本文選題：食管和胃靜脈曲張 + 測壓法　； 參考：《安徽醫(yī)科大學(xué)》2016年博士論文

【摘要】：研究背景食管曲張靜脈壓力增高是導(dǎo)致門脈高壓食管靜脈曲張破裂出血的關(guān)鍵因素,測量食管曲張靜脈壓力對于預(yù)測曲張靜脈出血風(fēng)險以及評估藥物治療效果具有重要意義�，F(xiàn)有的無創(chuàng)性食管曲張靜脈測壓方法,包括普通壓力探頭測壓法、氣囊測壓法以及超聲內(nèi)鏡引導(dǎo)測壓法都是依據(jù)血管被剛剛壓陷時,血管腔內(nèi)外壓力平衡的原理進(jìn)行測壓。操作者按照自己的經(jīng)驗(yàn)判斷曲張靜脈被壓陷時刻,計算曲張血管壓力,存在主觀性,同時由于對設(shè)備要求較高,操作過程復(fù)雜,因此沒有得到大規(guī)模應(yīng)用。近年來,隨著光纖技術(shù)的發(fā)展,光纖壓力傳感器已經(jīng)大規(guī)模應(yīng)用于臨床進(jìn)行器官和組織的壓力檢測,光纖壓力傳感器具有傳統(tǒng)壓力傳感器所不可比的優(yōu)點(diǎn):靈敏度高、響應(yīng)速度快、重量輕、機(jī)械強(qiáng)度高。如果能建立一種基于光纖技術(shù)的食管曲張靜脈測壓技術(shù),利用光纖壓力傳感器所具備的操作簡便,靈敏度高,可靠性強(qiáng)等特點(diǎn)進(jìn)行食管曲張靜脈的貼壁測壓,可以提高食管曲張靜脈無創(chuàng)測壓技術(shù)的精確性。目的1.建立碰觸式醫(yī)用光纖食管曲張靜脈測壓技術(shù);2.通過模擬食管曲張靜脈的體外測壓實(shí)驗(yàn),驗(yàn)證該項(xiàng)測壓技術(shù)指標(biāo)的準(zhǔn)確性和可靠性;3.通過雜交犬腸系膜上靜脈(等同于門靜脈)和下腔靜脈的體內(nèi)測壓實(shí)驗(yàn),與有創(chuàng)血壓監(jiān)護(hù)儀測量的實(shí)際壓力值相對照,驗(yàn)證該項(xiàng)測壓技術(shù)的可操作性和可靠性;4.通過門脈高壓癥食管靜脈曲張患者的體內(nèi)測壓驗(yàn)證,與TIPS術(shù)中測量的門靜脈壓力梯度相對照,評估體內(nèi)測壓的可行性和準(zhǔn)確性。材料與方法1.建立碰觸式醫(yī)用光纖食管曲張靜脈測壓技術(shù),由光纖壓力探頭、光纖傳感器接收裝置、電子胃鏡圖像采集單元以及數(shù)據(jù)處理終端組成,將光纖壓力探頭貼壁放置在曲張靜脈上能實(shí)時記錄曲張靜脈壓力變化曲線圖,并能通過軟件計算出曲張靜脈壓力。2.通過體外實(shí)驗(yàn)驗(yàn)證醫(yī)用光纖靜脈測壓儀的準(zhǔn)確性:將光纖壓力探頭通過胃鏡活檢通道放置在模擬曲張靜脈表面進(jìn)行貼壁測壓。模擬曲張靜脈模型有兩種不同直徑(4 mm,8 mm),分別模擬小、中大食管曲張靜脈,模擬血管內(nèi)充滿水并與玻璃水柱相連,通過調(diào)節(jié)水柱的高度而改變模擬血管內(nèi)壓力。由兩名操作者分別進(jìn)行測壓,操作者不知道模擬血管內(nèi)壓力的實(shí)際值和測量值,兩種不同直徑模擬血管的實(shí)際壓力值范圍均在6∽40 mm Hg之間。3.通過動物實(shí)驗(yàn)驗(yàn)證醫(yī)用光纖靜脈測壓儀的可操作性:在10只雜交犬中選擇腸系膜上靜脈(壓力等同于門靜脈)和下腔靜脈作為測量血管,將光纖壓力傳感器測壓結(jié)果與有創(chuàng)血壓監(jiān)護(hù)儀測量的實(shí)際壓力值相對照,由兩名操作者分別進(jìn)行測壓,操作者不知道被測血管壓力的實(shí)際值和測量值,以驗(yàn)證醫(yī)用光纖靜脈測壓儀測壓的可操作性和可靠性。通過門脈高壓癥食管靜脈曲張患者的體內(nèi)測壓驗(yàn)證醫(yī)用光纖靜脈測壓儀的可行性和準(zhǔn)確性:在81例門脈高壓癥食管靜脈曲張患者中,將食道曲張靜脈無創(chuàng)測壓結(jié)果與TIPS術(shù)中測量的門靜脈壓力梯度相對照,同時與有無腹水、不同食管曲張靜脈直徑以及肝功能Child-Pugh分級相對照,以驗(yàn)證醫(yī)用光纖靜脈測壓儀測壓的可行性和準(zhǔn)確性。結(jié)果1.碰觸式醫(yī)用光纖食管曲張靜脈測壓技術(shù)運(yùn)行穩(wěn)定,在體外實(shí)驗(yàn)、動物實(shí)驗(yàn)和體內(nèi)驗(yàn)證中均順利完成壓力檢測;2.體外實(shí)驗(yàn)發(fā)現(xiàn),不同直徑模擬血管的測壓值與實(shí)際值之間具有良好相關(guān)性(r≥0.998,P0.001),兩名操作者分別測量的壓力值之間具有良好相關(guān)性(r≥0.998,P0.001),模擬血管的直徑大小和經(jīng)驗(yàn)不同的操作者均不影響測壓結(jié)果;3.動物實(shí)驗(yàn)發(fā)現(xiàn),醫(yī)用光纖靜脈測壓儀測量的腸系膜上靜脈壓力值與有創(chuàng)血壓測量的實(shí)際值之間具有良好相關(guān)性(r=0.731,P0.001),兩名操作者分別測量的壓力值之間具有良好相關(guān)性(r=0.757,P0.001),下腔靜脈的測量值與有創(chuàng)血壓實(shí)際值之間具有良好相關(guān)性(r=0.862,P0.001),兩名操作者分別測量的壓力值之間具有良好相關(guān)性(r=0.778,P0.001),醫(yī)用光纖靜脈測壓儀測量的數(shù)值較有創(chuàng)血壓監(jiān)護(hù)儀更為精確;4.檢測81例門脈高壓癥患者的食管曲張靜脈壓力,全部病例均測壓成功,沒有胸骨后疼痛、食管曲張靜脈出血、難以控制的咳嗽及呼吸困難等嚴(yán)重副作用。平均食管曲張靜脈壓(22.9±4.0 mm Hg)低于TIPS術(shù)中測量的門靜脈壓力梯度(38.0±6.4mm Hg),回歸分析表明,食管曲張靜脈壓力與門靜脈壓力梯度間具有良好的相關(guān)性(r=0.932,P0.001)。有腹水患者(n=56)的食管曲張靜脈壓力明顯高于無腹水患者(n=25)(24.56±4.36 mm Hg vs 15.74±3.92 mm Hg,P0.05),F3粗大血管(n=71)的食道曲張靜脈壓力值較F2(n=10)的高(23.6±4.8mm Hg vs 19.5±3.7 mm Hg,P0.05)。Child-Pugh分級與食管曲張靜脈壓力無相關(guān)性,Child A級(n=15)患者平均壓力為23.5±3.4 mm Hg,Child B+C級(n=66)患者平均壓力為22.2±4.1 mm Hg(t=1.09,P=0.28)。結(jié)論我們的研究顯示,碰觸式醫(yī)用光纖食管曲張靜脈測壓技術(shù)具有較高的準(zhǔn)確性與可行性,據(jù)此測定的食管曲張靜脈壓力是預(yù)測食管曲張靜脈破裂出血的主要危險因素,具有進(jìn)一步開發(fā)應(yīng)用的潛在價值。
[Abstract]:Background esophageal variceal pressure is the key factor in the bleeding of portal hypertensive esophageal varices. The measurement of esophageal variceal pressure is important for predicting the risk of variceal bleeding and the evaluation of the effect of drug treatment. The existing noninvasive esophageal Zhang Jingmai pressure measurement, including the common pressure probe Pressure measurement, balloon pressure measurement and endoscopic ultrasound guided pressure measurement are all based on the principle of pressure balance between the intravascular cavity and the intravascular