CN101920049B - 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 medical field, relate in particular to a kind of method and system of measuring recirculation rate and/or the recirculation volume of dialyzing access.
Background technology
Hemodialysis refers to draws patient's blood outside health, and removes wherein some morbid substance by a kind of purifier, thereby purifies the blood to reach the object for the treatment of disease.Maintenance hemodialysis is one of critical treatment measure of End-stage Renal Disease Patients.Whether fully dialysing is the key factor that affects dialysis patient life quality and prognosis.Dialyzing access comprises dialysis blood vessel/interior fistula and dialysis apparatus pipeline, the important structure of cardiovascular circulation in connector outer circulation and body when it is dialysis, and suitable dialyzing access is the key factor that determines dialysis treatment success or failure.But there will be recirculation phenomenon in actual blood dialysis, recirculation can obviously weaken the efficiency of hemodialysis, the adequacy of impact dialysis.Periphery dialyzing access exists recirculation may point out dialyzing access underfed, and it can cause thrombosis, thereby makes the large increase of having a big risk of path failure.
The recirculation of hemodialysis generally comprises cardiopulmonary recirculation and path recirculation, wherein:
(1) cardiopulmonary recirculation: the part blood flow of process dialysis, without body tissue, is again got back to path arterial end with cardiac output (CO) and entered extracorporeal circulation (Qb).This part blood flow (Qa) is just defined as cardiopulmonary recirculation (CPR) with the ratio of cardiac output (CO).It can use equation expression below: 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.Clearance of dialyzer, vascular access flow and cardiac output (CO) etc. all can affect the amount of CPR.CPR increases along with the increase of Access flow.In high pump speed situation, cardiac output in 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 again the entrance of extracorporeal circulation pipeline, the blood of having dialysed is from intravenous needle to arterial needle reverse flow, and the adverse current blood flow (Qr) that this part purified has formed path recirculation (AR).It can be expressed as AR=Qr/Qb.Path recirculation blood flows into dialyser within the several seconds.The reason that causes AR has multiple.Be when Access flow (Qa) does not reach loop flow (Qb) and requires, formed local decompression, cause part venous side blood to backflow to arterial side, the extracorporeal circulation blood flow (Qr) that a part purified forms short circuit between path; Another common cause is that puncture of internal arteriovenous fistula pin spacing is too small, or punctures in same road blood vessel, or the puncture poor direction of puncture needle is true or contrary.If get rid of above situation, still have recirculation, should consider to exist path problem, as abnormal in vascular anatomy or passage downstream section appearance is narrow etc.When these path problems make blood backflow, resistance increment causes occurring path recirculation.
Detecting dialyzing access recirculation is to formulate the reasonably important prerequisite of dialysis prescription.Detect recirculation and may find angiostenosis, in time angiostenosis is taked the intervening measures such as angioplasty, may extend 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 front glucose injection method of dialysis etc.
In essence, the method for all quantifications and measurement dialyzing access recirculation is all based on indicator dilution principle.It is all in circulation blood flow, to inject a kind of tracer or manufacture a physical change, and along with the dilution completely of tracer, the tracer concentration detecting with sensor in the downstream of injection point is exactly a kind of result relevant to 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 various dilution technologies, if only have a sensor, need double injection tracer; If there are two sensors, only need a shot.The mensuration of recirculation requires to be undertaken and not disturb dialysis treatment by demand frequency.And the suitable tracer detecting for recirculation must be nontoxic, stablize and can rest on blood.
But the technology ubiquity complex steps of recirculation, consuming time, consumption power in existing mensuration dialyzing access, be not suitable for the defect of accurately tackling fast a large amount of dialysis patients, so be necessary to be improved.
