| Arterio sclerosis obliterance(ASO) is the body-wide atherosclerosis in the body partial performance. In limb arteries , the lower limbs arterial are easily to be put in to trouble , especially , the femoral artery shares the highest incidence rates. At present , the color Doppler ultrasound has become the first choice of the clinical examination of arteriosclerosis obliterans because of its simple , real-time ,accurate and other advantages . However , applies the colored Doppler supersonic inspection to carry on the whole graduation to the ASO pathological change degree, at present still not related report. In order to further study colored Doppler supersonic to the arteriosclerosis unenlightened sickness degree graduation and the clinical graduation relevant research.We through to ASO the patient colored Doppler supersonic inspection, analyze the lower limb arteri- osclerosis unenlightened sickness patient two-dimensional, the colored Doppler blood stream developing, the frequency spectrum Doppler supersonic characteristic, has carried on the whole graduation according to the pathological change degree, and simultaneously carries on to it clinically by stages, analyzes the bouth relevance.Material and Method:This research selected the ASO patient 125cases, application colored Doppler supersonic has carried on the inspection, used two-dimensional, colored Doppler and frequency spectrum Doppler carries on the vascular diameter, in-diameter, wall thickness, the calcium spot distribution, the narrow degree, the unenlightened stage, the lateral support to the arteriosclerosis unenlightened sickness patient forms and the blood stream dynamics change carries on the observation, referred to the arteriostenosis degree the determination standard to carry on the whole graduation to this group of case of illness:Mild: Artery entire journey or in the partial stages the ~ specific weight is narrow, not unenlightened; Or the unenlightened stage does not surpass 1, also periphery has the colored blood stream signal to demonstrate the collateral circulation has established; -odd place lumen is light ~ moderate narrow.Moderate: Artery unenlightened stage 2~3, around the unenlightened stage the colored blood stream demonstrated already has 2~3 collateral circulation artery establishment.Specific weight: Above artery unenlightened stage 4 or the aorta entire journey are unenlightened, the non-collateral circulation establishment, or the lateral support is below 2; -odd place lumen is the specific weight is narrow.Clinical rests on following standard by stages:1. In October, 1995 China around the cooperation of Chinese and Western medicine academic society the blood vessel disease specialized committee revised clinically the standard to be by stages as follows:The first issue (partial ischemic stage): Has the chronic body to lack the blood performance, limps by the intermittence primarily, has sends, numb, the painfully swollen, the cold resistant ability decrease coolly.The second issues (trophopathy time): The body lacks the blood performance to aggravate, simultaneously has the skin to be rough, the fine hair falls off, the foot (points to) the armor accumulation, the foot (refers to) the fat pad to wither, the muscle withers, the intermittence limps, has ceases activity the ache.The third issues (necrosis time): Except that has the chronic body to lack the blood performance, the intermittence limps, ceases activity outside the ache, has the body ulcer gangrene, divides into three levels according to necrosis scope.1 level of necroses (gangrene) limits to the tip of toe or the finger.2 levels of necroses (gangrene) expands delays until the dorsum pedis or the full bottom, surpasses the foot zhi joint (finger to surpass refers to palm joint).3 levels of necroses (gangrene) expands extends to the malleolus joint or the calf (hand to wrist)2. Fontaine by stages:First issue: The slight host sues the time: The patient only felt the trouble extremity skin temperature drop is low, is sensitive to cold or mild numb, after activity easy weary, but the extremity easy to have the full ringworm to infect not not easily to control;Second issue: The intermittence limps the time: When walks, because lacks the blood and the oxygen deficit, the calf muscle has the convulsion, the ache, tired incapable (most common);Third issue: Ceases activity the pain time: Collateral circulation establis- hment serious insufficient, lacks the blood to be serious, even if in rest time also feels the ache, numb, paraesthesia (ache by extremity primarily)Fourth issue: Organization necrosis time: The pathological change develops to the unenlightened time, the collateral circulation is extremely limited, the trophopathy symptom, has before ulcer and the gangrene, skin temperature drop, the skin dull purple, early ulcer and the gangrene often in the organization department, may further upwardly develop, serious may have the whole body poison symptom.Colored Doppler supersonic divides into this group of case of