CN101920049A - Method and system for measuring recirculation rate and/or recirculation volume of dialyzing access - Google Patents
Method and system for measuring recirculation rate and/or recirculation volume of dialyzing access Download PDFInfo
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Abstract
The invention discloses a method for measuring the recirculation rate and/or the recirculation volume of a dialyzing access, comprising the following steps of: injecting a contrast agent on the dialyzing access which comprises a dialyzing vessel/internal fistula access and a dialyzator pipeline; extracting an ultrasonic dialyzing echo signal or a Doppler signal of the contrast agent on the dialyzing access to generate a corresponding time intensity curve; and calculating the recirculation rate and/or the recirculation volume of the dialyzing access according to the parameters of a time intensity curve of an ultrasonic dialyzing echo signal or the Doppler signal. Accordingly, the invention also provides a system for measuring the recirculation rate and/or the recirculation volume of the dialyzing access, and therefore, the invention can be used for quickly and accurately measuring the recirculation rate and/or the recirculation volume of the dialyzing access in large quantity.
Description
Technical field
The present invention relates to the detection technique of hemodialysis in the medical field, relate in particular to a kind of method and system of measuring the recirculation rate and/or the recirculation volume of dialyzing access.
Background technology
Hemodialysis is meant draws patient's blood outside the health, and removes wherein some morbid substance by a kind of purifier, thereby purifies the blood to reach the purpose of treatment disease.Maintenance hemodialysis is one of critical treatment measure of end stagerenaldisease patient.Whether fully dialysing is the key factor that influences dialysis patient life quality and prognosis.Dialyzing access comprises dialysis blood vessel/internal fistula path and dialysis apparatus pipeline, cardiovascular circulation important structure in connector outer circulation and body when it is dialysis, and suitable dialyzing access is the key factor of decision dialysis treatment success or failure.But recirculation phenomenon can occur in actual blood dialysis, recirculation can obviously weaken the efficient of hemodialysis, the adequacy of influence dialysis.The periphery dialyzing access exists recirculation may point out the dialyzing access underfed, and it can cause thrombosis, and having a big risk of path failure is big to be increased thereby make.
The recirculation of hemodialysis generally comprises cardiopulmonary recirculation and path recirculation, wherein:
(1) cardiopulmonary recirculation: the part blood flow of process dialysis is got back to the path arterial end with cardiac output (CO) once more and is entered extracorporeal circulation (Qb) without body tissue.This part blood flow (Qa) just is defined as cardiopulmonary recirculation (CPR) with the ratio of cardiac output (CO).It can be with following equation expression: R=Qb/ (CO-Qa+Qb).Cardiopulmonary recirculation blood flows into dialyser approximately needs 2min.The amount of cardiopulmonary recirculation is relevant with patient itself with dialysis parameters.Dialyzer clearance rate, vascular access flow and cardiac output (CO) etc. all can influence the amount of CPR.CPR increases along with the increase of path flow.Under high pump speed situation, cardiac output in the dialysis procedure (CO) reduces, and can aggravate CPR accordingly.CPR generally between 20%～30%, reaches as high as 50%.
(2) path recirculation: the blood that part was dialysed is got back to the inlet of extracorporeal circulation pipeline again, and to the arterial needle reverse flow, the adverse current blood flow (Qr) that this part purified has constituted path recirculation (AR) to the blood of promptly having dialysed from intravenous needle.It can be expressed as AR=Qr/Qb.Path recirculation blood flows into dialyser in the several seconds.The reason that causes AR has multiple.A kind of is not reach loop flow (Qb) when requiring when path flow (Qa), has formed local decompression, causes part venous side blood to backflow to arterial side, and the extracorporeal circulation blood flow (Qr) that a part purified forms short circuit between path; Another common cause is that internal arteriovenous fistula puncture needle spacing is too small, perhaps punctures in same road blood vessel, and perhaps the puncture poor direction of puncture needle is true or opposite.Still have recirculation if get rid of above situation, then should consider to exist the path problem, unusual or passage downstream section occurs narrow etc. as vascular anatomy.The resistance increase caused taking place the path recirculation when these path problems refluxed blood.
Detecting the dialyzing access recirculation is to formulate the reasonably important prerequisite of dialysis prescription.Detect recirculation and may find angiostenosis, in time angiostenosis is taked intervening measures such as angioplasty, may prolong the service life of dialyzing access.Existing recirculation detection method has comprised the dilution process of urea method and non-carbamide.Wherein urea method comprises three pin urea methods and crosspointer urea method etc., and the dilution process of non-carbamide comprises normal saline dilution technology, ultrasonic dilution technology, hot dilution technology, electrical conductivity technology, packed cell volume dilution technology, light dilution method/optical concentration method, the dilution method based on serum potassium ion, bicarbonate radical method, the preceding glucose injection method of dialysis or the like.