Summary of the invention
For above-mentioned defect, 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 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 recirculation rate and/or the recirculation volume of dialyzing access, described method comprises:
A, on the dialyzing access that comprises dialysis blood vessel/interior fistula and dialysis apparatus pipeline injection of contrast medium;
B, the ultrasonic contrast echo-signal of extracting the contrast agent on described dialyzing access or Doppler signal also generate corresponding time-activity curve;
C, according to the parameter of the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal, calculate recirculation rate and/or the recirculation volume of described dialyzing access.
The method according to this invention, in described steps A at the described contrast agent of outlet tube 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:
B1, extract ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on described dialyzing access;
B2, described ultrasonic contrast echo-signal or Doppler signal are carried out to association and the matching 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; In described step B1, 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 section, arterial end section or the input pipe section of dialysis blood vessel/interior fistula and dialysis apparatus pipeline extracted in while or gradation.
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 refers to and is confined to the image-region of ultrasonic instrument to vein end section shown on the ultra sonic imaging cross section of described dialysis blood vessel/interior fistula and dialysis apparatus pipeline or outlet tube section, arterial end section or input pipe section; Described full width contrastographic picture refers to that ultrasonic instrument is to shown all images on the ultra sonic imaging cross section of described dialysis blood vessel/interior fistula and dialysis apparatus pipeline.
The method according to this invention, described step C further comprises:
C1, on the vein end section of described dialysis blood vessel/interior fistula and dialysis apparatus pipeline or outlet tube section, arterial end section or input pipe section, produce described time-activity curve at least one value of at least one parameter or ratio as the first value;
C2, measurement dialysis blood vessel/interior fistula and the vein end section of dialysis apparatus pipeline or the sectional area in outlet tube section, arterial end section or input pipe section or internal diameter ratio are as the second value;
C3, described the first value and the second value are multiplied each other or be divided by after obtain the 3rd value, and will between the flow of described the 3rd value and described dialyzing access and/or flow velocity and ratio thereof, set up recirculation rate and/or the recirculation volume that corresponding relation draws described dialyzing access.
The method according to this invention, described the first value refers to that described contrast agent produces after and the matching associated with gamma function or class gamma function of ultrasonic contrast echo-signal in the vein end section of dialysis blood vessel/interior fistula and dialysis apparatus pipeline, vein end section or the outlet tube section of dialysis blood vessel/interior fistula and the dialysis apparatus pipeline of calculating, area and ratio thereof under the time-activity curve in arterial end section or input pipe 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 the second value refers to the sectional area that measures described dialysis blood vessel/interior fistula in ultra sonic imaging cross section or the sectional area in outlet tube section or the ratio of internal diameter of internal diameter and described dialysis apparatus pipeline to dialysis blood vessel/interior fistula by ultrasonic instrument; Or the sectional area in input pipe section of the sectional area in the outlet tube section of 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 mensuration dialyzing access and/or system of recirculation volume that realizes said method, and described system comprises:
Acoustic contrast agent injection device, for injection of contrast medium on the dialyzing access comprising dialysis blood vessel/interior fistula and dialysis apparatus pipeline;
Ultrasonic signal extraction element, for extracting ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on described dialyzing access and generating corresponding time-activity curve;
Recirculation accountant, with described ultrasonic signal extraction element communication connection, for according to the parameter of the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal, calculates 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, by injection of contrast medium on dialyzing access, extracts ultrasonic contrast echo-signal or Doppler signal the rise time intensity curve of contrast agent, according to 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 ultrasonic/sonic wave reflex strength and the acoustic interface of dialyzing access, and not affecting hyperacoustic spread speed, it can measure recirculation rate and/or the recirculation volume of dialyzing access fast, accurately, in large quantity.
Accompanying drawing explanation
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 first embodiment of the invention;
Fig. 3 measures the recirculation rate of dialyzing access and/or the system construction drawing of recirculation volume in 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 object of the present invention, technical scheme and advantage clearer, below in conjunction with drawings and Examples, the present invention is further elaborated.Should be appreciated that specific embodiment described herein, only in order to explain the present invention, is not intended to limit the present invention.
