CN114515144A - System for detecting flow rate and pressure of thoracic aortic dissection false cavity and in-vivo measurement method - Google Patents
System for detecting flow rate and pressure of thoracic aortic dissection false cavity and in-vivo measurement method Download PDFInfo
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- CN114515144A CN114515144A CN202210157841.8A CN202210157841A CN114515144A CN 114515144 A CN114515144 A CN 114515144A CN 202210157841 A CN202210157841 A CN 202210157841A CN 114515144 A CN114515144 A CN 114515144A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/026—Measuring blood flow
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
- A61B5/0215—Measuring pressure in heart or blood vessels by means inserted into the body
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6851—Guide wires
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6852—Catheters
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
Abstract
The invention discloses a system for detecting the flow rate and pressure of a thoracic aorta interbedded false cavity and an in-vivo measurement method, wherein the device comprises: the catheter sheath is used for puncture and indwelling of the thoracic aortic dissection; the support catheter is arranged in the catheter guide sheath in a penetrating mode and can slide along the catheter guide sheath; the detection guide wire is arranged in the support catheter in a sliding manner, the front end of the detection guide wire is provided with a sensor, and the sensor can acquire the blood flow rate and the pressure in the false cavity of the thoracic aorta interlayer and can generate blood flow rate and pressure signals; and the computer terminal can receive the blood flow rate and the pressure signal acquired by the sensor, and can acquire the real-time pressure value in the true cavity of the thoracic aorta interlayer through the arterial transducer. The invention can help clinicians to better understand the hemodynamic distribution characteristics of the interlayer according to the variation trend of functional indexes of different parts of the interlayer, and provides functional reference indexes for the accurate treatment of the interlayer.
Description
Technical Field
The invention relates to the technical field of medical functional index detection, in particular to a system for detecting flow rate and pressure of a thoracic aorta dissection false cavity and an in-vivo measurement method.
Background
Clinically, the hemodynamic indexes such as flow velocity and pressure in the true lumen and the false lumen of the aortic dissection are mainly measured by post-processing analysis based on CT images, but the method has great limitation. Since the simulation analysis is based on the CT image of the patient to construct a three-dimensional reconstruction structure of the aortic dissection, certain boundary conditions are defined at the entrance and exit of the aortic dissection for analysis, and these boundary conditions are not the patient itself, but are derived from literature or indirectly inferred. Therefore, the simulation results are far from the real blood flow state in vivo. Meanwhile, the influence of a plurality of important branches of the aorta and the interbedded intima membrane on blood flow is not considered during simulation analysis, so that the reliability and the authenticity of the result are influenced to a certain extent.
At present, it is also studied to analyze hemodynamic indexes such as Flow velocity and pressure in a true-false aortic dissection cavity by imaging with four-dimensional Flow magnetic resonance (4D Flow MRI). However, this MRI examination takes a long time and cannot be completed by patients who have MRI examination contraindications such as grafts or claustrophobia. At the same time, the range of the MRI scan is limited, and at present the scan length for the examination sequence is about 35 cm. Therefore, the full surrounding of the affected area of aortic dissection is not achieved, and the hemodynamic analysis is greatly limited. Meanwhile, the post-processing analysis of the MRI image is mainly scientific research and is not routinely developed clinically at present.
Disclosure of Invention
In view of the above, there is a need to provide a thoracic aortic dissection pseudolumen flow rate and pressure detection system and an in vivo measurement method, which have real and reliable results, are helpful for clinicians to better understand the hemodynamic distribution characteristics of the dissection and provide functional reference indexes for accurate treatment of the dissection.
A thoracic aortic dissection false lumen flow rate and pressure detection system comprising:
the catheter sheath is used for puncture and indwelling of the thoracic aortic dissection;
the supporting catheter is arranged in the catheter guide sheath in a penetrating mode and can slide along the catheter guide sheath;
the detection guide wire is slidably arranged in the support catheter, a sensor is arranged at the front end of the detection guide wire, and the sensor can acquire the blood flow rate and the pressure in the false cavity of the thoracic aortic dissection and can generate blood flow rate and pressure signals;
and the computer terminal is connected with the tail end of the detection guide wire, can receive the blood flow rate and the pressure signal acquired by the sensor, and can acquire the real-time pressure value in the true cavity of the thoracic aorta interlayer through the arterial transducer.