In essence, the method for all quantifications and measurement dialyzing access recirculation all is based on the indicator dilution principle.It all is injection a kind of tracer or make a physical change in the circulation blood flow, along with the dilution fully of tracer, in the downstream of injection point with sensor to tracer concentration be exactly a kind of result relevant with blood flow.Because recirculation is the ratio of flow, in general the mensuration of recirculation just can change into the ratio of concentration so.The process of carbamide controlled removal in hemodialysis can be considered as a kind of important special case that tracer dilutes.In the various dilution technologies,, then need the double injection tracer if having only a pick off; If two pick offs are arranged, then only need a shot.The mensuration of recirculation requires and can be undertaken and do not disturb dialysis treatment by the demand frequency.And being used for suitable tracer that recirculation detects must be nontoxic, stablize and can rest on blood.
But existing technology ubiquity complex steps, consuming time, the consumption power of measuring recirculation in the dialyzing access is not suitable for the defective of accurately tackling a large amount of dialysis patients fast, so be necessary to be improved.
Summary of the invention
At above-mentioned defective, the object of the present invention is to provide a kind of recirculation rate of dialyzing access and/or method and system of recirculation volume measured, it can measure the recirculation rate and the recirculation volume of dialyzing access fast, accurately, in large quantity.
To achieve these goals, the invention provides a kind of method of measuring the recirculation rate and/or the recirculation volume of dialyzing access, described method comprises:
A, on the dialyzing access that comprises dialysis blood vessel/internal fistula path and dialysis apparatus pipeline injection of contrast medium;
The ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on B, the described dialyzing access of extraction also generates corresponding time-activity curve;
C, according to the parameter of the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal, calculate the recirculation rate and/or the recirculation volume of described dialyzing access.
The method according to this invention, in the described steps A at the described contrast agent of outlet tube highway section bullet formula (bolus injection) the injection scheduled volume of the dialysis apparatus pipeline of next-door neighbour's internal fistula vein end.
The method according to this invention, described step B further comprises:
The ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on B1, the described dialyzing access of extraction;
B2, described ultrasonic contrast echo-signal or Doppler signal are carried out the association and the match of gamma function or class gamma function, generate the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal.
The method according to this invention, described ultrasonic contrast echo-signal and Doppler signal comprise ultrasonic backscattering echo-signal, doppler shifted signal or Doppler frequency shift audio signal; Ultrasonic backscattering echo-signal, doppler shifted signal or the Doppler frequency shift audio signal that described contrast agent produces in vein end section or outlet tube highway section, arterial end section or the input pipe highway section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline extracted in while or gradation among the described step B1.
The method according to this invention, described ultrasonic backscattering echo-signal is extracted in area-of-interest contrastographic picture or full width contrastographic picture; Described area-of-interest contrastographic picture is meant and is confined to the vein end section shown on the ultra sonic imaging cross section of ultrasonic instrument to described dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or the image-region in outlet tube highway section, arterial end section or input pipe highway section; Described full width contrastographic picture is meant that ultrasonic instrument is to shown all images on the ultra sonic imaging cross section of described dialysis blood vessel/internal fistula path and dialysis apparatus pipeline.
The method according to this invention, described step C further comprises:
C1, at least one value that produces at least one parameter in the described time-activity curve on the vein end section of described dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or outlet tube highway section, arterial end section or input pipe highway section or ratio are as first value;
The sectional area in C2, the vein end section of measuring dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or outlet tube highway section, arterial end section or input pipe highway section or internal diameter ratio are as second value;
C3, described first value and second value multiplied each other or be divided by after obtain the 3rd value, and will set up recirculation rate and/or the recirculation volume that corresponding relation draws described dialyzing access between the flow of described the 3rd value and described dialyzing access and/or flow velocity and the ratio thereof.
The method according to this invention, described first value is meant that described contrast agent is after the vein end section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline produces and the match related with gamma function or class gamma function of ultrasonic contrast echo-signal, the vein end section or the outlet tube highway section of dialysis blood vessel/internal fistula path and the dialysis apparatus pipeline of calculating, area and ratio thereof under the time-activity curve in arterial end section or input pipe highway section, mean transit time and ratio thereof, Mean Transit Time and ratio thereof, peak time and ratio thereof, time and ratio thereof partly fall, the rate of rise and ratio thereof and descending slope and ratio thereof.
The method according to this invention, described second value are meant by ultrasonic instrument the sectional area in the outlet tube highway section of the sectional area that measures described dialysis blood vessel/internal fistula path in ultra sonic imaging cross section of dialysis blood vessel/internal fistula path or internal diameter and described dialysis apparatus pipeline or the ratio of internal diameter; The sectional area in the input pipe highway section of the sectional area in the outlet tube highway section of perhaps described dialysis apparatus pipeline or internal diameter and described dialysis apparatus pipeline or the ratio of internal diameter.