illness the light, medium and heavy three groups, has the very good uniformity with the clinical by stages light, medium and heavy three groups.Result:1. colored Doppler supersonic whole graduationThis group of 125 example patient whole graduation, in which mild group 46 cases, male 35 cases, female 11 cases; Moderate group 42 cases, male 30 cases, female 12 cases; Specific weight group 37 cases, male 23 cases, female 14 cases. This group of 125 cases patient, in 173 lower limb arteries, common iliac artery(CIA) 12, external iliac artery(EIA) 12, common femoral artery(CFA) 17, femoral artery (FA) 65, popliteal artery (POA) 31, arterior tibial artery(ATA) 60,posterior tibial artery (PTA) 42, dorsum pedis artery(DPA) 29. Altogether demonstrates 139 collateral arteries.2. clinical by stagesThis group of 125 case patient acts according to the standard to divide into 3 groups by stages clinically, in which mild 42 cases, moderate 40 cases, specific weight 43 cases. Mild group male 33 cases, female 9 cases ; Moderate group male 29 cases, female 11 cases; Specific weight group male 26 cases, female 17 cases .125 example patients have the lower limb coolly, performance and so on hemp, ache, occupies 100%.In the specific weight group the intermittence limps occupies this group 70%, but is higher than the mild group, the moderate group far 40% and 52%; But appears ulcer and the gangrene completely in the specific weight group.3. colored Doppler supersonic and clinical has the good uniformity Through this group of research to indicate by stages the colored Doppler supersonic whole graduation and clinical has by stages the very good relevance, the Spearman rank analysis result demonstrated, the supersonic graduation and clinical presents by stages is connected (rs=0.797, P<0.01), the difference has statistics significance and clinical demonstrates the good uniformity by stages.Conclusion1.colored Doppler's supersonic carries on graduation At present in the whole to the ASO pathological change degree the artery graduation standard to the partial artery stage narrow degree determination, has not been able to analyze the lower limb artery change overall the situation, for the more objective reflection arteriosclerosis unenlightened sickness overall pathological change degree, this group of case of illness referred to in the colored Doppler's supersonic graduation formerly grades the standard, tried to carry on the whole to establish the comprehensive determination standard, carried on the appraisal in the whole to the lower limb arteriosclerosis unenlightened sickness patient, had the positive sense.2. lateral support artery establishment demonstrated to lower limb artery pathological change situation improvementThis group of case of illness that, 173 lower limb arteries altogether esta- blished 139 lateral support arteries, in which lateral support artery establis- hment obviously improve the unenlightened stage far-end blood stream situation, the lower limb symptom were improved obviously, the skin warm ascension, ceased activity pain vanishing, ulcer reduces, because the collateral circulation was rich, commutation ability strengthened, body gangrene reduction.In this group of 173 lower limb artery, 65 artery establishment lateral support artery, in which mild group 13, moderate group 32, specific weight group 20; 108 arteries have not established the collateral circulation, in which mild group 39 examples, moderate group 28 examples, specific weight group 41 examples.Colored Doppler supersonic energy accurate, sensitive examination lateral support artery establishment situation, and can in the very good demonstration lateral support artery and the far-end artery blood stream situation, be appraises the lower limb arteriosclerosis unenlightened sickness pathological change degree the reliable method.3. colored Doppler supersonic and clinical has the good uniformity by stages to the artery pathological change degree graduation.This group of case of illness in the reference formerly in the colored Doppler's supersonic graduation standard foundation, have established the whole synthesis determination standard.The goal lies in to the lower limb artery change degree, the narrow scope and the unenlightened stage makes a more direct- viewing analysis.Simultaneously is precise judges ASO the pathological change spot and the scope and the unenlightened after collateral circulation forms the situation, provides more comprehensive information for clinician, and unifies patient's clinical symptom, makes the synthesis to sentence the section, to clinician's diagnosis, the treatment as well as the operative approach choice and the surgery plan formulation has provided the reliable phantom study diagnosis basis.Applies colored Doppler supersonic unenlightened sickness to carry on the diagnosis and the graduation to the arteriosclerosis, and with the clinical by stages relevant research, explained the two have the very good uniformity. |
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