Lensing A W, Levi M M, Büller H R, Prandoni P, Vigo M, Agnelli G, Lupatelli L, Huisman M V, ten Cate J W
Academic Medical Center, Amsterdam, The Netherlands.
Ann Intern Med. 1990 Jul 1;113(1):9-13. doi: 10.7326/0003-4819-113-1-9.
To determine the diagnostic criteria (phase I) and to assess the accuracy (phase II) of an objective Doppler-Valsalva pressure method as compared with contrast venography for the diagnosis of acute deep-leg-vein thrombosis in symptomatic outpatients.
A two-phase prospective study in consecutive patients. Doppler ultrasound strip-chart recordings and venograms were independently analyzed by experienced observers.
Referral-based medical clinics at university medical centers.
One hundred and ten (phase I) and one hundred and fifty-five (phase II) patients who had clinically suspected venous thrombosis and were referred by their general practitioners were included.
A normal Doppler test result was defined as a cyclic spontaneous signal (S-signal), a continuous S-signal with a Valsalva pressure of less than 6.5 mm Hg, or an absent S-signal with flow after cessation of the Valsalva maneuver. A continuous S-signal with a Valsalva pressure of 6.5 mm Hg or more or an absent S-signal without flow after cessation of the Valsalva maneuver were defined as abnormal test results. The accuracy indices for proximal vein thrombosis in phase II (155 patients; prevalence, 31%) were sensitivity, 91% (95% CI, 79% to 98%), and specificity, 99% (CI, 97% to 100%). All 3 patients with isolated calf-vein thrombosis had normal Doppler test results.
The objective Doppler method is an accurate, reproducible, and simple method for detection of venous thrombosis in symptomatic outpatients.
确定客观的多普勒 - 瓦尔萨尔瓦压力法（Doppler-Valsalva pressure method）诊断有症状门诊患者急性下肢深静脉血栓形成的诊断标准（第一阶段），并评估其与静脉造影相比的准确性（第二阶段）。
对连续患者进行的两阶段前瞻性研究。经验丰富的观察者独立分析多普勒超声带状图记录和静脉造影。
大学医学中心基于转诊的医疗诊所。
纳入了110名（第一阶段）和155名（第二阶段）临床上疑似静脉血栓形成且由其全科医生转诊的患者。
正常的多普勒测试结果定义为周期性自发信号（S信号）、瓦尔萨尔瓦压力小于6.5 mmHg时的连续S信号，或瓦尔萨尔瓦动作停止后有血流的无S信号。瓦尔萨尔瓦压力为6.5 mmHg或更高时的连续S信号或瓦尔萨尔瓦动作停止后无血流的无S信号定义为异常测试结果。第二阶段近端静脉血栓形成的准确性指标（155例患者；患病率31%）为敏感性91%（95%可信区间，79%至98%），特异性99%（可信区间，97%至100%）。所有3例孤立性小腿静脉血栓形成患者的多普勒测试结果均正常。
客观的多普勒方法是检测有症状门诊患者静脉血栓形成的一种准确、可重复且简单的方法。