Fig. 1 shows the structure that the present invention measures the recirculation rate of dialyzing access and/or the system of recirculation volume 100, and described system 100 at least comprises acoustic contrast agent injection device 10, ultrasonic signal extraction element 20 and recirculation accountant 30, wherein:
Acoustic contrast agent injection device 10, for injection of contrast medium on the dialyzing access comprising dialysis blood vessel/interior fistula (dialyse blood vessel internal fistula and/or vascular access) and dialysis apparatus pipeline.Acoustic contrast agent is mainly the microbubble of the various bio-compatible membrane materials of a class (such as albumin, phospholipid, polymer etc.) parcel, and it is comprised of noble gas, and the advantage of acoustic contrast agent maximum is there is no nephrotoxicity.Contrast-enhanced ultrasound technique is very responsive to microvesicle, as long as there is a microvesicle in blood, just can be detected by ultrasonic probe and imaging acumen thereof.Preferably, the contrast agent of acoustic contrast agent injection device 10 bolus in ection (Bolus Techniques) scheduled volume on the outlet tube section of the dialysis apparatus pipeline at next-door neighbour's internal fistula vein end.Bolus in ection can form a high and narrow pulse at injection point.This tracer pulse, along with blood flow going down, is first mixed by the blood flow of extracorporeal circulation, is then path blood flow, finally from the organized venous blood of whole body, is mixed.After heart, the diluted tracer of a part 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 whole blood volume uniformly.Tracer enters vein loop from bolus in ection, and through said process, again getting back to path needs 15-25s, and tracer only needs 10-15s by internal fistula.
Ultrasonic signal extraction element 20, for extracting ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on dialyzing access and generating corresponding time-activity curve.Described Doppler signal is doppler sample volume to be placed in to the vein end section of dialysis blood vessel/interior fistula and dialysis apparatus pipeline or Doppler's enhancing signal that extract in outlet tube section, arterial end section or input pipe 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 section, arterial end section or the input pipe section of dialysis blood vessel/interior fistula 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 association and the matching 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 by ultrasonic probe and corresponding processing program module composition.
The present invention measures the recirculation rate of dialyzing access and/or the system of recirculation volume 100 also comprises a ultrasonic instrument 40, ultrasonic instrument 40 refer to possess 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.
As shown in Figure 2, described ultrasonic signal extraction element 20 and recirculation accountant 30 are embedded in ultrasonic instrument 40 the first example structure that the present invention measures the recirculation rate of dialyzing access and/or the system of recirculation volume 100.Wherein, ultrasonic signal extraction element 20 can, by ultrasonic probe and corresponding processing program module composition, can be used for impulse ejection and echo-wave imaging storage and the playback of contrast imaging.Recirculation accountant 30 consists of handler module.
The second example structure that the present invention measures the recirculation rate of dialyzing access and/or the system of recirculation volume 100 as shown in Figure 3, described ultrasonic signal extraction element 20 and recirculation accountant 30 are external in ultrasonic instrument 40, by ultrasonic signal extraction element 20 and ultrasonic instrument 40 communication connections, and recirculation accountant 30 and 20 communication connections of ultrasonic signal extraction element.Ultrasonic signal extraction element 20 and recirculation accountant 30 can be the stand-alone computers with handler module, by video, radio frequency or audio signal wire, video, radio frequency or the audio output port by ultrasonic instrument 40 self connects for it, gathers at the same time or separately contrastographic picture, radio frequency or Doppler frequency shift audio signal.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 after 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/interior fistula and dialysis pipeline, through the outlet tube section of dialysis apparatus pipeline bolus in ection acoustic contrast agent, in the imaging cross section of ultrasonic instrument 40, position, apply ultrasonic pulse, via fixedly ultrasonic probe while or gradation are extracted contrast agent in vein end section or the outlet tube section of dialysis blood vessel/interior fistula and dialysis apparatus pipeline, the radiography echo-signal that arterial end section or input pipe section produce, the extraction of sort signal can be the dynamic change sequence of surveying local video signal strengthening, also can be the dynamic change sequence of surveying local radiofrequency signal strengthening, also corresponding video signal or the radiofrequency signal of dynamic change sequence of Studies of Power Doppler Imaging, also the dynamic change sequence that Doppler frequency spectrum strengthens, also the dynamic change sequence that Doppler frequency shift audio signal strengthens.