pressure when the blood vessel is just pressed. The operator determines the pressure of the varicose veins in the time of the compression of the varicose veins according to his own experience. In recent years, with the development of optical fiber technology, optical fiber pressure sensors have been widely used in clinical organ and tissue pressure detection. Fiber pressure sensors have the advantages of traditional pressure sensors: high sensitivity, quick response, light weight, high mechanical strength. A kind of esophageal variceal pressure measurement technique based on fiber optic technology is established. It is easy to operate, with high sensitivity and high reliability, which can improve the accuracy of esophageal variceal noninvasive pressure measurement technology. Objective 1. to establish touch type medical fiber esophageal varices. Intravenous pressure measurement; 2. the accuracy and reliability of the pressure measurement technique were verified by an in vitro pressure test of a esophageal varicose vein. (3.) the pressure measurement of the superior mesenteric vein (equivalent to the portal vein) and the inferior vena cava in a hybrid dog was compared with the actual pressure measured by a invasive blood pressure monitoring instrument to verify the pressure measurement technique. The maneuverability and reliability of the operation; 4. to evaluate the feasibility and accuracy of the body pressure measurement in the body of the portal hypertensive patients with esophageal varices, compared with the pressure gradient of the portal vein measured in TIPS. Material and method 1. a touch type medical optical fiber esophagus Zhang Jingmai pressure measurement technique was established by the optical fiber pressure probe and fiber. The sensor receiving device, the electronic gastroscope image acquisition unit and the data processing terminal are composed of the optical fiber pressure probe placed on the varicose vein to record the curve of the varicose vein pressure in real time, and the veracity of the varicose vein pressure.2. can be calculated through the software to verify the accuracy of the medical optical fiber vein piezometer through in vitro experiment: The optical fiber pressure probe is placed on the surface of the analogue varicose vein by a gastroscope biopsy channel. The simulated varicose vein model has two different diameters (4 mm, 8 mm), which simulate small, medium and large esophageal varicose veins, simulate the water filled with water in the blood vessel and connect with the glass water column, and change the simulated intravascular pressure by adjusting the height of the water column. Two operators were measured separately, the operator did not know the actual value of the simulated intravascular pressure and the measured values. The actual pressure range of the two different diameters was between 6 and 40 mm Hg.3. through animal experiments to verify the operability of the medical optical fiber vein piezometer. In 10 hybrid dogs, the superior mesenteric vein was selected (pressure). The force is equal to the portal vein) and the inferior vena cava as the measuring blood vessel. The pressure measurement results of the optical fiber pressure sensor are compared with the actual pressure values measured by the invasive blood pressure monitor. The pressure is measured by two operators respectively. The operator does not know the actual value and the measured value of the measured vascular pressure, so as to verify the availability of the pressure measuring instrument of the medical optical fiber venous pressure measuring