책소개
뇌혈관질환 및 심혈관질환은 한국에서도 사망원인으로 높은 순위를 차지하고 있는 중요한 질환이며 그 원인 중 가장 흔한 것은 죽상동맥경화증입니다. 이러한 죽상동맥경화증을 조기에 발견하고 치료하여 심각한 뇌혈관질환 및 심혈관질환을 예방하려는 노력이 계속되고 있습니다.

경동맥 초음파는 죽상 동맥경화증의 유무 및 정도를 간단히 알 수 있는 좋은 검사로서 앞으로 더욱 많이 사용될 것으로 생각됩니다. 한국에서도 서구식 식습관과 고령화로 인하여 동맥경화증이 늘고 있고 경동맥 초음파 검사에 대한 수요도 따라서 늘고 있습니다. 그러나 경동맥 초음파를 제대로 배울 수 있는 여건은 제한되어 있습니다.

목차

I . 기초

1. 경부 혈관계 해부학 ························2

경동맥 초음파 검사 순서 ······················ 4

경동맥 초음파 검사를 통한 접근 ····················5

2. 검사법 ······························6

(1) Probe를 잡는 방법 ·······················6

● 와위(누운 자세)에서의 검사법 ··················7

(2) 총경동맥 찾기 ·························8

(3) 내경동맥 찾기 ·························9

(4) 추골동맥 찾기 ·························10

● 좌위(앉은 자세)에서의 검사법 ·················11

(5) 총경동맥 찾기 ·························11

(6) 내경동맥 찾기 ·························12

(7) 추골동맥 찾기 ·························13

3. 경동맥 초음파 검사의 포인트 ··················14

(1) 내경동맥과 외경동맥의 구별 ···················17

● 해부학적 특징에 따른 구별 ···················17

● 혈류속도 파형에 따른 구별 ···················18

(2) 추골동맥 찾기 ·························20

4. 측정법과 유의점 ························22

(1) IMT 측정 ··························· 22

(2)혈관지름측정 ························· 26

(3) pulsed Doppler 측정 및 유의점 ················28

◆ MEMO-pulsed Doppler법에 따른 2가지 평균 유속 ·······31

(4) 내경정맥과의 비교 ·······················32

◆ MEMO-혈관저항에 따른 도플러 파형 변화 ···········33

5. Plaque의 기본 ·························34

(1) Plaque의 정의 ························34

(2) 표면 형태에 따른 분류 ·····················35

(3) 에코에 따른 분류 ·······················36

(4) 성상과 초음파상 ························39

(5) 궤양 병변과 그 분류 ······················ 41

(6) 기재 방법에서 풀어야 할 과제 ·················43

◆ MEMO-오해하기 쉬운 경동맥 초음파로 얻은 경동맥 협착률 ····44

II . 표준화 기준치

1. 총경동맥 ····························46

(1)혈관지름과박동폭 ······················· 46

(2)혈류속도 ···························48

(3)혈류량 ····························52

2. 내외경동맥 ···························56

(1)혈관지름 ···························56

(2)혈류속도···························· 57

(3)혈류량 ····························60

3. 추골동맥 ····························61

(1)혈관지름···························· 61

(2)혈류속도 ···························63

(3)혈류량 ····························68

III . 경동맥 질환

1. IMT 비후 ····························72

(1) IMC와 IMT ·························· 72

(2) IMT 정상치와 연령 증가에 따른 변화 ··············74

(3) IMT 측정 부위························· 76

(4) mean-IMT, max-IMT·····················78

2. Plaque ····························81

(1) Plaque란? ·························· 82

(2) Plaque의 형태 ························83

(3) Plaque 분류와 초음파 소견 ··················85

(4) Plaque의 정량화 ·······················88

(5) 협착 부위 측정법························ 91

IV . 질환과의 상관관계

1. 경동맥 초음파를 통해알수있는것 ··············96

2. 전신 동맥경화증의 지표가 되는 것 ···············97

3. 동맥경화증 유발 인자 ······················99

(1) 연령 증가 ··························99

(2) 성별차 ···························100

(3) 고혈압 ···························100

(4) 당뇨병 ···························101

(5) 고지혈증 ··························102

(6) 흡연 ····························102

(7) 알코올 ···························103

(8) 비만 ····························104

(9) 염증반응 및 감염증 ·····················105

(10) 기타 ····························106

4. 위험인자 및 동맥경화성 질환과 각종 변수와의 관계 ······107

5. 동맥경화성 질환 예측 ·····················109

V. 고도의 측정법과 사례

1. 혈관지름과 용적탄성률 ·····················115

(1) 용적탄성률의 정의······················· 115

(2) 혈관지름 측정과 용적탄성률의 산출 ···············117

2. 동맥경직도 측정과 의의 ····················118

(1) 원리적 사고·························· 118

(2) 측정법과 실측 예 ·······················120

(3) 건강한 성인의 예 ·······················122

3. 혈관벽 두께 변화 ························124

4. wave intensity: WI ·····················126

5. 말초순환 임피던스 ·······················129

VI. 치료 기술과의 관계

1. 치료의 영향 ··························136

(1) 고지혈증 ···························136

(2) 고혈압 ····························137

(3) 호르몬 보충요법 ·······················137

2. 재현성 ·····························138

3. 수술 전 검사로서 경동맥 초음파 ················140

4. 뇌혈관 장애와의 관련성 ····················142

(1) 경동맥 협착과 뇌경색 ·····················142

(2) 협착률 측정법과 정밀도 ····················143

(3) 뇌혈관 장애 병형과 각종 변수와의 관계············· 148

(4) Plaque 성상과의 관계 ····················149

참고 자료

경동맥 초음파를 활용한 동맥경화성 병변 평가의 주요 가이드라인

● 경동맥 초음파 측정 가이드라인 ·················154

● 경동맥 초음파 Doppler 정상 수치 ···············154

● B모드 소견과 병리조직과의 비교 ················ 155

● 혈류속도 평가 ·························155

찾아보기 ·····························156