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, by injection acoustic contrast agent microvesicle, reach enhancing, increase ultrasonic/sonic wave reflex strength and acoustic interface in dialysis pipeline, thereby ultrasonic scan can be quick and precisely to the video picture simultaneously of blood vessel/interior fistula and dialysis apparatus pipeline, the location of dialysing.Contrast-enhanced ultrasound technique 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 is all through intravenous injection contrast agent, thereby the obvious strengthening of formation internal organs reaches the object of contrast imaging.Therefore, the intensity of the image pixel of area-of-interest correspondingly has also partly reflected the dilution of contrast agent in local organization perfusion over time, and this process can be used 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 intravasation external series gap.By comparison, there is following advantage pouring into quantitative study field in acoustic contrast agent: 1. blood pond radiography; 2. can be broken.Second Characteristic 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 is realized by the system 100 as in Fig. 1～3, specifically comprises that step is as follows:
Step S401, injection of contrast medium on the dialyzing access that comprises dialysis blood vessel/interior fistula and dialysis apparatus pipeline, this step is specifically realized by acoustic contrast agent injection device 10.
Step S402, extracts ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on 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 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 is realized by the system 100 as in Fig. 1～3, specifically comprises that step is as follows:
Step S501, contrast agent at the outlet tube section bolus in ection scheduled volume of the dialysis apparatus pipeline of next-door neighbour's internal fistula vein end, described bolus in ection refers to and is less than in one second in acoustic contrast agent filling line and the mode of injecting with set time length, and this step is specifically realized by acoustic contrast agent injection device 10.
Step S502, ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on 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 section, arterial end section or the input pipe section of dialysis blood vessel/interior fistula and dialysis apparatus pipeline.Preferably, ultrasonic backscattering echo-signal is on ultrasonoscopy (as two-dimensional ultrasonic image), delineate area-of-interest contrastographic picture or carry in power full width contrastographic picture and extracting.Area-of-interest contrastographic picture refers to and is confined to ultrasonic instrument to vein end section shown on the ultra sonic imaging cross section of dialysis blood vessel/interior fistula and dialysis apparatus pipeline or the image-region in outlet tube section, arterial end section or input pipe section; Full width contrastographic picture refers to that ultrasonic instrument is to shown all images on the ultra sonic imaging cross section of dialysis blood vessel/interior fistula and dialysis apparatus pipeline.
Step S503, automatically or under manually controlling, ultrasonic contrast echo-signal or Doppler signal are carried out to association and the matching 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/interior fistula and dialysis apparatus pipeline or outlet tube section, arterial end section or input pipe section in generation time intensity curve at least one value of at least one parameter or ratio as the first value.Described the first value refers to that contrast agent produces after and the matching associated with gamma function or class gamma function of ultrasonic contrast echo-signal in the vein end section of dialysis blood vessel/interior fistula and dialysis apparatus pipeline, area and the ratio thereof under dialysis blood vessel/interior fistula and the vein end section of dialysis apparatus pipeline or the time-activity curve in outlet tube section, arterial end section or input pipe section that calculates, 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 dialysis blood vessel/interior fistula and the vein end section of dialysis apparatus pipeline or the sectional area in outlet tube section, arterial end section or input pipe section or internal diameter ratio as the second value.Described the second value refers to the sectional area that measures dialysis blood vessel/interior fistula in ultra sonic imaging cross section or the sectional area in outlet tube section or the ratio of internal diameter of internal diameter and dialysis apparatus pipeline to dialysis blood vessel/interior fistula by ultrasonic instrument; Or the sectional area in input pipe section of the sectional area in the outlet tube section of dialysis apparatus pipeline or internal diameter and dialysis apparatus pipeline or the ratio of internal diameter.