instrument. Practicality and reliability. The feasibility and accuracy of the medical fiber-optic venous piezometer in patients with esophageal varicose portal hypertension: in 81 patients with portal hypertensive esophageal varices, the results of the esophageal variceal noninvasive pressure are compared with the pressure gradient of the portal vein measured during the TIPS operation, with the presence of the abdomen. Water, the diameter of different esophageal varices and the Child-Pugh classification of liver function, to verify the feasibility and accuracy of the medical optical fiber venous pressure measuring instrument. Results 1. touch type medical fiber-optic esophageal variceal pressure measurement technique was stable, and the pressure detection was successfully completed in the experiment in vitro, in animal experiments and in the body, and 2. in vitro. It was found that there was a good correlation between the measured values of the simulated blood vessels of different diameters and the actual values (r > 0.998, P0.001). The pressure values measured by the two operators had good correlation (r > 0.998, P0.001). The diameter of the simulated blood vessels and the experience of different experience did not affect the results of the pressure measurement; 3. animal experiments found that the medical light was used for medical light. There was a good correlation between the value of the superior mesenteric vein pressure measured by the fibrinometer and the actual value of the invasive blood pressure measurement (r=0.731, P0.001). There was a good correlation between the pressure values measured by two operators (r=0.757, P0.001). There was a good correlation between the measured values of the inferior vena cava and the actual value of invasive blood pressure (r=0.862, P 0.001) there was a good correlation between the pressure values measured by two operators (r=0.778, P0.001), and the value of the medical fiber venous piezometer was more accurate than that of the invasive blood pressure monitor; 4. the esophageal variceal pressure of 81 patients with portal hypertension was detected. All cases were successfully measured, without post sternal pain and esophageal variceal vein. Severe side effects such as bleeding, uncontrollable cough and dyspnea. Average esophageal variceal venous pressure (22.9 + 4 mm Hg) was lower than that measured in TIPS (38 + 6.4mm Hg). Regression analysis showed a good correlation between the esophageal variceal pressure and the pressure gradient of the portal vein (r=0.932, P0.001). Patients with ascites (n=5). 6) the venous pressure of esophageal varices was significantly higher than that of the patients without ascites (n=25) (24.56 + 4.36 mm Hg vs 15.74 + 3.92 mm Hg, P0.05). The value of the esophageal variceal pressure in F3 large vessels (n=71) was higher than that of F2 (n=10) (23.6 + 4.8mm 19.5 + 3.7), and there was no correlation between the esophageal variceal pressure and the esophageal variceal pressure. The average pressure was 23.5 + 3.4 mm Hg and the average pressure of Child B+C (n=66) patients was 22.2 + 4.1 mm Hg (t=1.09, P=0.28). Conclusion our study showed that the touch type medical fiber-optic esophageal variceal pressure measurement technique has high accuracy and feasibility. The esophageal variceal Zhang Jingmai pressure measured accordingly is the main prediction of the bleeding of esophageal variceal rupture. Risk factors are of potential value for further development and application.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R575.2;TP212

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