In one embodiment, the tip of the catheter sheath is curved, the curvature of the curve is 15-30 degrees, and the distance that the support catheter extends out of the tip of the catheter sheath is 0-70 cm.
In one embodiment, the medical device further comprises an ultra-smooth guide wire which can be slidably guided into or out of the support catheter.
An invasive in vivo measurement method for flow rate and pressure of a thoracic aortic dissection false cavity comprises the following steps:
s1, evaluating a CTA image of the thoracic aortic dissection of the patient, and distinguishing a true cavity, a false cavity, a distal secondary laceration and a proximal laceration;
s2, puncturing the femoral artery to keep the guide sheath of the guide catheter, leading the supporting guide catheter and the detection guide wire into the femoral artery, extending the supporting guide catheter and the detection guide wire into a false cavity from a secondary breach at the far end of the aorta through the iliac artery and the aorta, and bending the supporting guide catheter and the detection guide wire to the position of the near-end breach;
s3, adjusting the positions of the support catheter and the detection guide wire in the false cavity, acquiring blood flow rate and pressure real-time values at different positions, acquiring the pressure real-time value of the tip of the guide sheath of the catheter in the true cavity, and processing the real-time value to acquire functional indexes before operation;
s4, repeating the steps S2-S3 after the thoracic aortic dissection of the patient is subjected to the endoluminal stent repair, and obtaining functional indexes after the operation;
And S5, analyzing and evaluating the change trend of preoperative functional indexes and postoperative functional indexes.
In one embodiment, in step S1, the range of the thoracic aortic dissection, the positions and sizes of the true and false lumens, and the positions and sizes of the distal secondary and proximal crevasses are resolved by enhancing the CT image.
In one embodiment, the step S2 includes:
s21, guiding the ultra-smooth guide wire into a guide sheath of the catheter in cooperation with a support catheter, and entering a false cavity through a secondary breach at the far end of the thoracic aortic dissection to the proximal end of the false cavity;
s22, withdrawing the ultra-smooth guide wire, guiding the detection guide wire to the proximal end of the false cavity through the support catheter, and connecting the tail end of the detection guide wire with the computer terminal;
s23, adjusting the head end of the support catheter, and maintaining the detection guide wire in the center of the false cavity of the thoracic aortic dissection;
and S24, fixing and maintaining the position of the detection guide wire for 10-30 seconds, and recording the dynamic change waveform of the average pressure, the pressure along with the cardiac cycle, the average blood flow velocity, the maximum peak blood flow velocity and the dynamic change curve of the average blood flow velocity along with the cardiac cycle in the lumen passing through the detection point.
In one embodiment, the step S3 includes:
S31, moving the position of the detection guide wire and the position of the support catheter to the positions f1, f2, f3, f4 or fx in the false cavity respectively;
s32, detecting real-time values of blood flow rate Vf1, Vf2, Vf3, Vf4 or Vfx at the corresponding sites, and pressure Pf1, Pf2, Pf3, Pf4 or Pfx;
s33, externally connecting an arterial transducer, and collecting a real-time value of pressure Pt in the thoracic aorta interlayer vacuum cavity;
s34, calculating the ratio Pfx/Pt of the pressure of the false cavity to the pressure of the true cavity, and obtaining functional indexes before operation.
Above-mentioned thoracic aorta intermediate layer false chamber velocity of flow and pressure detecting system and at somatic measurement method, through leading-in the false intracavity with detecting seal wire and sensor, gather pressure and blood velocity of flow information, its result is true and reliable, and, can be according to clinical needs, utilize seal wire pipe technique, gather functional indexes such as the pressure of true chamber, false chamber and thoracic aorta important branch department, the blood velocity of flow, simultaneously, can be according to the trend of change of the different position functional index of intermediate layer, help clinician's better understanding the hemodynamics of intermediate layer to distribute the characteristic, provide functional reference index for the accurate treatment of intermediate layer.
Drawings
In order to more clearly illustrate the technical solutions in the embodiments of the present invention, the drawings needed to be used in the embodiments will be briefly described below, and it is obvious that the drawings in the following description are only some embodiments of the present invention, and it is obvious for those skilled in the art that other drawings can be obtained according to these drawings without creative efforts.