Correspondingly, the present invention also provides a kind of recirculation rate of the mensuration dialyzing access of realizing said method and/or the system of recirculation volume, and described system comprises:
The acoustic contrast agent injection device is used for injection of contrast medium on the dialyzing access that comprises dialysis blood vessel/internal fistula path and dialysis apparatus pipeline;
The ultrasonic signal extraction element is used to extract the ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on the described dialyzing access and generates corresponding time-activity curve;
The recirculation accountant communicates to connect with described ultrasonic signal extraction element, is used for the parameter according to the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal, calculates the recirculation rate and/or the recirculation volume of described dialyzing access.
According to system of the present invention, described system also comprises a ultrasonic instrument, and described ultrasonic signal extraction element and/or described recirculation accountant are embedded or be external in described ultrasonic instrument.
The present invention extracts ultrasonic contrast echo-signal or the Doppler signal and the rise time intensity curve of contrast agent by injection of contrast medium on dialyzing access, according to the recirculation rate and/or the recirculation volume of the calculation of parameter dialyzing access of this time-activity curve.What the method for prior art mensuration dialyzing access recirculation adopted is that certain medium of infusion dilutes erythrocyte, thereby reduces hyperacoustic spread speed to calculate the recirculation of dialyzing access.Distinctly with prior art be, acoustic contrast agent used in the present invention can significantly strengthen and improve the ultrasonic/sonic wave reflex strength and the acoustic interface of dialyzing access, and not influencing hyperacoustic spread speed, it can measure the recirculation rate and/or the recirculation volume of dialyzing access fast, accurately, in large quantity.
Description of drawings
Fig. 1 is that the present invention measures the recirculation rate of dialyzing access and/or the system construction drawing of recirculation volume;
Fig. 2 measures the recirculation rate of dialyzing access and/or the system construction drawing of recirculation volume in the first embodiment of the invention;
Fig. 3 measures the recirculation rate of dialyzing access and/or the system construction drawing of recirculation volume in the second embodiment of the invention;
Fig. 4 is that the present invention measures the recirculation rate of dialyzing access and/or the method flow diagram of recirculation volume;
Fig. 5 is that the present invention preferably measures the recirculation rate of dialyzing access and/or the method flow diagram of recirculation volume.
The specific embodiment
In order to make purpose of the present invention, technical scheme and advantage clearer,, the present invention is further elaborated below in conjunction with drawings and Examples.Should be appreciated that specific embodiment described herein only in order to explanation the present invention, and be not used in qualification the present invention.
Fig. 1 shows the structure that the present invention measures the system 100 of the recirculation rate of dialyzing access and/or recirculation volume, and described system 100 comprises acoustic contrast agent injection device 10, ultrasonic signal extraction element 20 and recirculation accountant 30 at least, wherein:
Acoustic contrast agent injection device 10 is used for injection of contrast medium on the dialyzing access that comprises dialysis blood vessel/internal fistula path (promptly dialyse blood vessel internal fistula and/or vascular access) and dialysis apparatus pipeline.Acoustic contrast agent mainly is the microbubble of the various bio-compatible membrane materials of a class (for example albumin, phospholipid, polymer etc.) parcel, and it is made up of noble gas, and the acoustic contrast agent biggest advantage is not have nephrotoxicity.The ultrasonic contrast technology is very responsive to microvesicle, as long as a microvesicle is arranged in the blood, just can be detected by ultrasonic probe and imaging acumen thereof.Preferably, the contrast agent of acoustic contrast agent injection device 10 bullet formula injection (Bolus Techniques) scheduled volume on the outlet tube highway section of the dialysis apparatus pipeline that is being close to the internal fistula vein end.The injection of bullet formula can form a high and narrow pulse at injection point.This tracer pulse is along with blood flow transmits downwards, at first mixed by the blood flow of extracorporeal circulation, and then be the path blood flow, at last by from the venous blood mixing in a organized way of whole body institute.After heart, the tracer that a part has been diluted is finally got back to path.In this process, this pulse more and more postpones, broadens, diminishes.After some circulations, tracer will be dispersed in the whole blood volume uniformly.Tracer is injected into into the vein loop from the bullet formula, and getting back to path once more through said process needs 15-25s, and tracer only needs 10-15s by internal fistula.