Step S506, the first value and the second value are 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 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 recirculation rate and the recirculation volume of dialyzing access:
One, integration method
When the vein end being directly connected with dialyser, arterial end catheter flow do not enter in body, should be definitely to equate, because the flow in conduit is pump by dialyser, determine.The a certain amount of contrast agent of conduit bolus injection from vein end outer body, as there is path recirculation (flowing from the vein end of internal fistula to arterial end), can in the conduit at the external position of the arterial end of internal fistula, record the contrast agent Strength Changes that recirculation is come.So just have:
Blood flow Qr in 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), at the homogenizing blood flow volume of the external conduit of vein end position sampling volume (being all full of blood), be V, 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:
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 path recirculation rates) that the blood flow volume coming accounts for blood flow volume V in vein end tube chamber, so in arterial end, anti-stream flow should be R * Q
b.
M
a(t)＝R×Q
b×C
a(t) (2)
(2) behind/(1), with the time, carrying out integration obtains
After supposing injection, microvesicle mixes rapidly, and blood and microbubble are to reach while measuring arterial end from counter the flowing to of vein end, and its vein end and arterial end concentration equate, according to mass conservation law, has
M
aand M (t)
v(t) not directly to measure, need to be by video intensity I
aand I (t)
v(t) replace, linear according to the microvesicle content of the unit volume of the indicator video intensity in hypothesis sampling volume v and sampling point, draw respectively thus the video intensity relational expression of vein end and arterial end:
M
v(t)＝V×I
v(t)×ξ
1
(5)
M
a(t)＝V×I
a(t)×ξ
2
(6)
Constant ξ
1and ξ
2on the same degree of depth and position, equate have (6)/(5) with the time, carry out integration and obtain
Formula (7) is the computing formula of the recirculation rate of path, namely the area under curve ratio of vein end and arterial end contrast time intensity curve.
Two, pass through Time Method
This method is by measuring acoustic contrast agent by mean transit time calculating recirculation rates and the recirculation volume in ultrasonic cross section.Can measure on dialysis blood vessel/interior fistula with dialysis pipeline on mean transit time, also can by time difference, calculate the mean transit time on dialysis blood vessel/interior fistula by what measure arterial end section and vein end section.
Directly measure and derive:
The width d of the ultrasonic acoustic beam in cross section, on to the cross section of above-mentioned dialysis pipeline, the length that after injection acoustic contrast agent, contrast agent all will pass through is d, and the distance required time that contrast agent is d by length is T, the diameter of dialysis pipeline is D, and the flow Q of the pipeline of dialysing should be:
Q＝(d/T)×π×(D/2)
2 (8)
Flow Q on dialysis blood vessel/interior fistula
rfor
Q
r＝(d/T
r)×π×(D
r/2)
2 (9)
Flow in dialysis pipeline internal fistula vein end section is:
Q
b＝(d/T
v)×π×(D
v/2)
2 (10)
Ratio (9)/(10) that the recirculation rate of dialysing is for both
Q
r/Q
b＝(T
v/T
r)×(D
r/D
v) (11)
Actual by the known recirculation rate of formula 11 is exactly sectional area or internal diameter and the contrast agent mean transit time ratio between blood vessel/interior fistula and dialysis pipeline of dialysing.
Indirect determination is derived: in response to recirculation order of occurrence, contrast agent is injected from vein end, after again by dialysis blood vessel/interior fistula, then to the arterial end section of dialysis pipeline.The difference of the dialyzing access mean transit time of arterial end section and vein end section equals contrast agent by dialysis blood vessel/interior fistula institute's time spent altogether.
