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。

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。排除了患有外周动脉疾病、心力衰竭、阻碍 KEE 努力的神经和肌肉骨骼疾病以及研究前 2 周内出现疾病症状的个体。
1. 参与者的设置
<ol><li>将参与者放在单腿膝伸椅上，参与者的背部靠在椅子上（补充图1）。给参与者穿上内衣，以便用超声探头进入腹股沟区域。</li>
	<li>将三个心电图电极（参见 材料表）放在参与者身上。将电极放置在第三肋间隙的胸壁右侧，第三肋间隙的左侧和第十一肋间隙的左侧，使电极与心脏等距。</li>
	<li>将参与者置于腹部和大腿之间 >90 度角。</li>
	<li>调整将单膝伸肌椅连接到飞轮的手臂，使参与者能够完全伸展膝盖。</li>
	<li>将参与者的腿紧紧地绑在椅子的踏板上，以避免使用肢体下部的肌肉。</li>
	<li>放置一把椅子或长凳以稳定不活动的腿。 注意： >90 度的角度被认为是最小角度。增加角度将打开腹股沟区域，从而使用超声探头更好地进入股动脉。当受试者有可能干扰扫描的腹部肥胖时，通常使用这种方法。 根据类型和型号的不同，增加单腿膝伸椅的阻力会有所不同，因此不作详细描述。绝对强度和相对强度均可报告。为了报告相对强度，请在前一天进行疲惫测试。</li>
</ol>2. 超声仪器的设置
<ol><li>按 打开 按钮。</li>
	<li>按 “患者 ”创建一个文件，用于保存检查。将光标移动到“新患者”，然后按回车键。填写“患者ID”，将光标移动到“创建”，然后按Enter键（补充图2 和 补充图3）。</li>
	<li>按探头，选择线性探头 （9 MHz），然后将超声凝胶（参见材料表）涂在探头上。 注意：如果不分配“患者 ID”，则无法保存参与者的数据。可以为这张纸分配更多数据，但不是执行检查的必要条件。</li>
</ol>3. 多普勒超声扫描
<ol><li>用最靠近参与者的手操作线性探头，并将其放置在腹股沟区域。找到最佳动脉切片，以便仔细获得 LBF 测量值。这是在腹股沟韧带下方，在动脉直段的股总动脉分叉上方 3-4 厘米处。</li>
	<li>将探头垂直于容器。按下 2D 按钮并制作股总动脉 （CFA） 的横截面图像。</li>
	<li>优化增益和深度，在整个实验过程中保持，以确保动脉位于屏幕中间，血液是黑色的。顺时针转动增益按钮可增加增益，逆时针转动按钮可降低 增益 。顺时针转动深度以增加 深度 ，逆时针转动以减小深度。 注意： 请参阅补充图 2 和补充图 3 了解按钮的定位，请参阅补充图 4 了解使用增益和深度优化的超声图像。</li>
	<li>在 2D 模式下，按一次 冻结 并使用轨迹球滚动以查找收缩末期图像。在心电图引导下，通过在 T 波结束时停止图像来执行此操作。</li>
	<li>按一次 测量 ，将光标移动到动脉的浅表内膜层，然后按 Enter。将光标移动到动脉的深层内膜层，然后按 Enter 键以获得收缩末期的直径。直径将显示在左上角。</li>
	<li>按 Freeze 并将探头顺时针旋转 90 度，同时将动脉保持在屏幕中间并使其与动脉平行以创建纵向视图。按下脉搏波按钮 PW ，然后按 测量。这将在屏幕右侧创建一个下拉菜单。将光标移动到 CFA，然后按 Enter 键。</li>
	<li>将光标移动到“自动”，然后按 Enter。将光标移动到“流量”，然后按 Enter。将光标移动到“实时”，然后按 Enter 获取跟踪，然后按一次 测量 完成。</li>
	<li>以尽可能低的共振角获得速度，并且始终低于 60 度。顺时针转动转向角按钮可减小转向角，逆时针转动按钮可增大 转向角 。转动 角度校正 按钮，确保在光标与动脉水平的情况下获得迹线，如 补充图 4 所示。</li>
	<li>按 Sample vol. 根据动脉的宽度进行调整，并远离动脉壁。要减小样本数量，请按 向左箭头。要增加样本数量，请按 向右箭头。</li>
	<li>通过动脉的同步 2D 可视化和视听血流速度反馈获得血流速度轨迹。顺时针转动声音按钮，确保 声音 已打开。</li>
	<li>在坐姿休息至少 30 秒期间获取第一条轨迹，然后按两次 图像存储 以保存轨迹。然后指导参与者在测试期间保持每分钟 60 轮 （RPM） 的速度，并且仅使用股四头肌进行腿部伸展并保持腘绳肌放松。在整个实验过程中保持探头固定。</li>
	<li>指导参与者在 60 W 时保持每分钟 0 轮 （RPM） 的速度，并且仅使用股四头肌进行腿部伸展并保持腘绳肌放松。在整个实验过程中保持探头固定，并按两次 图像存储 以保存迹线。</li>
	<li>增加阻力并让参与者完成至少 150 秒的运动，然后获得 30 秒的轨迹，然后按两次 图像存储 以保存轨迹。</li>
</ol>4. 血流定量
<ol><li>获得所有图像后，按 “查看”。</li>
	<li>按 Track Ball 并将光标移动到欲望图像上，然后双击 Enter。</li>
	<li>出现所需的迹线后，按 测量 并将光标移动到屏幕右侧下拉菜单中的“流量”，然后按 Enter。</li>
	<li>将光标移动到 2D 超声图像上，按 Enter 键，然后拖动光标直到达到静止期间测量的直径，然后再次按 Enter 键。 </li>
	<li>顺时针转动 光标选择 按钮两次，然后通过滚动轨迹球并按 Enter 键选择将在两条垂直线之间显示的 30 秒轨迹。</li>
	<li>将 LBF 计算为平均血流速度 （cm/s） 和股动脉横截面积 （cm2） 的乘积，将显示在左上角。 注意： 在数据分析之前，通过目视检查迹线进行质量控制，并排除受运动伪影和不规则心跳影响的脉搏波。完成检查后，可以通过顺时针转动 Angle Corr. 按钮减小角度，逆时针转动角度调整校正角度，以确保光标与动脉水平。</li>
</ol>