Ultrasonic signal extraction element 20 is used to extract the ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on the dialyzing access and generates corresponding time-activity curve.Described Doppler signal is doppler sample volume to be placed the vein end section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or Doppler's enhancing signal that extract in outlet tube highway section, arterial end section or input pipe highway section in ultrasonic instrument.Described ultrasonic contrast echo-signal or Doppler signal comprise ultrasonic backscattering echo-signal, doppler shifted signal or Doppler frequency shift audio signal.More particularly, ultrasonic backscattering echo-signal, doppler shifted signal or the Doppler frequency shift audio signal that contrast agent produces in vein end section or outlet tube highway section, arterial end section or the input pipe highway section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline extracted in 20 whiles of ultrasonic signal extraction element or gradation.And 20 pairs of ultrasonic contrast echo-signals of ultrasonic signal extraction element or Doppler signal carry out the association and the match of gamma (Gamma) function or class gamma function, generate the time-activity curve of ultrasonic contrast echo-signal or Doppler signal.Ultrasonic signal extraction element 20 can be to be made of ultrasonic probe and corresponding processing program module.
The present invention measures the recirculation rate of dialyzing access and/or the system 100 of recirculation volume also comprises a ultrasonic instrument 40, ultrasonic instrument 40 be meant possess the contrast imaging technology, the Vltrasonic device of frequency spectrum Doppler measuring ability, power doppler imaging function and/or color Doppler imaging function, described ultrasonic signal extraction element 20 and/or recirculation accountant 30 are embedded or be external in ultrasonic instrument 40.
The present invention measure the recirculation rate of dialyzing access and/or recirculation volume system 100 first example structure as shown in Figure 2, described ultrasonic signal extraction element 20 and recirculation accountant 30 are embedded in the ultrasonic instrument 40.Wherein, ultrasonic signal extraction element 20 can be made of ultrasonic probe and corresponding processing program module, can be used for pulse emission and the echo-wave imaging storage and the playback of contrast imaging.Recirculation accountant 30 is made of handler module.
The present invention measure the recirculation rate of dialyzing access and/or recirculation volume system 100 second example structure as shown in Figure 3, described ultrasonic signal extraction element 20 and recirculation accountant 30 are external in ultrasonic instrument 40, communicate to connect by ultrasonic signal extraction element 20 and ultrasonic instrument 40, and recirculation accountant 30 communicates to connect with ultrasonic signal extraction element 20.Ultrasonic signal extraction element 20 and recirculation accountant 30 can be the stand-alone computers with handler module, it connects by video, radio frequency or audio signal wire video, radio frequency or the audio output port by ultrasonic instrument 40 self, gathers contrastographic picture, radio frequency or Doppler frequency shift audio signal at the same time or separately.Ultrasonic signal extraction element 20 and recirculation accountant 30 also can directly read contrastographic picture, radio frequency or the Doppler frequency shift audio signal of ultrasonic instrument 40 behind the ultrasonic contrast of depositing, and are automatically converted to time-activity curve.
In the recirculation mensuration process of dialyzing access, the ultrasonic probe of ultrasonic instrument 40 is placed on dialysis blood vessel/internal fistula path and the dialysis pipeline, through the outlet tube highway section of dialysis apparatus pipeline bullet formula injection acoustic contrast agent, position in the imaging cross section of ultrasonic instrument 40, apply ultrasonic pulse; Via fixedly vein end section or the outlet tube highway section of contrast agent at dialysis blood vessel/internal fistula path and dialysis apparatus pipeline extracted in ultrasonic probe while or gradation, the radiography echo-signal that arterial end section or input pipe highway section produce, the extraction of sort signal can be to survey the dynamic change sequence that partial video signal is strengthened, also can be to survey the dynamic change sequence that partial radiofrequency signal is strengthened, the also video signal or the radiofrequency signal of the dynamic change sequence correspondence of Studies of Power Doppler Imaging, also Doppler frequency spectrum increased dynamic change sequence, also Doppler frequency shift audio signal increased dynamic change sequence.Said extracted video signal or radiofrequency signal or doppler shifted signal comprise that ultrasonic instrument 40 is in specific contrast imaging pattern or color Doppler pattern, power doppler mode or the formed video signal of ultrasonic doppler frequency spectrum mode, radiofrequency signal, doppler shifted signal or Doppler frequency shift audio signal.
The present invention proposes a kind of scheme of recirculation rate and/or recirculation volume of non-invasive mensuration dialyzing access, reach enhancing, increase ultrasonic/sonic wave reflex strength and acoustic interface in the dialysis pipeline by injection acoustic contrast agent microvesicle, thereby ultrasonic scan can be quick and precisely to the video picture simultaneously of blood vessel/internal fistula path and dialysis apparatus pipeline, the location of dialysing.The ultrasonic contrast technology is the medical image imaging technique of a kind of novelty of appearance after the radiography of CT (computed tomography), MRI (NMR (Nuclear Magnetic Resonance)-imaging) etc. strengthens.It is the same with CT, MRI all to be through the intravenous injection contrast agent, thereby the obvious reinforcement that forms internal organs reaches the purpose that contrasts imaging.Therefore, the time-dependent variation in intensity of the image pixel of area-of-interest correspondingly also part has reflected contrast agent in the dabbling dilution of local organization, and this process can be used the indicator dilution principle analysis, and can be used for computation organization's perfusion.But the contrast agent of CT, MRI is not the blood pond contrast agent of complete meaning, and they all want the intravasation external series gap.There is following advantage in acoustic contrast agent pouring into the quantitative study field by comparison: 1. blood pond radiography; 2. can be broken.Second feature is that other shadowgraph techniques do not have, for the perfusion quantitative study of acoustic contrast agent provides good physical basis.
