6 курс / Кардиология / Шиллер_Клиническая_эхокардиография
.PDF/ . 3-1. * , , " ) ,B , " ,B .
& & % ! & : & , ! " ! #7 , " ".(8 - , % " , R - ,
% " ).
(0): ! ! #7 , ft! fr.
(5): F #7 ( - ) ! ,& ! .
()): F #7 ! ! % , # &! . , #7 # ! , & fd ! #7 . (Feigenbaum H.: Echocardiography, 4th ed. Philadelphia, Lea & Febiger, 1986)
/ . 3-2. ' D " .
F & " & , cos = 1 & ! # & & . # 20º # "". F & " , & # ! # & (cos90° = 0)
3 " # ". , " , # ! ! ; ,
" - . 5 |
|
! & |
# ( &% |
& , & " " ! ). 3 # ",! , & % & ., % " , & # ! , " . / " & & " , # & & & .
& " |
& |
|||
, - ! . |
|
|
|
|
|
|
|
|
|
3.1. # (#/ ) # |
|
|||
|
|
|
|
|
|
|
|
' |
|
9 & " |
1,0 (0,8-1,2) |
|
0,9 (0,4-1,3) |
|
8 " |
0,6 (0,5-0,8) |
|
0,5 (0,3-0,7) |
|
( |
0,9 (0,7-1,1) |
|
0,75 (0,6-0,9) |
|
5 " ! |
1,0 (0,7-1,2) |
|
0,9 (0,7-1,1) |
|
0 |
1,5 (1,2-1,8) |
|
1,35 (1,0-1,7) |
|
(Hatle L., Angelsen 5. Doppler ultrasound |
in cardiology: physical principles and clinical application, |
|
||
2nd ed., Philadelphia. Lea & Febiger, 1985) |
|
|
|
:% -
' & [Pulsed Wave Doppler] & & & " & . 3 % &
"! " ! . & & & (1540 / ), ! & &, % , & , ! ,. 9 & & #7| , : & - # " #7 [sample volume], # & & . %! ! & &, # % & #7 & #7 ( . 3-3). 3 & #7 # ! & 2 20 . 5 ! & " " # -& . . 3-4& . 5 #. 3.1& & " .
> & [PRF] - , " % & . > & % & # !
& #7 |
& % , . 5 |
||
# & |
& |
||
|
& #7 . > # & |
& , |
|
|
# # " ! # & . & & , |
|
% & " -, " . , " " , ! [aliasing]. ) & % . 3-5. F & & , % " 2,5 96 , & & , ! # & & #7| 8 ,2,4 / ; 12 & & - 1,6 / .
/ . 3-3.
5 & !! ! & & # % # & #7 & #7 .
Sample Volume - ,B
(Wagonner A. D., Perez J. E. Principles and Physics of Doppler, in: Doppler Echocardiography, ed. N. Schiller, Cardiology Clinics, Vol. 8(2), 1990)
$
'
D
/ . 3-4. " .
(0) — ! , (5) - " , ()) -& " , (D) - & " .
J - , $ -
) " " &- ! & " . %# " " ! . 3# # & " ! & - ! " & [high PRF Doppler]. $
! " ! [range ambiguity]: & #7% # ( . . " ! & )! ! " , # , . . % " %. & % # : ! " & % &
#7 . |
, |
12 , |
" |
|
& " #7 |
|
% # 6 |
; & |
& |
, & , & |
. 3 |
|||
& #7 & 4 8 |
. . |
% & & % &
& 5 , # |
5 & #7 . |
||||
Z & ! & |
& # |
|
|
|
|
& , & #7 |
# . |
||||
! " |
& |
|
|
& |
|
; # |
|
! . ; , # ", # ! " # |
" - - [Continuous Wave Doppler].
/ . 3-5. K + " > > Q .
3 ! , % , " 1 .1/4 # (0), % &! . 5 # & & ! (5) " . ! 3/4 # ()) % ! % : , 1/4 #" . 1 # (D) ! , .5/4 # (F) % &
! , ! % & ! . 8 # |
, & ! # & |
1/2 # , # ! # & |
& |
! " 1 .