评估训练工作负载中的腿部血流

作者声明，该研究是在没有任何可被解释为潜在利益冲突的商业或财务关系的情况下进行的。

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...

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。

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			<td>EKO GEL</td>
			<td>EKKOMED A7S</td>
			<td>DK-7500 Holstebro</td>
			<td></td>
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		<tr>
			<td>RStudio, version 1.4.1717</td>
			<td>R Project for Statistical Computing</td>
			<td></td>
			<td></td>
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			<td>Saltin Chair</td>
			<td></td>
			<td></td>
			<td>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.</td>
		</tr>
		<tr>
			<td>Ultrasound apparatus equipped with a linear probe (9 MHz, Logic E9)</td>
			<td>GE Healthcare</td>
			<td>Unknown</td>
			<td>GE Healthcare, Milwaukee, WI, USA</td>
		</tr>
		<tr>
			<td>&#160; &#160;</td>
			<td>&#160; &#160;</td>
			<td>&#160; &#160;</td>
			<td>Ultrasound gel</td>
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doppler ultrasound-based leg blood flow assessment during single-leg knee-extensor exercise in an uncontrolled setting

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。

Doppler ultrasound, introduced in the 1980s, has been extensively used to determine contracting muscle blood flow, particularly in the single-leg knee-extensor model, allowing measurement of blood flow in the common femoral artery (CFA) during small muscle mass activation1,2,3,4,5,6. Doppler ultrasound-based blood flow technology has provided valuable insights into vascular regulation in various populations, including healthy adults7,8, individuals with diabetes9, hypertension10, COPD11,12, and heart failure13,14.
One advantage of Doppler ultrasound is its non-invasiveness compared to other blood flow determination methods like thermodilution, and it can be combined with arterial and venous catheterization if necessary3,4,6,15. It also enables beat-to-beat blood flow velocity measurement, allowing for the detection of rapid changes16. However, Doppler ultrasound-based blood measurements have limitations, including difficulties in obtaining stable recordings during excessive limb movement at near-maximal exercise intensities and the requirement for ultrasound accessibility to the targeted blood vessel, excluding evaluations during ergometer bicycling15. Hence, the single-leg knee-extensor model is well-suited for LBF evaluation using Doppler ultrasound during dynamic exercise at submaximal intensities17, minimizing the influence of exercise-related heart and lung limitations and facilitating comparisons between healthy subjects and patients with cardio-pulmonary diseases11.
Despite being widely used, the between-day reliability of the single-leg knee-extensor model using Doppler ultrasound has not been investigated on a larger scale in recent decades, with prior studies involving small populations (n = 2)3,18,19,20.
This study aimed to investigate (1) the within-day test-retest reliability, (2) the between-day test-retest reliability, and (3) the inter-rater reliability of Doppler ultrasound for LBF evaluation during single-leg knee-extensor exercise at 0 W, 6 W, 12 W, and 18 W. The measurements were conducted in a clinically realistic scenario where the probe was removed between measurements. It is important to note that several intrinsic and extrinsic environmental factors known to influence LBF were not controlled during the measurements, which could introduce variability and affect reliability. Considering advancements in Doppler ultrasound technology and blood flow analysis software, we hypothesized that, even in an uncontrolled setting, acceptable within- and between-day reliability of LBF measurements could be achieved at all intensities when performed by the same sonographer.