Fig. 4 shows the present invention and measures the recirculation rate of dialyzing access and/or the method flow of recirculation volume, and it passes through to realize as the system in Fig. 1～3 100, comprises that specifically step is as follows:
Step S401, injection of contrast medium on the dialyzing access that comprises dialysis blood vessel/internal fistula path and dialysis apparatus pipeline, this step is specifically realized by acoustic contrast agent injection device 10.
Step S402 extracts the ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on the dialyzing access and generates corresponding time-activity curve, and this step is specifically realized by ultrasonic signal extraction element 20.
Step S403 according to the parameter of the time-activity curve of ultrasonic contrast echo-signal or Doppler signal, calculates the recirculation rate and/or the recirculation volume of dialyzing access, and this step is specifically realized by recirculation accountant 30.
Fig. 5 shows the present invention and preferably measures the recirculation rate of dialyzing access and/or the method flow of recirculation volume, and it passes through to realize as the system in Fig. 1～3 100, comprises that specifically step is as follows:
Step S501, contrast agent at the outlet tube highway section of the dialysis apparatus pipeline that is close to internal fistula vein end bullet formula injection scheduled volume, the injection of described bullet formula be meant less than in one second with the mode of injecting in the acoustic contrast agent filling line and with set time length, this step is specifically realized by acoustic contrast agent injection device 10.
Step S502, the ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on the extraction dialyzing access, this step is specifically realized by ultrasonic signal extraction element 20.Ultrasonic signal extraction element 20 can be simultaneously or gradation extract ultrasonic backscattering echo-signal, doppler shifted signal or the Doppler frequency shift audio signal that contrast agent produces in vein end section or outlet tube highway section, arterial end section or the input pipe highway section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline.Preferably, the ultrasonic backscattering echo-signal is to delineate the area-of-interest contrastographic picture or carry in the power full width contrastographic picture and extracting on ultrasonoscopy (as two-dimensional ultrasonic image).The area-of-interest contrastographic picture is meant and is confined to the vein end section shown on the ultra sonic imaging cross section of ultrasonic instrument to dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or the image-region in outlet tube highway section, arterial end section or input pipe highway section; The full width contrastographic picture is meant that ultrasonic instrument is to shown all images on the ultra sonic imaging cross section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline.
Step S503, automatically or under manual control, ultrasonic contrast echo-signal or Doppler signal are carried out the association and the match of gamma function or class gamma function, generate the time-activity curve of ultrasonic contrast echo-signal or Doppler signal, this step is specifically realized by ultrasonic signal extraction element 20.
Step S504, on the vein end section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or outlet tube highway section, arterial end section or input pipe highway section in the generation time intensity curve at least one value of at least one parameter or ratio as first value.Described first value is meant that contrast agent is after the vein end section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline produces and the match related with gamma function or class gamma function of ultrasonic contrast echo-signal, area and ratio thereof under the vein end section of dialysis blood vessel/internal fistula path and the dialysis apparatus pipeline of calculating or the time-activity curve in outlet tube highway section, arterial end section or input pipe highway section, mean transit time and ratio thereof, Mean Transit Time and ratio thereof, peak time and ratio thereof, time and ratio thereof partly fall, the rate of rise and ratio thereof and descending slope and ratio thereof etc.
Step S505 measures the vein end section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or the sectional area or the internal diameter ratio in outlet tube highway section, arterial end section or input pipe highway section and is worth as second.Described second value is meant by ultrasonic instrument the sectional area in the outlet tube highway section of the sectional area that measures dialysis blood vessel/internal fistula path in ultra sonic imaging cross section of dialysis blood vessel/internal fistula path or internal diameter and dialysis apparatus pipeline or the ratio of internal diameter; The perhaps sectional area in the input pipe highway section of the sectional area in the outlet tube highway section of dialysis apparatus pipeline or internal diameter and dialysis apparatus pipeline or the ratio of internal diameter.
Step S506, first value and second value multiplied each other or be divided by after obtain the 3rd value.
Step S507 will set up recirculation rate and/or the recirculation volume that corresponding relation can draw dialyzing access between the flow of the 3rd value and dialyzing access and/or flow velocity and the ratio thereof.
