臺灣博碩士論文加值系統

超音波掃描因不具侵襲性傷害，故廣用於人及各種動物之醫學診療，尤其在心血管疾病之檢查上更是不可或缺之工具。本研究鑑於長臂猿爲瀕臨絕種保育類野生動物，且因其壽命可達25-30歲而心臟疾病發生機率亦相對較大。然而欲應用超音波掃描此一利器於心疾病之診療上，則其正常心超音波掃描術 ( echocardiography ) 和心功能參考值之建立至為必要，為此針對 22隻臨床上健康 ( clinically healthy )，體重1.5-9.2公斤長臂猿 ( 13公，9母 )，分別以吹箭肌肉注射ketamine 7.61-20.0 mg/kg、或medetomidine 0.04-0.06 mg/kg混合ketamine 2.4-4.0 mg/kg兩種目前常用之麻醉方法保定後，以二維B模式 ( two-dimensional B-mode ) 建立其左尾側胸骨旁掃描心四腔室像和五腔室像、右頭側胸骨旁掃描心四腔室長軸像和左心室流出路像及心短軸像等心超音波掃描術，並由各標準斷面圖測得M模式 ( M-mode ) 及都卜勒模式 ( Doppler-mode ) 心功能參考值。結果由直線回歸分析顯示心室中隔舒張末期厚度 ( IVSTD )、左心室後壁舒張末期和收縮末期厚度 ( LVPWD、LVPWS )、左心室舒張末期和收縮末期內徑 ( EDD、ESD )、左心室舒張末期容積 ( EDV )、左心室心動排出量 ( SV ( m ))、左心室心輸出量 ( CO ( m ))、僧帽瓣E波振幅 ( C-E )、僧帽瓣E點與心室中隔之距離 ( EPSS )、主動脈內徑 ( AOD ) 以及左心房內徑 ( LAD ) 等心功能參考值均與體重有顯著相關 ( P<0.05 )，故再依體重分成三個區分，建立各區分之心功能參考值；並挑選體重分佈相近但麻醉方式不同之長臂猿各4隻進行比較分析，結果顯示僅有心跳速率、EDD、EDV和SV ( m ) 在兩種不同麻醉方式間有顯著差異 ( P<0.05 )；另外挑選體重分布相近且皆以ketamine麻醉但性別不同各4隻長臂猿進行比較分析，結果僅有經僧帽瓣血流速率與時間之積分值 ( VTIv ) 在性別間有顯著差異 ( P<0.05 )。

Ultrasonography has been widely applied in human and various animals as a medical diagnosis purpose, especially in cardiovascular evaluation. Gibbons is an endangered wild species, and the heart diseases may increase relatively, because their life span could reach until 25-30 years old or more. It is necessary to build up the normal echocardiographic techniques and the reference values of echocardiographies, if we wish to use ultrasonograhy as a convenient tool in heart diseases diagnosis. For this purpose, twenty-two “clinically healthy” gibbons ( weight 1.5-9.2 kg, 13 male and 9 female ) were anesthetized with two commonest methods administrated the ketamine 7.6-20.0 mg/kg or combination of medetomidine 0.04-0.06 mg/kg and ketamine 2.4-4.0 mg/kg through blowgun. Then the 4 chamber and 5 chamber views of left caudal parasternal location, and the long-axis 4 chamber, long-axis left ventricular outflow and right short-axis views of right parasternal location were obtained in two-dimensional echocardiographies. The variant reference values of echocardiographic were measured in M-mode and Doppler echocardiographies. With the line regression analysis, the result revealed that the interventricular septal thickness at end diastole ( IVSTD ), left ventricular posterior wall thickness at end diastole ( LVPWD ) and at end systole ( LVPWS ), end-diastolic dimension ( EDD ), end-systolic dimension ( ESD ), end-diastolic volume ( EDV ), stroke volume ( SV ) by M-mode, cardiac output ( CO ) by M-mode, mitral E wave amplitude ( C-E ), E poient to septal separation ( EPSS ), aortic dimension ( AOD ) and left atrial dimension ( LAD ) were significantly related to the body weight ( P<0.05 ). So the reference values of echocardiographies in three differnt groups of body weight were established. Besides, only the heart rate, EDD, EDV and SV ( m ) were showed significant difference ( P<0.05 ) between two different anesthesia groups ( 4 individual values in each group that had the similar body weight ). And significant difference ( P<0.05 ) of velocity-time integral of transmitral flow ( VTIv ) was observed between male and female gibbons that had similar body weight and chemical restraint ( anesthesia with ketamine ) in each group.

