在不受控制的环境中进行单腿膝伸肌运动期间基于多普勒超声的腿部血流评估
1Centre for Physical Activity Research,Copenhagen University Hospital, 2Department of Clinical Physiology and Nuclear Medicine,Copenhagen University Hospital, 3Department of Biomedical Sciences, Faculty of Health and Medical Sciences,University of Copenhagen, 4Department of Nutrition, Exercise and Sports,Integrated Physiology Group, 5Neurovascular Research Laboratory, Faculty of Life Sciences and Education,University of South Wales, 6Department of Anaesthesiology and Intensive Care,Copenhagen University Hospital, Hvidovre Hospital
Summary
这项重测研究评估了单腿膝伸肌运动期间通过多普勒超声技术测量的腿部血流量。研究了该方法的日内、日间和评分者间信度。该方法在日内和可接受的日间可靠性方面表现出很高。然而，在休息和低工作量下，评分者之间的可靠性低得令人无法接受。
Abstract
多普勒超声彻底改变了器官血流的评估，并广泛用于研究和临床环境。虽然基于多普勒超声的腿部肌肉收缩血流评估在人体研究中很常见，但这种方法的可靠性需要进一步研究。因此，本研究旨在调查多普勒超声在休息和分级单腿膝关节伸展（0 W、6 W、12 W 和 18 W）期间评估腿部血流的日内重测、日间重测和评估者间可靠性，在测量之间移除超声探头。该研究包括 30 名健康受试者（年龄：33 ± 9.3，男性/女性：14/16），他们在两个不同的实验日访问实验室，相隔 10 天。该研究没有控制主要的混杂因素，如营养状态、一天中的时间或荷尔蒙状态。在不同的运动强度下，结果显示出较高的日内可靠性，变异系数 （CV） 范围为 4.0% 至 4.3%，可接受的日间可靠性，CV 范围为 10.1% 至 20.2%，评分者间可靠性为 17.9% 至 26.8%。因此，在控制各种环境因素具有挑战性的现实临床场景中，多普勒超声可用于确定次最大单腿膝伸肌运动期间的腿部血流量，当由同一超声医师进行时，日内可靠性高，日间可靠性可接受。
Introduction
多普勒超声于 1980 年代引入，已广泛用于确定收缩的肌肉血流，特别是在单腿膝伸肌模型中，允许在小肌肉质量激活期间测量股总动脉 （CFA） 的血流 1,2,3,4,5,6 .基于多普勒超声的血流技术为各种人群的血管调节提供了宝贵的见解，包括健康成年人7,8、糖尿病患者9、高血压 10、慢性阻塞性肺病 11,12 和心力衰竭 13,14。
多普勒超声的一个优点是，与热稀释等其他血流测定方法相比，多普勒超声具有非侵入性，必要时可与动脉和静脉导管插入术结合使用3,4,6,15。它还能够进行心跳到心跳的血流速度测量，从而可以检测快速变化16。然而，基于多普勒超声的血液测量具有局限性，包括在接近最大运动强度的过度肢体运动期间难以获得稳定的记录，以及要求超声可及目标血管，不包括测力计骑自行车期间的评估15。因此，单腿膝伸肌模型非常适合在次最大强度的动态运动期间使用多普勒超声进行 LBF 评估17，最大限度地减少与运动相关的心肺限制的影响，并促进健康受试者与心肺疾病患者之间的比较11。
尽管被广泛使用，但近几十年来，使用多普勒超声的单腿膝伸肌模型的日间可靠性尚未得到更大规模的研究，先前的研究涉及小人群 （n = 2）3,18,19,20。
本研究旨在调查 （1） 日内重测信度，（2） 日间重测信度，以及 （3） 多普勒超声在 0 W、6 W、12 W 和 18 W 下单腿膝伸肌运动期间评估 LBF 的评分者间信度。测量是在临床现实场景中进行的，在两次测量之间移除探头。需要注意的是，在测量过程中，已知影响LBF的几个内在和外在环境因素没有得到控制，这可能会引入可变性并影响可靠性。考虑到多普勒超声技术和血流分析软件的进步，我们假设，即使在不受控制的环境中，当由同一超声医师进行时，也可以在所有强度下实现可接受的日内和日间 LBF 测量可靠性。
Protocol
该研究由丹麦首都地区区域伦理委员会（文件编号 H-21054272）评估，该委员会确定这是一项高质量的研究。根据丹麦立法，该研究因此在当地获得了Rigshospitalet临床生理学和核医学系内部研究和质量改进委员会的批准（文件编号。KF-509-22）。该研究是根据《赫尔辛基宣言》的指导方针进行的。所有受试者在入组前都提供了口头和书面知情同意书。该研究包括≥18岁的男性和女性。排除了患有外周动?…
Representative Results
参与者2022 年 5 月至 2022 年 10 月，共招募了 30 名健康男性和女性参与研究。所有受试者均无心血管、代谢或神经系统疾病史。他们没有被指示改变他们的日常习惯，包括咖啡因、酒精、尼古丁、剧烈运动或任何其他可能影响血管功能的因素。 实验步骤参与者在两个不同的实验日向实验室报告，相隔 10 天。对于每个参与者，实验在一天中的同一…
Discussion
本研究评估了多普勒超声方法在健康参与者次最大单腿膝伸肌运动期间评估腿部血流量 （LBF） 的可靠性。结果表明，日内信度高，日间信度可接受，而评分者间信度在静息和0 W时不可接受。
尽管测量之间的探头移除似乎影响不大，但日内和日间测量之间的可靠性差异可归因于不受控制的环境因素。在整个研究过程中，扫描部位、超声医师和实验装置保持一致。然而，参与者…
Declarações
The authors have nothing to disclose.
Acknowledgements
体育活动研究中心 （CFAS） 由 TrygFonden（授予 ID 101390 和 ID 20045）支持。JPH 得到了 Helsefonden 和 Rigshospitalet 的资助。在这项工作中，RMGB得到了post.doc的支持。Rigshospitalet的赠款。
Materials
| EKO GEL | EKKOMED A7S | DK-7500 Holstebro | |
| RStudio, version 1.4.1717 | R Project for Statistical Computing | ||
| Saltin Chair | This was built from an ergometer bike and a carseat owned by Professor Bengt Saltin. The steelconstruction was built from a specialist who custommade it. | ||
| Ultrasound apparatus equipped with a linear probe (9 MHz, Logic E9) | GE Healthcare | Unknown | GE Healthcare, Milwaukee, WI, USA |
| Ultrasound gel |
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