Above-mentioned steps S504 to S507 realizes by recirculation accountant 30.
Below, specifically enumerate two examples and describe the method that the present invention calculates the recirculation rate and the recirculation volume of dialyzing access:
One, integration method
When vein end, arterial end catheter flow that dialyser directly links to each other do not enter in the body, it should be absolute equating, because the flow in the conduit is the pump decision by dialyser.From a certain amount of contrast agent of conduit bolus injection of vein end outer body, as there is path recirculation (promptly flowing to arterial end), then can in the conduit at the external position of the arterial end of internal fistula, records the contrast agent Strength Changes that recirculation is come from the vein end of internal fistula.So just have:
Blood flow Qr in the path recirculation accounts for dialyser flow Q
bRatio, i.e. path recirculation R=Qr/Q
bCan obtain according to the analytical calculation of the time-activity curve of two different parts.Suppose that contrast agent quantity is time function M
v(t), be V at the homogenizing blood flow volume of the external conduit of vein end position sampling volume (all being full of blood), equate C with the sampling volume volume of sample tissue
v(t) be the function of the concentration changes with time of homogenizing blood flow interimage agent bubble, then:
M
v(t)＝Q
b×C
v(t) (1)
Similarly the contrast agent quantity at arterial end is M
a(t), contrast concentration is C
a(t), R is that the counter of arterial end of same big or small sampling volume in the unit interval flow through the ratio (R is the path recirculation rates) that the blood flow volume that comes accounts for blood flow volume V in the vein end tube chamber, so anti-stream flow should be R * Q in the arterial end
b
M
a(t)＝R×Q
b×C
a(t) (2)
(2)/(1) carrying out integration with the time after gets
Suppose that injection back microvesicle mixes rapidly, blood and microbubble are to reach when measuring arterial end from counter the flowing to of vein end, and its vein end and arterial end concentration equate, then has according to mass conservation law
M
a(t) and M
v(t) not directly to measure, need be by video intensity I
a(t) and I
v(t) replace, linear according to the microvesicle content of the unit volume of indicator video intensity in the hypothesis sampling volume v and sampling point, draw the video intensity relational expression of vein end and arterial end thus respectively:
M
v(t)＝V×I
v(t)×ξ
1
(5)
M
a(t)＝V×I
a(t)×ξ
2
(6)
Constant ξ
1And ξ
2Equate then have (6)/(5) and carry out integration with the time and get on the degree of depth and position
Formula (7) is the computing formula of the recirculation rate of path, just the area under curve ratio of vein end and arterial end radiography time-activity curve.
Two, by the time method
This method is by measuring mean transit time calculating recirculation rates and the recirculation volume of acoustic contrast agent by ultrasonic cross section.Can measure on dialysis blood vessel/internal fistula path with the dialysis pipeline on mean transit time, also can calculate mean transit time on dialysis blood vessel/internal fistula path by the time difference that passes through of measuring arterial end section and vein end section.
Directly measure and derive:
The width d of the ultrasonic acoustic beam in cross section, then on the cross section to above-mentioned dialysis pipeline, contrast agent all will pass through behind the injection acoustic contrast agent length is d, contrast agent by length be d be T apart from required time, the diameter of dialysis pipeline is D, and the flow Q of the pipeline of then dialysing should be:
Q＝(d/T)×π×(D/2)
2 (8)
Flow Q on dialysis blood vessel/internal fistula path
rFor
Q
r＝(d/T
r)×π×(D
r/2)
2 (9)
Flow on dialysis pipeline internal fistula vein end section is:
Q
b＝(d/T
v)×π×(D
v/2)
2 (10)
Ratio (9)/(10) of recirculation rate of then dialysing for both
Q
r/Q
b＝(T
v/T
r)×(D
r/D
v) (11)
Recirculation rate is actual as can be known by formula 11 is exactly sectional area or internal diameter and the contrast agent mean transit time ratio between blood vessel/internal fistula path and the dialysis pipeline of dialysing.
Indirect determination is derived: in response to the recirculation order of occurrence, contrast agent is injected from vein end, after again by dialysis blood vessel/internal fistula path, arrive the arterial end section of the pipeline of dialysing again.Then the difference of the dialyzing access mean transit time of arterial end section and vein end section equals contrast agent by dialysis blood vessel/internal fistula path institute's time spent altogether.