作者聚焦：评估多普勒超声测量腿部血流的可靠性 

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

This method is widely recognized and applied in numerous clinical and research settings. The primary objective of this study was to assist the reproducibility of the method, thereby providing valuable insights into the measurement error. By doing so, we can say what is genuine physiological change and what is due to measurement error.Ultimately, this will enhance our understanding of this method. The primary obstacle lies in exploring physiological changes during various activities in everyday life, as conducting such investigation is feasible only under specific experimental setups. t has been over two decades since the last reliability study was conducted during single leg knee extensor exercise.Over this period, technology has significantly evolved, making it imperative to revisit this research area to gain valuable insight into the measurement era associated with the current method. Doppler ultrasound is non-invasive compared to other blood flow determination methods like Thermodilution, and it can be combined with arterial and venous catheterization if necessary. It also enables beat to beat blood flow velocity measurements so we could detect rapid changes.In the future, our main goal is to investigate the regulation of blood flow to contracting skeletal muscle in patients with chronic obstructive pulmonary disease.

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...

Watch this Scientific Journal Video about Assessing the Reliability of Doppler Ultrasound in Measuring Leg Blood Flow at JoVE.com

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。

Doppler ultrasound has revolutionized the assessment of organ blood flow and is widely used in research and clinical settings. While Doppler ...

这种方法在众多临床和研究环境中得到广泛认可和应用。本研究的主要目的是帮助提高方法的可重复性，从而为测量误差提供有价值的见解。通过这样做，我们可以说出什么是真正的生理变化，什么是由于测量误差引起的。最终，这将增强我们对这种方法的理解。主要障碍在于探索日常生活中各种活动期间的生理变化，因为只有在特定的实验设置下才能进行此类研究。自上一次可靠性研究是在单腿膝伸肌锻炼期间进行以来，已经过去了二十多年。在此期间，技术发生了重大变化，因此必须重新审视这一研究领域，以获得对与当前方法相关的测量时代的宝贵见解。与热稀释等其他血流测定方法相比，多普勒超声是非侵入性的，必要时可以与动脉和静脉导管插入术结合使用。它还能够进行心跳到心跳的血流速度测量，因此我们可以检测到快速变化。未来，我们的主要目标是研究慢性阻塞性肺疾病患者骨骼肌收缩的血流调节。

doppler-ultrasound-based-leg-blood-flow-assessment-during-single-leg

Research

JoVE Journal

Medicine

Doppler Ultrasound-Based Leg Blood Flow Assessment During Single-Leg Knee-Extensor Exercise in an Uncontrolled Setting

1.5K 次观看.  Copenhagen University Hospital. 这种方法在众多临床和研究环境中得到广泛认可和应用。本研究的主要目的是帮助提高方法的可重复性，从而为测量误差提供有价值的见解。通过这样做，我们可以说出什么是真正的生理变化，什么是由于测量误差引起的。最终，这将增强我们对这种方法的理解。主要障碍在于探索日常生活中各种活动期间的生理变化，因为只有在特定的实验设置下才能进行此类研究。?...

视频: 作者聚焦：评估多普勒超声测量腿部血流的可靠性 

Doppler ultrasound has revolutionized the assessment of organ blood flow and is widely used in research and clinical settings. While Doppler ultrasound-based assessment of contracting leg muscle blood flow is common in human studies, the reliability of this method requires further investigation. Therefore, this study aimed to investigate the within-day test-retest, between-day test-retest, and inter-rater reliability of Doppler ultrasound for assessing leg blood flow during rest and graded single-leg knee-extensions (0 W, 6 W, 12 W, and 18 W), with the ultrasound probe being removed between measurements. The study included thirty healthy subjects (age: 33 &#177; 9.3, male/female: 14/16) who visited the laboratory on two different experimental days separated by 10 days. The study did not control for major confounders such as nutritional state, time of day, or hormonal status. Across different exercise intensities, the results demonstrated high within-day reliability with a coefficient of variation (CV) ranging from 4.0% to 4.3%, acceptable between-day reliability with a CV ranging from 10.1% to 20.2%, and inter-rater reliability with a CV ranging from 17.9% to 26.8%. Therefore, in a real-life clinical scenario where controlling various environmental factors is challenging, Doppler ultrasound can be used to determine leg blood flow during submaximal single-leg knee-extensor exercise with high within-day reliability and acceptable between-day reliability when performed by the same sonographer.