FIG. 1 is a schematic view showing the structure of the thoracic aortic dissection of the present invention;
FIG. 2 is a diagram showing the usage of the flow rate and pressure detection system of the thoracic aortic dissection false chamber of the invention.
Detailed Description
To facilitate an understanding of the invention, the invention will now be described more fully hereinafter with reference to the accompanying drawings. Preferred embodiments of the present invention are shown in the drawings. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete.
It will be understood that when an element is referred to as being "secured to" another element, it can be directly on the other element or intervening elements may also be present. When an element is referred to as being "connected" to another element, it can be directly connected to the other element or intervening elements may also be present.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. The terminology used in the description of the invention herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention.
The main conception of the invention is as follows:
the two-in-one detection guide wire for pressure and flow velocity can be used for carrying out functional index detection in the stenosis lesion of the coronary artery at present, so that the two-in-one detection guide wire can be used for effectively detecting and acquiring the real blood flow and pressure related indexes in vivo, and can also be used for acquiring more accurate functional indexes when being applied to the lumen of the thoracic aorta. However, the anatomical morphology of the thoracic aortic dissection is complex and changeable, and the noninvasive imaging detection means has great limitation, so that the method for detecting the indexes related to the in-vivo hemodynamics by the intracavity intervention is very valuable. The invention detects in the false cavity of the thoracic aortic dissection by the guide wire catheter technology, and does not influence the hemodynamics of the dissection; meanwhile, the secondary crevasses existing at the far end are selected into the false cavity for detection through a minimally invasive technology, and the diaphragm in the interlayer cannot be damaged. Therefore, the method for measuring the indexes such as pressure, flow rate and the like in vivo is safe and reliable.
Referring to fig. 1-2, an embodiment of the present invention provides a system for measuring flow rate and pressure in a thoracic aortic dissection cavity, comprising:
The catheter sheath 1 is used for puncture and indwelling of the thoracic aortic dissection;
the support catheter 2 is arranged in the catheter sheath 1 in a penetrating mode, and the support catheter 2 can slide along the catheter sheath 1;
the detection guide wire 3 is arranged in the support catheter 2 in a sliding mode, a sensor 4 is arranged at the front end of the detection guide wire 3, and the sensor 4 can collect the blood flow rate and the blood pressure in a false cavity 7 of the thoracic aortic dissection and can generate blood flow rate and pressure signals;
Above-mentioned thoracic aorta intermediate layer false chamber velocity of flow and pressure detecting system and at-body measurement method, through leading-in false intracavity 7 with detecting seal wire 3 and sensor 4, gather pressure and blood velocity of flow information, its result is true and reliable, and, can be according to clinical needs, utilize guide wire pipe technique, gather functional indexes such as the pressure of true chamber 8, false chamber 7 and the important branch department of thoracic aorta, blood velocity of flow, simultaneously, can be according to the trend of change of the functional index of the different positions of intermediate layer, help clinician's better understanding the hemodynamics distribution characteristic of intermediate layer, provide functional reference index for the accurate treatment of intermediate layer.
In an embodiment of the present invention, the tip of the catheter sheath 1 is curved, the curvature of the curve is 15 to 30 degrees, and the distance that the support catheter 2 extends out of the tip of the catheter sheath 1 is 0 to 70 cm. In this embodiment, the tip of the catheter sheath 1 is bent to facilitate the tip of the catheter sheath 1 to be inserted into the secondary laceration 9 at the distal end of the thoracic aortic dissection, so that the support catheter 2 and the detection guide wire 3 can smoothly enter the prosthetic cavity 7 of the thoracic aortic dissection.
In an embodiment of the present invention, the present invention further comprises an ultra-smooth guide wire which can be slidably introduced into or slid out of the support catheter 2. In this embodiment, the ultra-smooth guide wire has a diameter of 0.014 inches, and is guided into the catheter sheath 1 in cooperation with the support catheter 2, passes through the secondary breach 9 at the distal end of the aortic dissection, enters the prosthetic lumen 7 of the aortic dissection, and reaches the proximal end of the prosthetic lumen 7, thereby completing the positioning of the catheter sheath 1 and the support catheter 2.