The contrast agent that setting bullet formula is injected into dialysis pipeline vein end section is Tv by ultrasonic cross-sectional length d required time, contrast agent is T by the time of dialysis blood vessel/internal fistula path, contrast agent enters Dialysis tubing road arterial end section then again by ultrasonic cross-sectional length d after having crossed the internal fistula path, and the mean transit time that is obtained is Ta.The dialysis pipeline is arterial end or vein end no matter, because caliber equates that all flow all equates (all the rotating speed by dialysate pump determines).As not having the internal fistula re-circulation path to exist, the time of passing through of arterial end section and the vein end section radiography enhanced signal on ultrasonic cross section must equate.But owing to the existence that dialysis blood vessel/internal fistula path is arranged has caused the prolongation of the time of passing through of arterial end section, the time of prolongation is exactly to equal contrast agent by the dialysis total time that blood vessel/the internal fistula path is spent.Therefore contrast agent is the difference of arterial end section and vein end section contrast agent mean transit time by the total time of blood vessel internal fistula.
At this moment, can clearly know the length L and the blood vessel internal fistula inside diameter D of dialysis blood vessel/internal fistula path by ultra sonic imaging.Then: the flow of vascular access is Qr=(L/ (Ta-Tv)) * π * (D/2)
2The flow Q of dialysis pipeline
bIt is fixed value.Then both ratio is just calculated recirculation rate accurately.
The present invention is not limited to above-mentioned two specific embodiments, by gather other all can be because of contrast agent forms the enhanced method of ultrasound echo signal, the mensuration of the recirculation that all can be used for dialysing.
In sum, the present invention is by injection of contrast medium on dialyzing access, extract ultrasonic contrast echo-signal or the Doppler signal and the rise time intensity curve of contrast agent, according to the recirculation rate and/or the recirculation volume of the calculation of parameter dialyzing access of this time-activity curve.What the method for prior art mensuration dialyzing access recirculation adopted is that certain medium of infusion dilutes erythrocyte, thereby reduces hyperacoustic spread speed to calculate the recirculation of dialyzing access.Distinctly with prior art be, acoustic contrast agent used in the present invention can significantly strengthen and improve the ultrasonic/sonic wave reflex strength and the acoustic interface of dialyzing access, and not influencing hyperacoustic spread speed, it can measure the recirculation rate and/or the recirculation volume of dialyzing access fast, accurately, in large quantity.
Certainly; the present invention also can have other various embodiments; under the situation that does not deviate from spirit of the present invention and essence thereof; those of ordinary skill in the art work as can make various corresponding changes and distortion according to the present invention, but these corresponding changes and distortion all should belong to the protection domain of the appended claim of the present invention.
Claims (10)
1. method of measuring the recirculation rate and/or the recirculation volume of dialyzing access is characterized in that described method comprises:
A, on the dialyzing access that comprises dialysis blood vessel/internal fistula path and dialysis apparatus pipeline injection of contrast medium;
The ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on B, the described dialyzing access of extraction also generates corresponding time-activity curve;
C, according to the parameter of the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal, calculate the recirculation rate and/or the recirculation volume of described dialyzing access.
2. method according to claim 1 is characterized in that, injects the described contrast agent of scheduled volume in the described steps A in the outlet tube highway section of the dialysis apparatus pipeline that is close to internal fistula vein end bullet formula.
3. method according to claim 2 is characterized in that, described step B further comprises:
The ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on B1, the described dialyzing access of extraction;
B2, described ultrasonic contrast echo-signal or Doppler signal are carried out the association and the match of gamma function or class gamma function, generate the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal.
4. method according to claim 3 is characterized in that, described ultrasonic contrast echo-signal and Doppler signal comprise ultrasonic backscattering echo-signal, doppler shifted signal or Doppler frequency shift audio signal; Ultrasonic backscattering echo-signal, doppler shifted signal or the Doppler frequency shift audio signal that described contrast agent produces in vein end section or outlet tube highway section, arterial end section or the input pipe highway section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline extracted in while or gradation among the described step B 1.
5. method according to claim 4 is characterized in that, described ultrasonic backscattering echo-signal is extracted in area-of-interest contrastographic picture or full width contrastographic picture; Described area-of-interest contrastographic picture is meant and is confined to the vein end section shown on the ultra sonic imaging cross section of ultrasonic instrument to described dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or the image-region in outlet tube highway section, arterial end section or input pipe highway section; Described full width contrastographic picture is meant that ultrasonic instrument is to shown all images on the ultra sonic imaging cross section of described dialysis blood vessel/internal fistula path and dialysis apparatus pipeline.
6. method according to claim 3 is characterized in that, described step C further comprises:
C1, at least one value that produces at least one parameter in the described time-activity curve on the vein end section of described dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or outlet tube highway section, arterial end section or input pipe highway section or ratio are as first value;
The sectional area in C2, the vein end section of measuring dialysis blood vessel/internal fistula path and dialysis apparatus pipeline or outlet tube highway section, arterial end section or input pipe highway section or internal diameter ratio are as second value;
C3, described first value and second value multiplied each other or be divided by after obtain the 3rd value, and will set up recirculation rate and/or the recirculation volume that corresponding relation draws described dialyzing access between the flow of described the 3rd value and described dialyzing access and/or flow velocity and the ratio thereof.