目 錄
中文摘要………………………………………………………………Ⅰ
英文摘要………………………………………………………………Ⅲ
誌謝……………………………………………………………………Ⅴ
目錄…………………………………………………………………Ⅵ
圖表目錄…………………………………………………………………Ⅷ
第1章 前言…………………………………………………………1
第2章 文獻回顧……………………………………………………3
2.1長臂猿之簡介………………………………………………………3
2.2心超音波掃描術（echocardiography）之應用………………10
2.3心超音波掃描術之模式…………………………………………11
2.3.1二維B模式心超音波掃描法（two-dimensional B-mode echocardiography)11
2.3.2M模式心超音波掃描法（M-mode echocardiography）…19
2.3.3都卜勒心超音波掃描法（Doppler echocardiography）…27
2.3.3.1 光譜都卜勒（septral Doppler）……………………28
2.3.3.2 彩色都卜勒（color flow Doppler）………………32
2.3.3.3 能量都卜勒（power Doppler）……………………34
2.4心臟超音波掃描術在野生動物之應用……………………………36
2.5心臟超音波影像窗………………………………………………36
2.6非人靈長類之心臟疾病……………………………………………37
第3章 材料與方法………………………………………………………38
3.1試驗設計……………………………………………………………38
3.2試驗用動物…………………………………………………………38
3.3一般臨床檢查………………………………………………………41
3.4血液學檢查…………………………………………………………41
3.5血清生化學檢查……………………………………………………41
3.6結核菌素試驗………………………………………………………41
3.7 B型肝炎表面抗原檢查……………………………………………41
3.8心臟超音波掃描檢查………………………………………………42
3.9二維B模式心臟超音波掃描法……………………………………42
3.10 M模式心超音波掃描測定…………………………………………42
3.11脈動式都卜勒心臟超音波掃描掃描( pulse-wave Doppler
echocardiography ).................................43
3.12統計分析……………………………………………………………44
第4章 結果…………………………………………………………………45
4.1 X光攝影下長臂猿心臟解剖位置…………………………………45
4.2二維B模式心超音波掃描法………………………………………46
4.2.1左尾側 ( 心尖部 ) 胸骨旁掃描術………………………46
4.2.1.1長軸四腔室和五腔室斷面…………………………46
4.2.2右側胸骨旁掃描術…………………………………………49
4.2.2.1長軸斷面……………………………………………49
4.2.2.2短軸斷面……………………………………………52
4.3 M模式心超音波掃描測定…………………………………………54
4.4脈動式都卜勒心超音波掃描………………………………………64
第5章 討論………………………………………………………………72
參考文獻……………………………………………………………………79
縮寫對照表……………………………………………………………90
作者簡介…………………………………………………………………92

