臺灣博碩士論文加值系統

右心處於衰竭狀態時，無法容納正常的靜脈血液回流量，造成中央靜脈壓以及血液量上升，後腔靜脈的管徑便會擴張。評估犬後腔靜脈大小的方法是於胸腔X光影像下測量後腔靜脈直徑。但此法有許多限制，包括影像的品質以及胸腔疾病的影響，皆會影響判讀的正確性。因此本研究嚐試利用超音波來測量後腔靜脈的直徑，期望能建立正常犬隻後腔靜脈超音波影像的基本資料，並比較臨床上正常犬隻與右心衰竭犬隻的後腔靜脈直徑，評估後腔靜脈擴張的程度與右心衰竭的嚴重程度間之相關性。本研究共收集51隻臨床上正常的犬隻以及20隻右心衰竭的犬隻作為研究對象。使用5 MHz的凸形探頭，從右側第11肋間掃描Porta hepatis 區域的後腔靜脈以及主動脈影像，稍微調整探頭即可得到後腔靜脈及主動脈橫切面影像，分別於呼氣末期主動脈舒張及收縮時記錄後腔靜脈與主動脈的直徑。正常犬隻於主動脈舒張時記錄之後腔靜脈（CVCd）平均直徑為8.71 ± 0.37 mm，兩者的比例（CVCd/AOd）平均為1.08 ± 0.01。而於主動脈收縮時記錄之後腔靜脈（CVCs）平均直徑為8.87 ± 0.37 mm，兩者的比例（CVCs/AOs）平均為1.19 ± 0.01。CVCd以及CVCs與體重呈高度正相關，而CVCd/AOd與CVCs/AOs則與體重呈低度負相關。本研究依據紐約心臟病協會所制訂的心衰竭程度分級將右心衰竭再分成第二級到第四級（NYHA II-IV）三個組別，連同正常組共四個組別進行後腔靜脈各參數的比較。結果顯示CVCd與CVCs在各組別中皆無顯著差異。CVCd/AOd以及CVCs/AOs則在NYHA IV最大，NYHA III次之，兩組間具有顯著差異，且與正常者以及NYHA II者皆有顯著差異，NYHA II 與正常組間則無顯著差異。運用後腔靜脈直徑與主動脈直徑的比例，可以有效區別出嚴重右心衰竭的患犬，且可成為胸腔X光評估法外的另一較佳選擇。

The caudal vena cava (CVC) is a highly compliant vessel. As central venous pressure rises, the CVC dilates because the failing right atrium can not accommodate the systemic venous return. Although radiographic evaluation of CVC size in dogs has been reported, certain limitations restrict its clinical application. The aim of this study was to establish fundamental ultrasonographic imaging data of CVC diameter in dogs and to compare CVC diameters between normal group (n=51) and right heart failure group (n=20) classed from II to IV according to New York Heart Failure Association (NYHA). These dogs were examined by two-dimensional ultrasound using a 5.0-MHz sector transducer. A right intercostal approach at eleventh intercostal space were used to obtain clear images of CVC and aorta at the level of the porta hepatis in the same plan. The luminal diameter of CVC was measured concurrently with peak diastolic (AOd) and peak systolic (AOs) aorta diameters respectively at quiet expiration. In normal dogs, the mean of CVC diameter measured with AOd was 8.71 ± 0.37 mm and the mean of CVC/AOd ratio (CVCd/AOd) was 1.08 ± 0.01, whereas the mean of CVC diameter measured with AOs was 8.87 ± 0.37 and the mean of CVC/AOs ratio (CVCs/AOs) was 1.19 ± 0.01. Body weight significantly affected CVCd and CVCs, but had little influence on CVCd/AOd and CVCs/AOs. The CVCd and CVCs showed no significant difference between normal and all NYHA heart failure groups. The CVCd/AOd and CVCs/AOs were getting higher with the severity of heart failure and there were significant difference between this three group and normal except the NYHA II. Adding it up, measurement of CVC/AO ratio is able to differentiate severity right heart failure from normal and mild right heart failure, and this ratio is more reliable than the CVC diameters.

中文摘要……………………………………i
英文摘要……………………………………ii
目錄…………………………………………iii
表次…………………………………………v
圖次…………………………………………vi
第一章 緒言………………………………1
第二章 文獻探討…………………………3
　第一節 心衰竭…………………………3
　　一、心衰竭之定義…………………3
　　二、心衰竭之原因…………………3
　　三、心衰竭之病態生理學…………7
　　四、心衰竭之評估…………………10
　　五、右心衰竭………………………11
　第二節 右心衰竭之診斷……………11
　　一、臨床症狀……………………11
　　二、理學檢查……………………12
　　三、臨床生化學檢查……………14
　　四、X光放射線學檢查…………14
　　五、心電圖檢查………………16
　　六、超音波學檢查………………16
　第三節 以超音波診斷右心衰竭…16
　　一、心臟超音波學檢查…………16
　　二、腹腔超音波…………………22
　第四節 後腔靜脈……………………23
　　一、解剖位置………………………23
　　二、生理特性………………………23
　　三、臨床應用………………………24
　第五節 以超音波掃描後腔靜脈評估右心功能以及預後………28
　　一、掃描方式…………………………………………………28
　　二、B-mode 超音波掃描……………………………………29
　　三、M-mode超音波掃描……………………………………31
　　四、預後……………………………………………………32
第三章 材料與方法……………………………………………34
　第一節 實驗研究犬…………………………………………34
　　一、正常組…………………………………………………34
　　二、右心衰竭組…………………………………………34
　第二節 重要儀器及設備……………………………………34
　第三節 實驗方法……………………………………………35
　　一、臨床診斷模式…………………………………………35
二、後腔靜脈超音波檢查…………………………………38
第四章 結果………………………………………………………41
第五章 討論………………………………………………………55
參考文獻…………………………………………………………61

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