): 346-349.

目的

探讨阻断下肢浅静脉的位置及最适压力值。

方法

选取12位健康志愿者的双侧下肢静脉为研究对象，经足背静脉进行超声造影，使用气压袖带分别在距离踝关节上方5、10、15 cm处绑扎并施加压力，当小隐静脉（small saphenous vein，SSV）不显影时为有效阻断下肢浅静脉血流，记录压力值。另外，评估踝上10 cm处有效阻断浅静脉前后，同侧腘静脉（popliteal vein，POPV）内径、流速及血流量的变化。

结果

踝上5、10、15 cm有效阻断下肢浅静脉的压力阈值分别为（66～69） mmHg（1 mmHg=0.133 kPa）、（68～71）mmHg、（73～75）mmHg（95%置信区间）；踝上10 cm处有效阻断下肢浅静脉后，同侧POPV的内径、血流量显著增加（P<0.05），流速无明显增加（P>0.05)。

结论

踝上不同部位有效阻断下肢浅静脉所需要的压力阈值不同，超声造影可无创监测气压止血带有效阻断下肢浅静脉血流，为临床治疗下肢深静脉血栓提供帮助。

关键词: 超声造影, 溶栓治疗, 浅静脉阻断, 气压止血带
Objective

To explore the position and optimal pressure of blocking the superficial vein of lower extremities.

Methods

The bilateral lower limb veins of 12 healthy volunteers were selected for the study. Contrast-enhanced ultrasound was performed through the dorsalis pedis vein. Pneumatic cuffs were used to bind and apply pressure at 5 cm, 10 cm and 15 cm above the ankle joint. When the small saphenous vein (SSV) was not visible, the superficial vein blood flow of the lower extremities was effectively blocked and the pressure was recorded. In addition, the changes of diameter, flow velocity and blood flow of ipsilateral popliteal vein (POPV) before and after effective occlusion of superficial vein at 10cm of ankle were evaluated.

Results

The pressure thresholds of supramalleolar 5 cm, 10 cm and 15 cm for effectively blocking the superficial veins of lower extremities were (66-69) mmHg, (68-71) mmHg and (73-75) mmHg (95% confidence interval), respectively. After effectively blocking the superficial veins of lower extremities at 10 cm on the ankle, the internal diameter and blood flow of ipsilateral POPV increased significantly (P<0.05), but the flow velocity did not increase significantly (P>0.05).

Conclusions

Different parts of the ankle require different pressure thresholds to effectively block the superficial veins of the lower extremities. CEUS can non-invasive monitor the blood flow of the superficial veins of the lower extremities effectively blocked by pneumatic tourniquet, which is helpful for the clinical treatment of deep venous thrombosis of the lower extremities.

Key words: Contrast-enhanced ultrasound, Thrombolytic therapy, Superficial vein occlusion, Pneumatic tourniquet
表1 12例健康志愿者的一般资料
一般资料 男性 女性 合计
人数 6 6 12
年龄（岁） 23.83±1.94 35.00±9.55 29.42±8.79
BMI 22.51±3.07 21.70±2.60 22.10±2.74
收缩压（mmHg） 116.17±10.21 125.50±18.38 120.83±14.99
舒张压（mmHg） 78.00±6.69 81.17±10.85 79.58±8.75
图1 超声造影检查
表2 踝上不同部位有效阻断下肢浅静脉的压力平均值及95%置信区间（mmHg）
分组 例数 均值 95%置信区间
上限 下限
踝上5 cm 20 68 66 69
踝上10 cm 20 70 68 71
踝上15 cm 20 74 73 75
表3 踝上10 cm处有效阻断下肢浅静脉前后POPV内径、流速及血流量比较
组别 例数 内径(mm) 流速(cm/s) 流量（mL/min）
阻断前 20 4.84±0.48 5.11±0.54 56.27±10.67
阻断后 20 4.86±0.48 5.18±0.47 57.03±10.32
t值   -3.077 -0.517 -2.077
P值   0.005 0.610 0.049
[1]
Arcasoy SM, Vachani A. Local and systemic thrombolytic therapy for acute venous thromboembolism[J]. Clin Chest Med, 2003, 24(1): 73-91.
[2]
Konstantinides SV, Warntges S. Acute phase treatment of venous thromboembolism: advanced therapy. Systemic fibrinolysis and pharmacomechanical therapy[J]. Thromb Haemost, 2015, 113(6): 1202-1209.
[3]
Schweizer J, Kirch W, Koch R, et al. Short- and long-term results after thrombolytic treatment of deep venous thrombosis[J]. J Am Coll Cardiol, 2000, 36(4): 1336-1343.
[4]
Popuri RK, Vedantham S. The role of thrombolysis in the clinical management of deep vein thrombosis[J]. Arterioscler Thromb Vasc Biol, 2011, 31(3): 479-484.
[5]
Ippolito E, Molinari A, Romagnoli S, et al. Deep vein thrombosis: a mininvasive locoregional thrombolytic treatment[J]. Minerva Ardioangiologica, 2008, 56: 63-70.
[6]
Grunewald M, Griesshammer M, Ellbruck D, et al. Loco-regional thrombolysis for deep vein thrombosis: fact or fiction? A study of hemostatic parameters[J]. Blood Coagul Fibrinolysis, 2000, 11(6): 529-536.
[7]
张青云，丁萌，陈磊, 等. 不同溶栓途径在急性下肢深静脉血栓形成中的应用评价[J]. 中国医药导报, 2017, (29): 111-114.
[8]
李燕，陈宇辰，郑乃霞, 等. 下肢深静脉溶栓采用血压计止血带浅静脉血流阻断效果比较[J]. 护理学杂志, 2017, (12): 37-39.
[9]
Sidhu PS, Cantisani V, Dietrich CF, et al. The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017[J]. Ultraschall in der Medizin, 2018, 39(2): 154-180.
[10]
Morel DR, Schwieger I, Hohn L, et al. Human pharmacokinetics and safety evaluation of SonoVue, a new contrast agent for ultrasound imaging[J]. Invest Radiol, 2000, 35(1): 80-85.
[11]
Labropoulos N, Webb KM, Kang SS, et al. Patterns and distribution of isolated calf deep vein thrombosis[J]. J Vasc Surg, 1999, 30(5): 787-791.
[12]
孙进仓，葛珊珊. 下肢深静脉溶栓采用血压计止血带浅静脉血流阻断效果比较[J]. 双足与保健, 2019(24): 131-132.
[13]
Piscaglia F, Bolondi L, SIUMB. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations[J]. Ultrasound Med Biol, 2006, 32(9): 1369-1375.
[14]
Jorfeldt L, Vedung T, Forsstrom E, et al. Influence of leg position and environmental temperature on segmental volume expansion during venous occlusion plethysmography[J]. Clin Sci, 2003, 104(6): 599-605.
[15]
Zachrisson H, Volkmann R, Bergerheim T, et al. Selectivity of superficial vein occlusion at the ankle and calf level: a methodological study in healthy volunteers[J]. Clinical Physiology, 1998, 18(1): 55-60.
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