7. method according to claim 6, it is characterized in that, described first value is meant that described contrast agent is after the vein end section of dialysis blood vessel/internal fistula path and dialysis apparatus pipeline produces and the match related with gamma function or class gamma function of ultrasonic contrast echo-signal, the vein end section or the outlet tube highway section of dialysis blood vessel/internal fistula path and the dialysis apparatus pipeline of calculating, area and ratio thereof under the time-activity curve in arterial end section or input pipe highway section, mean transit time and ratio thereof, Mean Transit Time and ratio thereof, peak time and ratio thereof, time and ratio thereof partly fall, the rate of rise and ratio thereof and descending slope and ratio thereof.
8. method according to claim 6, it is characterized in that described second value is meant by ultrasonic instrument the sectional area in the outlet tube highway section of the sectional area that measures described dialysis blood vessel/internal fistula path in ultra sonic imaging cross section of dialysis blood vessel/internal fistula path or internal diameter and described dialysis apparatus pipeline or the ratio of internal diameter; The sectional area in the input pipe highway section of the sectional area in the outlet tube highway section of perhaps described dialysis apparatus pipeline or internal diameter and described dialysis apparatus pipeline or the ratio of internal diameter.
9. a realization is characterized in that as the system of claim 1～8 method as described in each described system comprises:
The acoustic contrast agent injection device is used for injection of contrast medium on the dialyzing access that comprises dialysis blood vessel/internal fistula path and dialysis apparatus pipeline;
The ultrasonic signal extraction element is used to extract the ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on the described dialyzing access and generates corresponding time-activity curve;
The recirculation accountant communicates to connect with described ultrasonic signal extraction element, is used for the parameter according to the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal, calculates the recirculation rate and/or the recirculation volume of described dialyzing access.
10. system according to claim 9 is characterized in that described system also comprises a ultrasonic instrument, and described ultrasonic signal extraction element and/or described recirculation accountant are embedded or be external in described ultrasonic instrument.
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| Application Number | Priority Date | Filing Date | Title |
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| CN200910107958.XA CN101920049B (en) | 2009-06-11 | 2009-06-11 | Method and system for measuring recirculation rate and/or recirculation volume of dialyzing access |
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| CN200910107958.XA CN101920049B (en) | 2009-06-11 | 2009-06-11 | Method and system for measuring recirculation rate and/or recirculation volume of dialyzing access |
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| CN101920049B CN101920049B (en) | 2014-03-12 |
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104069557A (en) * | 2013-03-28 | 2014-10-01 | B·布莱恩·阿维图姆股份公司 | Method of detecting recirculation in an arteriovenous shunt during ongoing hemodialysis and dialysis system |
| JP2019187888A (en) * | 2018-04-26 | 2019-10-31 | 日機装株式会社 | Blood purification device |
| CN116509465A (en) * | 2023-06-26 | 2023-08-01 | 四川大学华西第二医院 | Pelvic cavity cyst biopsy puncture outfit with flushing device |
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| US5830365A (en) * | 1995-08-05 | 1998-11-03 | Fresenius Ag | Means for determining hemodynamic parameters during extracorporeal blood treatment |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP2198900B1 (en) * | 1998-10-23 | 2016-02-10 | Gambro Lundia AB | Method and device for detecting access recirculation |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US5830365A (en) * | 1995-08-05 | 1998-11-03 | Fresenius Ag | Means for determining hemodynamic parameters during extracorporeal blood treatment |
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| THOMAS SCHLOSSER.ET: ""FEASIBILITY OF THE FLASH-REPLENISHMENT CONCEPT IN RENAL", 《ULTRASOUND IN MED. & BIOL.》 * |
Cited By (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104069557A (en) * | 2013-03-28 | 2014-10-01 | B·布莱恩·阿维图姆股份公司 | Method of detecting recirculation in an arteriovenous shunt during ongoing hemodialysis and dialysis system |
| JP2019187888A (en) * | 2018-04-26 | 2019-10-31 | 日機装株式会社 | Blood purification device |
| WO2019208452A1 (en) * | 2018-04-26 | 2019-10-31 | 日機装株式会社 | Blood purification device |
| JP7061509B2 (en) | 2018-04-26 | 2022-04-28 | 日機装株式会社 | Blood purification device |
| CN116509465A (en) * | 2023-06-26 | 2023-08-01 | 四川大学华西第二医院 | Pelvic cavity cyst biopsy puncture outfit with flushing device |
| CN116509465B (en) * | 2023-06-26 | 2023-09-01 | 四川大学华西第二医院 | Pelvic cavity cyst biopsy puncture outfit with flushing device |
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| CN101920049B (en) | 2014-03-12 |
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