Comerota A J, White J V, Katz M L
Am J Surg. 1985 Oct 8;150(4A):14-24.
Since clinical diagnosis of DVT is often inaccurate, it has become accepted that an objective means of diagnosing clot in the deep venous system becomes critically important in the management of these patients. Important to understanding the diagnostic capabilities of any test are the anatomic and physiologic characteristics of the deep venous system. The venous Doppler examination monitors the velocity of blood flowing through a particular vein. Doppler probes in the 5 to 10 mHz range are routinely used. Respiratory variation is a normal finding due to a diminished flow signal during inspiration, followed by a progressive increase in flow signal during expiration. Characteristics of the spontaneous flow signals are the most important part of interpreting the venous Doppler examination. In addition, the response to distal or proximal compression (augmentation) adds important information to the interpretation; however, the response during any augmentation maneuver depends on the rapidity of compression, the force of compression, the quantity of blood in the veins at the time of compression, and the distance between the Doppler probe and the compression point. The literature reports a wide range of sensitivity and specificity for the Doppler examination, but there is uniform agreement and an observable trend that physicians with a large experience and a dedicated interest will obtain much better results than physicians with less experience and less interest. Phleborheography is a six-channel volumetric plethysmographic technique that monitors volume changes in the lower extremities associated with respiration and foot and calf compression. The volumetric tracings obtained are similar to the velocity profiles obtained on the venous Doppler examination. The criteria used in interpreting phleborheographic tracings are respiratory waves and baseline elevation (major criteria), and prominent arterial pulse waves and foot emptying (minor criteria). Previously reported overall sensitivities for detecting DVT are 83 to 93 percent, with sensitivities of detecting proximal vein thrombosis of 92 to 96 percent. Specificities have been reported to be 87 to 97 percent. In a prospective analysis of 126 extremities with phleborheography and phlebography carried out within the same 24 hour period at Temple University Hospital, we found an overall sensitivity of 79 percent (51 of 65 patients); however, the sensitivity for proximal vein thrombosis was 91 percent (49 of 54 patients).(ABSTRACT TRUNCATED AT 400 WORDS)
由于深静脉血栓形成（DVT）的临床诊断常常不准确，因此人们已经认识到，在这些患者的管理中，采用客观手段诊断深静脉系统中的血栓变得至关重要。了解任何检测方法的诊断能力，深静脉系统的解剖和生理特征很重要。静脉多普勒检查监测流经特定静脉的血流速度。通常使用5至10兆赫兹范围内的多普勒探头。呼吸变化是正常现象，表现为吸气时血流信号减弱，随后呼气时血流信号逐渐增强。自发血流信号的特征是解读静脉多普勒检查的最重要部分。此外，对远端或近端压迫（增强试验）的反应为解读增添了重要信息；然而，任何增强试验的反应取决于压迫的速度、压迫的力度、压迫时静脉中的血量以及多普勒探头与压迫点之间的距离。文献报道多普勒检查的敏感性和特异性范围很广，但有一致的看法和明显的趋势，即经验丰富且专注于此的医生比经验较少且兴趣不大的医生能获得更好的结果。静脉血流图是一种六通道容积描记技术，可监测与呼吸以及足部和小腿压迫相关的下肢容积变化。获得的容积描记图类似于静脉多普勒检查获得的速度剖面图。解读静脉血流图描记图所使用的标准是呼吸波和基线升高（主要标准），以及明显的动脉脉搏波和足部排空（次要标准）。先前报道的检测DVT的总体敏感性为83%至93%，检测近端静脉血栓形成的敏感性为92%至96%。特异性据报道为87%至97%。在坦普尔大学医院对126条肢体在同一24小时内进行静脉血流图和静脉造影的前瞻性分析中，我们发现总体敏感性为79%（65例患者中的51例）；然而，近端静脉血栓形成的敏感性为91%（54例患者中的49例）。（摘要截选至400字）