This test-retest study evaluated leg blood flow measured by the Doppler ultrasound technique during single-leg knee-extensor exercise. The within-day, between-day, and inter-rater reliability of the method was investigated. The approach demonstrated high within-day and acceptable between-day reliability. However, the inter-rater reliability was unacceptably low during rest and at low workloads.

科研

医学

Single-Leg Knee-Extensor Chair Setup and Ultrasound Apparatus Configuration for Leg Blood Flow Assessment

To begin, position the participant in the single leg knee extensor chair with their back resting against the chair. Place a chair or bench to stabilize the inactive leg. To ensure the electrodes are equidistant from the heart, fix one ECG electrode on the right side of the chest wall in the third intercostal space.Place the second one on the left side in the third intercostal space. Then place the third one on the left side in the 11th intercostal space. After electrode placement, position the participant at an angle greater than 90 degrees between the abdomen and thigh.Adjust the arm connecting the single knee extensor chair to the flywheel. This enables the participant to extend the knee fully. Tie the leg tightly to the pedal of the chair to avoid the usage of muscles in the lower part of the limb.Next, press the turn on button on the ultrasound apparatus. Press patient to create a new file for the examination. Move the cursor to new patient and press enter.Then fill out the patient ID.Move the cursor to create and press enter. Connect the lead to the electrodes. Press probe and choose the linear probe.Apply ultrasound gel to the probe.

用于腿部血流评估的单腿膝伸椅设置和超声设备配置

Doppler Ultrasound Scan and Blood Flow Quantitation in Leg-Extension Exercises

To begin, place the probe on the inguinal region of the participant then find the optimal arterial section for leg blood flow or LBF measurements. Make a cross-sectional image of the common femoral artery. Turn the Gain button clockwise to increase gain and counterclockwise to decrease gain.Turn the Depth button clockwise to increase the depth and counterclockwise to decrease it. After adjustment, ensure that the artery is in the middle of the screen and the blood is black. In 2D mode, press Freeze once then scroll using the track ball to find an end-systolic image.Press Measure once and move the cursor to the superficial intimal layer of the artery then press Enter. Next, move the cursor to the deep intimal layer of the artery and press Enter to obtain the diameter at end-systole. Press Freeze then turn the probe 90 degrees clockwise while keeping the artery centered on the screen and probe parallel to the artery to create a longitudinal view.Press the PW button, followed by the Measure button. Move the cursor to auto and press Enter then click Flow Volume and press Enter. Move the cursor to Live and press Enter to obtain the trace and finish by pressing Measure once.To obtain the velocity at an insonation angle of less than 60 degrees. Turn the Steer Angle button clockwise to decrease it and counterclockwise to increase it. Turn the Angle Correction button to validate the trace captured with the cursor horizontal to the artery.Press Sample Volume to adjust the volume according to the width of the artery while avoiding contact with the artery wall. To decrease the sample size, press the left arrow and increase by pressing the right arrow. Next, turn the Sound button clockwise then obtain the blood flow velocity trace with simultaneous 2D visualization of the artery and audiovisual blood velocity feedback.Obtain the first trace during seated rest for 30 seconds, and press Image Store twice to save the trace. Then, instruct the participant to maintain a pace of 60 RPM during the test. Using the same conditions, record the trace data at a pace of 60 RPM and zero watts.Add resistance to the single leg knee extensor chair. Then, ask the participant to complete a minimum of 150 seconds of exercise before obtaining 30 seconds of trace. Press Image Store twice to save the trace.Once all the images are obtained, press Review, press track ball and move the cursor to the desired image then double click on Enter. Once the desired trace appears, press Measure. Then, from the dropdown menu, select Flow Volume and press Enter.Next, select 2D Ultrasound Image and press Enter. Then drag the cursor until it reaches the diameter measured during rest and press Enter again. Turn the Cursor Select button clockwise twice.Then, by scrolling the track ball and pressing Enter, choose a 30-second trace between two vertical lines. There were no statistically significant differences in the absolute LBF values between the Within Day or Between Day measurements. LBF increased progressively across the incremental workloads.The value ranges from 0.36 liter per minute at rest to 2.44 liter per minute during exercise at 18 watts. Bland Altman Plots of LBF measurements for Within Day reliability showed no outliers. In contrast, a few outliers were observed in the Between Day measurements, and several outliers were observed during the Interrater measurements.In test/retest reliability, the smallest real difference values were lower for Within Day measurements compared to the Between Day and Interrater measurements. Similarly, the coefficient of variation values were higher in the Between Day and Interrater measurements compared to the Within Day measurements. The intraclass correlation coefficient values showed that the reliability at all workloads during Within Day and Between Day were higher than 0.90.Conversely, the Interrater measurements yielded ICC values as low as 0.41.