An embodiment of the invention provides an invasive in-vivo measurement method for flow rate and pressure of a thoracic aorta dissection false cavity, which comprises the following steps:
s1, evaluating a CTA image of the thoracic aortic dissection of the patient, and distinguishing a true cavity 8, a false cavity 7, a distal secondary crevasse 9 and a proximal crevasse 10; specifically, the range of the thoracic aortic dissection, the positions and sizes of the true lumen 8 and the false lumen 7, the positions and sizes of the distal secondary breach 9 and the proximal breach 10, and the like are distinguished by enhancing the image of the CT.
S2, puncturing the femoral artery to keep the catheter sheath 1, leading the supporting catheter 2 and the detecting guide wire 3 into the femoral artery, extending into the false cavity 7 from the secondary breach 9 at the far end of the aorta through the iliac artery and the aorta, and bending to the position of the near-end breach 10;
s3, adjusting the positions of the support catheter 2 and the detection guide wire 3 in the false cavity 7, acquiring blood flow rate and pressure real-time values at different positions, acquiring the pressure real-time value of the tip of the catheter sheath 1 in the true cavity 8, and processing the real-time value to acquire preoperative functional indexes;
s4, repeating the steps S2-S3 after the thoracic aortic dissection of the patient is subjected to the endoluminal stent repair, and obtaining functional indexes after the operation;
s5, analyzing and evaluating the preoperative functional indexes and postoperative functional indexes.
In an embodiment of the present invention, the step S2 includes:
s21, guiding the ultra-smooth guide wire into the guide sheath 1 by matching with the support catheter 2, and entering the false cavity 7 through the secondary crevasse 9 at the far end of the thoracic aorta dissection to the proximal end of the false cavity 7;
s22, withdrawing the ultra-smooth guide wire, guiding the detection guide wire 3 to the proximal end of the false cavity 7 through the support catheter 2, and connecting the tail end of the detection guide wire 3 with the computer terminal 5;
S23, adjusting the head end of the support catheter 2, and keeping the detection guide wire 3 in the center of the false cavity 7 of the thoracic aortic dissection; thus, the adherence of the detection guide wire 3 can be avoided;
s24, fixing and maintaining the position of the detection guide wire 3 for 10-30 seconds, and recording the dynamic change waveform of the average pressure, the pressure along with the cardiac cycle, the average blood flow velocity, the maximum peak blood flow velocity and the dynamic change curve of the average blood flow velocity along with the cardiac cycle in the lumen passing through the detection point.
In this embodiment, through the cooperation of super smooth seal wire and support catheter 2, can carry out preset regulation to support catheter 2 and the final position that detects seal wire 3, reach the set position after, withdraw from the super smooth seal wire again, leading-in detects seal wire 3 to the proximal end of false chamber 7, so, can reduce the wearing and tearing that detect seal wire 3, improve the life and the detection accuracy that detect seal wire 3. Alternatively, the sensing guidewire 3 may be a 0.014 inch Volcano (Volcano) flow rate and pressure two-in-one guidewire (Combowire).
In an embodiment of the present invention, the step S3 includes:
s31, the positions of the detection guide wire 3 and the support catheter 2 are adjusted to move to positions f1, f2, f3, f4 or fx in the false cavity respectively; in this embodiment, f1 is near the proximal break 10, and f2, f3, f4 … … fx, etc. are sequentially near the distal secondary break 9.
S32, detecting real-time values of blood flow rate Vf1, Vf2, Vf3, Vf4 or Vfx at the corresponding sites, and pressure Pf1, Pf2, Pf3, Pf4 or Pfx;
s33, externally connecting an arterial transducer, and collecting a real-time value of pressure Pt in the thoracic aorta interlayer true cavity 8;
s34, calculating the ratio Pfx/Pt of the pressure of the dummy cavity 7 to the pressure of the real cavity 8, and obtaining functional indexes before operation.
The technical features of the embodiments described above may be arbitrarily combined, and for the sake of brevity, all possible combinations of the technical features in the embodiments described above are not described, but should be considered as being within the scope of the present specification as long as there is no contradiction between the combinations of the technical features.
The above examples are only illustrative of several embodiments of the present invention, but should not be construed as limiting the scope of the present invention. It should be noted that, for a person skilled in the art, several variations and modifications can be made without departing from the inventive concept, which falls within the scope of the present invention. Therefore, the protection scope of the present patent shall be subject to the appended claims.