(Hatle L., Angelsen 5. Doppler ultrasound in cardiology: physical principles and clinical application, 2nd ed. Philadelphia. Lea & Febiger, 1985)
!- - |
|
||||
5 & , ! " |
, |
||||
, - |
|
|
# : |
||
" , |
" |
|
|
, |
! " |
& " |
, |
|
# . 8 # , |
& & (. 3-6). 6 -
|
, |
&% |
! # & |
||||||
%# & |
. |
|
|
|
& |
||||
% , |
|
|
& |
|
& . ' |
|
|
||
& |
|
# . > & - |
|||||||
|
, , |
& |
|
|
, |
" . ) % & ,
% 12 |
/ , ! ( & 12 / |
|
", % " 500 |
. .), &% -" - |
|
|
! & %# % & . |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
/ . 3-6. |
- |
|
|
||||||||||||
|
" |
|
. |
|
|
|
|
|
|
||||||
' & & . |
|
|
|
|
|
||||||||||
" " & " (AS) |
|
|
|
||||||||||||
" & " (AI). 9 & & (Vmax) |
|
|
|
||||||||||||
" 4,1 |
/ . |
% ? |
|
|
|||||||||||
|
& " (3 max) ! |
! |
", " |
|
|
||||||||||
|
67 |
. . |
|
|
|
|
|
|
|
|
|
|
|
||
CW Doppler Transducer - - |
, LV - " , |
|
|||||||||||||
LA - |
, $ - ) , Velocity - ( / ), Time - |
|
|
||||||||||||
( ). |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Judge . W., Otto ). 9. Doppler echocardiographic evaluation of aortic stenosis, in: Doppler Echocar- |
|
|
|||||||||||||
diography, ed. Schiller N. 5., Cardiology Clinics, 8(2), 1990) |
|
|
|
|
|
|
|||||||||
6 " |
- |
! & " . |
|||||||||||||
) & , |
& |
- |
% |
|
: |
|
|||||||||
& |
|
% # & |
, |
, |
, |
|
|||||||||
- |
- % |
&. - |
|
||||||||||||
# , & " % |
|
|
|||||||||||||
|
|
. |
) |
% |
& |
% |
% " &% . ' & " ! " # ! , ! & ! & & #7 . 5 # & ! &
" & |
- |
|
|
: |
& & . |
, # |
|
|
, % & |
- |
. |
# & & & & "" ", && .
; % % : $
& (CSA) = ‚D2/4, D — .
+ , ! # & # % #7 (. 3-7):
1) |
& & ! |
|
, " " ; |
2)" ! & , # ;
3) |
|
! & ! # & |
|
|
& ( 20°); |
4)& ! &
. ; % & " "! .
' ) + ) U1 (. 3-6):
1) " :
X/ = 4V2
X/ - # ( . ),
V - & & & # ( / ).
2) 3 " ( ! & & , & & # 1,2 / ):
X/ = 4(V12 – V22)
V1 - & & # ,
V2 - & & # .
1 + , % ? # , & ( " ) ! & - "" . 5 ! , 4, .
/ . 3-7. K )" : ,B .
+ " #7 (SV) (CSA)( ) " " (VTI).
=
4 [Color Doppler] - & ! " . ) & !" # ! . 4
|
& " -: # ! # 250-500 & |
|||
#7 |
, |
& & |
. 6 |
|
|
% |
|
! |
|
- |
! & # # ! ! # " % . # |
* & # ! ! # % # 100 " & ; ! " " % " # !
20 & . |
|
||||
! ! 10 |
& , |
||||
|
& |
. ; ! & & |
& |
||
#7 |
|
|
" % " # &%. |
|
|
|
! # ! ( ! " & " |
#7 ) |
# " "! " . + # & -90° # ! 30-45° . ) ! % # ! ", . .% " % " # . 4 & % & # ! ", ! & #7 " " 8 # & , # ! !.
) &% , , # % ! , &, # & ! & #7 !. 5 "% , " - . ) % # ! & " . F % , !% , # % ! ! . 5& " # # , , -, ! - ! # ! & !. ) & & & & , #. 4 ! " # !, ! % ; # % ,. 4 # ! !, # " . 3# % % 9- & # ! .
6 , # & % % . 4- , & & "% ! & & . $
% % & " " % " # |
! |
". + & & |
& |
& & # & " " & (2,0-2,5 96 ).% ;#. 3.2. + & - ,
! & |
. / |
, |
|||||
& # ! " : |
& ( |
||||||
& & #7 ), |
# ! ". |
|
|
||||
3.2. $# # # # |
|
||||||
|
|
|
|
|
|
|
|
|
5 |
|
5 |
|
" |
|
|
|
# ! " |
|
& & |
|
|
|
|
+ [color gain] |
0 |
|
+ |
' # |
|
||
|
|
& |
|
||||
|
|
|
|
|
|
|
|
[sector |
+ |
|
+ |
% |
|
||
size] |
|
|
|
|
|||
|
|
|
|
||||
* & [filters] |
0 |
|
+ |
% |
|
||
|
|
# & |
|
|
|||
|
|
|
|
& |
|
|
|
> |
0 |
|
+ |
5 # & |
|
||
& [PRF] |
|
% |
& |
|
|||
|
|
|
|
" & |
|
|
4 # & "" [125, 127, 128, 135] [174]." # , ! .
) " ! &% & " ! "&% [122]. # &, # ! % " % ! .
1)6 : & ", # % ; #7 ; "; & - ;