Objective To investigate the effect of patient positioning on the Duplex ultrasound evaluation of great saphenous vein reflux elicited by the pneumatic cuff method. Methods FFifty great saphenous veins (GSV) with relfux (relfux group) and iffteen with no prior history of venous disease (healthy group) were examined by duplex scanning in the supine, 20 degrees reverse-trendelenburg (RT-20), 40 degrees reverse-trendelenburg (RT-40) and standing position. Each GSV was assessed for relfux at three venous sites:two centimeter below the sapheno-femoral junction (SFJ), the greater saphenous vein in the mid thigh (MGV) and the greater saphenous vein in the upper calf (CGV). Pneumatic cuff compression pressure of conifned 100 mmHg (1 mmHg=0.133 kPa) was used onto the calf to elicit relfux. The incidence of positive venous relfux was calculated. The statistical differences of the peak relfux velocity and duration of relfux in four positions were analyzed. Results TThe relfux elicited in the standing position was set as the gold standard. In healthy group, there was no false positive results of relfux in supine, RT-20 and RT-40 positions. In relfux group, false negative results were found at all venous sites when limbs were examined in supine position [false negative rate:59%(19/32), 22%(11/50), 24%(12/50)]. At RT-20 and RT-40 positions, the incidence of venous relfux reached 100% at MGV and CGV, and false negative cases were only detected at SFJ [false negative rate:12%(4/32), 12%(4/32)]. The relfux time in standing, supine, RT-20 and RT-40 positions were (7.75±3.23) s, (5.27±3.66) s, (8.67±3.72) s, (8.55±3.93) s respectively. There were signiifcant differences among different positions in reflux time (F=56.9, P<0.01). In detail, no significant differences were identified between standing position and RT-20 or RT-40 position (q=1.51, 1.33 respectively, both P > 0.05), except for supine position (q=4.11, P<0.01). Peak relfux velocity in standing, supine, RT-20 and RT-40 positions were (55.26±22.24) cm/s, (22.87±12.03) cm/s, (38.46±16.30) cm/s, (45.13±19.21) cm/s respectively. There were also signiifcant differences among different positions in peak relfux velocity (F=13.7, P<0.01). Comparing the supine, RT-20 and RT-40 positions with standing position, differences of the peak relfux velocity between them were all statistically signiifcant (q=12.71, 6.59, 3.98 respectively, all P<0.01). Conclusions When GSV reflux was examined by pneumatic cuff compression, false negative rate was higher in the supine position. RT-20 and RT-40 position were effective to detect GSV relfux, espically for GSV at mid-thigh and upper calf.%目的：探讨不同体位条件对多普勒超声评估远端肢体加压法诱发大隐静脉反流的影响。方法选取存在反流的大隐静脉50条及健康志愿者大隐静脉15条，通过对大隐静脉小腿引流区施加恒定100 mmHg（1 mmHg=0.133 kPa）压力，在平卧位、整床升高20°头高脚低位、整床升高40°脚头高低位及站立位4种体位条件下，分别采集大隐静脉隐股交界下方约2 cm处、大腿中段及小腿上段大隐静脉的反流频谱，计算4种体位条件下不同节段大隐静脉的反流诱发率，分析大腿中段大隐静脉在不同体位条件下的反流时间和最高反流速度间的差异。结果统计分析时以站立位检查为标准。在入选研究的15名健康志愿者中，平卧位、20°和40°体位检查时均未出现假阳性受检者。在反流组中，平卧位检查大隐静脉不同节段时均有假阴性病例出现，假阴性率分别为59%（19/32）、22%（11/50）、24%（12/50）；20°和40°头高脚低位时，大腿中段及小腿上段大隐静脉的反流诱发率与站立位一致，诱发率均为100%（50/50），但在大隐静脉隐股交界下方约2 cm处均出现一定假阴性率，分别为12%（4/32）、12%（4/32）。反流组大腿中段大隐静脉在站立位、平卧位、20°头高脚低位、40°脚头高低位4种体位条件下反流时间分别为（7.75±3.23）s、（5.27±3.66）s、（8.67±3.72）s、（8.55±3.93）s，差异有统计学意义（F=56.9，P＜0.01）；20°及40°体位与站立位比较，差异无统计学意义（q=1.51、1.33， P均＞0.05），而平卧位与站立位在反流时间上的差异有统计学意义（q=4.11，P＜0.01）。反流组大腿中段大隐静脉在站立位、平卧位、20°头高脚低位、40°脚头高低位4种体位条件下最高反流速度分别为（55.26±22.24）cm/s、（22.87±12.03）cm/s、（38.46±16.30）cm/s、（45.13±19.21）cm/s，差异亦有统计学意义（F=13.7，P＜0.01）；平卧位、20°及40°体位条件下的最高反流速度与站立位比较，差异均有统计学意义（q=12.71、6.59、3.98，P均＜0.01）。结论采用挤压远端肢体法检查大隐静脉反流时，平卧位检查存在较高的假阴性率，不宜采用。20°和40°头高脚低位是检查大隐静脉反流的适宜体位，特别是大腿中段及小腿上段大隐静脉。
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