Claims (7)
1. A thoracic aortic dissection false lumen flow rate and pressure detection system, comprising:
The catheter sheath is used for puncture and indwelling of the thoracic aortic dissection;
the supporting catheter is arranged in the catheter guide sheath in a penetrating mode and can slide along the catheter guide sheath;
the detection guide wire is arranged in the support catheter in a sliding mode, a sensor is arranged at the front end of the detection guide wire, and the sensor can acquire the blood flow rate and the pressure in the false cavity of the thoracic aortic dissection and can generate blood flow rate and pressure signals;
the computer terminal, with the tail end that detects the seal wire is connected, the computer terminal can accept the sensor and gather blood velocity of flow and pressure signal, just the computer terminal can also gather the real-time numerical value of pressure in the true intracavity of thoracic aorta intermediate layer through arterial transducer.
2. The thoracic aortic dissection false lumen flow rate and pressure detection system of claim 1, wherein the tip of the catheter sheath is curved, the curvature of the curve is 15-30 degrees, and the support catheter extends out of the tip of the catheter sheath by a distance of 0-70 cm.
3. The thoracic aortic dissection prosthetic flow and pressure detection system of claim 2 further comprising a super-smooth guidewire slidably introducible or slidable out to the support catheter.
4. An invasive in vivo measurement method using the thoracic aortic dissection prosthesis flow rate and pressure detection system of any one of claims 1-3, comprising the steps of:
s1, evaluating the thoracic aorta interlayer CTA image of the patient, distinguishing a true cavity and a false cavity, and distinguishing a distal secondary crevasse and a proximal crevasse;
s2, the femoral artery puncture indwelling catheter sheath is led in, the supporting catheter and the detection guide wire are led in from the femoral artery, extend into the false cavity from the secondary breach at the far end of the aorta through the iliac artery and the aorta, and bend to the position of the near-end breach;
s3, adjusting the positions of the support catheter and the detection guide wire in the false cavity to obtain the blood flow rate and pressure real-time values at different positions, and meanwhile, collecting the pressure real-time value of the tip of the catheter sheath in the true cavity, and processing the real-time value to obtain the functional index before operation;
s4, repeating the steps S2-S3 after the thoracic aortic dissection of the patient is subjected to the endoluminal stent repair, and obtaining functional indexes after the operation;
and S5, analyzing and evaluating the change trend of preoperative functional indexes and postoperative functional indexes.
5. The invasive in vivo measurement method according to claim 4, wherein in step S1, the image of the enhanced CT is used to distinguish the range of thoracic aortic dissection, the positions and sizes of the true lumen and the false lumen, and the positions and sizes of the distal secondary laceration and the proximal laceration.
6. The invasive in vivo measurement method according to claim 5, wherein said step S2 comprises:
s21, guiding the ultra-smooth guide wire into a guide sheath of the catheter in cooperation with a support catheter, and entering a false cavity through a secondary breach at the far end of the thoracic aortic dissection to the proximal end of the false cavity;
s22, withdrawing the ultra-smooth guide wire, guiding the detection guide wire to the proximal end of the false cavity through the support catheter, and connecting the tail end of the detection guide wire with a computer terminal;
s23, adjusting the head end of the support catheter, and maintaining the detection guide wire in the center of the false cavity of the thoracic aortic dissection;
and S24, fixing and maintaining the position of the detection guide wire for 10-30 seconds, and recording the dynamic change waveform of the average pressure, the pressure along with the cardiac cycle, the average blood flow velocity, the maximum peak blood flow velocity and the dynamic change curve of the average blood flow velocity along with the cardiac cycle in the lumen passing through the detection point.
7. The invasive in vivo measurement method according to claim 6, wherein said step S3 comprises:
s31, moving the position of the detection guide wire and the position of the support catheter to the positions f1, f2, f3, f4 or fx in the false cavity respectively;
s32, detecting real-time values of blood flow rate Vf1, Vf2, Vf3, Vf4 or Vfx and pressure Pf1, Pf2, Pf3, Pf4 or Pfx at the corresponding sites;
S33, externally connecting an arterial transducer, and collecting a real-time value of pressure Pt in the thoracic aorta interlayer vacuum cavity;
s34, calculating the ratio Pfx/Pt of the pressure of the false cavity to the pressure of the true cavity, and obtaining functional indexes before operation.
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