Setting bolus in ection enter the to dialyse contrast agent of 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/interior fistula, contrast agent enters Dialysis tubing road arterial end section then again by ultrasonic cross-sectional length d after having crossed interior fistula, and the mean transit time obtaining is Ta.Dialysis pipeline is arterial end or vein end no matter, and because caliber all equates, flow all equates (all the rotating speed by dialysate pump determines).As do not have internal fistula re-circulation path, the time of passing through of arterial end section and the vein end section radiography enhanced signal on ultrasonic cross section to equate.But owing to there being the existence of dialysis blood vessel/interior fistula to cause the prolongation of the time of passing through of arterial end section, the time of prolongation is exactly to equal the total time that contrast agent is spent by dialysis blood vessel/interior fistula.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 by ultra sonic imaging the length L of dialysis blood vessel/interior fistula, and blood vessel internal fistula inner diameter D.: the flow of vascular access is Qr=(L/ (Ta-Tv)) * π * (D/2)
2.The flow Qb of dialysis pipeline is fixed value.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 contrast agent form the method that ultrasound echo signal strengthens, 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 Doppler signal the rise time intensity curve of contrast agent, according to 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 ultrasonic/sonic wave reflex strength and the acoustic interface of dialyzing access, and not affecting hyperacoustic spread speed, it can measure 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; in the situation that not deviating from spirit of the present invention and essence thereof; those of ordinary skill in the art are when making according to the present invention various corresponding changes and distortion, but these corresponding changes and distortion all should belong to the protection domain of the appended claim of the present invention.
Claims (2)
1. a system of measuring recirculation rate and/or the recirculation volume of dialyzing access, is characterized in that, described system comprises:
Acoustic contrast agent injection device, for injection of contrast medium on the dialyzing access comprising dialysis blood vessel/interior fistula and dialysis apparatus pipeline;
Ultrasonic signal extraction element, for extracting ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on described dialyzing access and generating corresponding time-activity curve;
Recirculation accountant, with described ultrasonic signal extraction element communication connection, for according to the parameter of the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal, calculates recirculation rate and/or the recirculation volume of described dialyzing access;
Described ultrasonic signal extraction element is also for extracting ultrasonic contrast echo-signal or the Doppler signal of the contrast agent on described dialyzing access; And described ultrasonic contrast echo-signal or Doppler signal are carried out to association and the matching of gamma function or class gamma function, generate the time-activity curve of described ultrasonic contrast echo-signal or Doppler signal;
Described recirculation accountant is also for the vein end section at described dialysis blood vessel/interior fistula and dialysis apparatus pipeline and arterial end section, or on outlet tube section and input pipe section, produces at least one value of at least one parameter in described time-activity curve or ratio as the first value; Measure vein end section and the arterial end section of dialysis blood vessel/interior fistula and dialysis apparatus pipeline, or the sectional area in outlet tube section and input pipe section or internal diameter ratio are as the second value; Described the first value and the second value are multiplied each other or be divided by after obtain the 3rd value, and will between the flow of described the 3rd value and described dialyzing access and/or flow velocity and ratio thereof, set up recirculation rate and/or the recirculation volume that corresponding relation draws described dialyzing access.
2. system according to claim 1, 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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| 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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| JP7061509B2 (en) * | 2018-04-26 | 2022-04-28 | 日機装株式会社 | Blood purification 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 |
Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5830365A (en) * | 1995-08-05 | 1998-11-03 | Fresenius Ag | Means for determining hemodynamic parameters during extracorporeal blood treatment |
| CN1324255A (en) * | 1998-10-23 | 2001-11-28 | 甘布罗股份公司 | Method and device for measuring access flow |
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Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5830365A (en) * | 1995-08-05 | 1998-11-03 | Fresenius Ag | Means for determining hemodynamic parameters during extracorporeal blood treatment |
| CN1324255A (en) * | 1998-10-23 | 2001-11-28 | 甘布罗股份公司 | Method and device for measuring access flow |
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| Title |
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| JP特开平7-275355A 1995.10.24 |
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