圖表目錄
Fig.1 Lateral ( A ) and dorsoventral ( B ) radiographic views of the
normal gibbon thorax, with the major structures emphasized…45
Fig.2 The transducer approach ( ultrasound window ) of left caudal
( apical ) parasternal scan……………………………………47
Fig.3 Four chamber ( inflow ) view ( A ) and five chamber ( left
ventricular outflow ) view ( B ) obtained from the left
caudal ( apical ) parasternal scans…………………………………48
Fig.4 The transducer approach ( ultrasound window ) of right
parasternal scan…………………………………………………49
Fig.5 Long-axis 4 chamber view obtained from the right
parasternal scans……………………………………………………………50
Fig.6 Long-axis left ventricular outflow view obtained from the
right parasternal scans………………………………………51
Fig.7 Short-axis views obtained from the right parasternal
scans…………………………………………………………53
Fig.8 Diagrams of measurements from the M-mode echocardiographic
views of gibbons obtained from the long-axis LV outflow view
or long-axis four chambers view of right parasternal
location……………………………………55
Fig.9 Pulse-wave Doppler echocardiographic tracings from the
gibbon....................................................64
Table 1 The species and their basic datum of gibbons under
anesthesia with ketamine 7.61-20 mg/kg ( keta ), or ketamin
2.4-4 mg/kg mix with medetomidine 0.04-0.06 mg/kg
keta+medeto ) for the test…………………………………39
Table 2 Echocardiographic value obtained from M-mode
echocardiographic at the LV chamber level of long-axis 4
chamber view in each clinically healthy gibbons under
anesthesia with ketamine 7.61-20 mg/kg ( keta ), or ketamin
2.4-4 mg/kg mix with medetomidine 0.04-0.06 mg/kg…………56
Table 3 Echocardiographic value obtained from M-mode
echocardiographic at mitral valve and aortic valve levels of
long-axis LV outflow view in each clinically healthy gibbon
under anesthesia with ketamine 7.61-20 mg/kg ( keta ), or
ketamin 2.4-4 mg/kg mix with medetomidine 0.04-0.06 mg/kg (
keta+medeto )………………………………………57
Table 4 Regression equations of M-mode echicardiographic measurements
vs. body weights with 95 % confidence interval of linear
regression in clinically healthy
gibbons………………………………………………………58
Table 5 The differences of M-mode echocardiographic values ( derived
from LV chamber level ) among three groups of body weights in
clinically healthy gibbons……………………59
Table 6 The differences of M-mode echocardiographic values ( derived
from mitral valve level ) among three groups of body weights
in clinically healthy gibbons……………………61
Table 7 The differences of M-mode echocardiographic values derived
from aortic valve level among three groups of body weights
in clinically healthy gibbons……………………………………62
Table 8 M-mode echocardiographic views of gibbons obtained from the
long-axis LV outflow view or long-axis four chambers view of
right parasternal location. The ultrasound beams were swept
from the levels of the left ventricular chamber ( A ),
mitral valve level ( B ), and aortic valve ( C )………………65
Table 9 Echocardiographic values obtained from pulse-wave Doppler
echocardiographic at the aortic valve in each clinically
healthy gibbon under anesthesia with ketamine 7.61-20 mg/kg
( keta )or ketamin 2.4-4 mg/kg mix with medetomidine 0.04-
0.06 mg/kg ( keta+medeto )…………66
Table 10 Regression equations of pulse-wave Doppler
echocardiographic measurements vs. body weights with 95 %
confidence interval of linear regression in clinically
healthy gibbons………………………………………………………67
Table 11 The differences of Doppler echocardiographic values at the
mitral valve among three groups of body weight in
clinically healthy gibbons under general
anesthesia………………………68
Table 12 The differences of Doppler echocardiographic values at the
aortic valve among three groups of body weight in
clinically healthy gibbons under general
anesthesia………………………70
Reference Fig.1 Hoolock gibbon ( Bunopithecus hoolock )……………6
Reference Fig.2 White-handed or lar gibbon ( Hylobates lar )………6
Reference Fig.3 Agile gibbon ( Hylobates agilis )……………………6
Reference Fig.4 Silvery gibbon ( Hylobates moloch )………………7
Reference Fig.5 Grey gibbon ( Hylobates muelleri )…………………7
Reference Fig.6 Pileated gibbon ( Hylobates pileatus )………………7
Reference Fig.7 Kloss’s gibbon ( Hylobates klossii )………………8
Reference Fig.8 Adult male western black crested gibbon ( Nomascus
concolcr )………………………………8
Reference Fig.9 Adult femaile white-cheeked crested gibbon ( N.
leucongenys ) and adult male white-cheeked crested
gibbon ( N. leucongenys )……………………………8
Reference Fig.10 Yellow-cheeked crested gibbon ( Nomascus
garbriellae )…………………………………………9
Reference Fig.11 Eastern black crested gibbon ( N. sp. cf. nasutus )
…9
Reference Fig.12 Siamang ( Symphala syndactylus )……………………9
Reference Fig.13 Diagram of the right parasternal location ( A ) and
the long-axis views ( B and C )..................14
Reference Fig.14 Short-axis views obtained from the right
parasternal location...................15
Reference Fig.15 Diagram of the left caudal ( apical ) parasternal
location ( A ) and the left cranial parasternal
location ( B )…………………………………………16
Reference Fig.16 Long-axis views obtained from the left caudal (
apical ) Parasternal location ( A) and ( B ) are
the four-chamber views, ( C ) and ( D ) are the two-
chamber views………………………………17
Reference Fig.17 Long-axis and short-axis views obtained from the
left cranial parasternal location…………………18
Reference Fig.18 The standard M-mode echocardiographic locations and
the diagrams of human……………………………20
Reference Fig.19 The standard M-mode echocardiographic locations and
the diagrams of dogs…………………………21
Reference Fig.20 Methods for measuring left ventricular volume by
two-dimensional echocardiography………………23
Reference Fig.21 Methods for measuring left ventricular muscle
mass……………………………………………………24
Reference Fig.22 Schematic diagram of the mitral valve M-mode
echocardiogram. The anterior mitral valve leaflet
had a wider excursion and inscribes a typical “M”
shape. The posterior mitral valve leaflet inscribes
a “W” shape……………………………………………26
Reference Fig.23 Pulse-wave and continuous-wave Doppler tracings of
dogs………………………………28
Reference Fig.24 Pulse-wave Doppler tracing demostrating turbulence
and aliasing.................29
Reference Fig.25 Schematic diagram of the tracing locations and
recording of pulse-wave Doppler echocardiography at
the left ventricular inflow tract………………30
Reference Fig.26 Schematic diagram of the tracing location and
recording of pulse-wave Doppler echocardiography at
the left ventricular outflow tract…………………31
Reference Fig.27 Two-dimensional color Doppler echocardiographic
images in dog...................................33
Reference Fig.28 Power Doppler imaging. blood flow within normal
splenic parenchyma is detected surrounding a
hypechoic, avasclar splenic lesion………………35
Reference Table 1 The systematics and species identification of
gibbon…………………………………………………………3
Reference Table 2 Teichholz formulas for systolic and diastolic
volume and the ejection phase indices of cardiac function.........................................22
Reference Table 3 The ejection phase indices of cardiac
function.........................................27

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