超声造影引导经皮注射治疗严重脾破裂出血  

Percutaneous injection of hemostatic agents under the guidance of contrast enhanced ultrasonography for stopping hemorrhage from severe splenic rupture

作　　者：吕发勤[1] 唐杰[1] 张惠琴[1] 李文秀[1] 罗渝昆[1] 汪伟[1] 黎檀实[2] 

机构地区：[1]解放军总医院超声科,北京100853 [2]解放军总医院急诊科,北京100853

出　　处：《中华超声影像学杂志》2008年第7期598-600,共3页Chinese Journal of Ultrasonography

基　　金：全军医药卫生科研基金资助（06G108）

摘　　要：目的探讨超声造影（CEUS）引导下经皮注射治疗脾外伤出血的临床价值。方法8例脾外伤患者，损伤程度为Ⅲ-Ⅳ级。在CEUS引导下经皮病灶局部注射蛇毒凝血酶、α-氰基丙烯酸酯黏合胶。注射后1d、3d、7d及14d进行超声复查。记录生命体征及血红蛋白（Hb）量的变化。结果局部注射后即刻CEUS显示无活动性出血。治疗30min后生命体征逐渐平稳。动脉收缩压上升（P〈0．05），增快的心率逐渐恢复至正常（P〈0．05）；而治疗后Hb测值先降低后逐渐升至正常。结论在CEUS引导下，蛇毒凝血酶与α-氰基丙烯酸酯联合局部注射治疗严重脾破裂出血，止血效果明确、可靠。用CEUS既可以对脾外伤的疑诊患者进行诊断，又可以评价疗效。Objective To evaluate percutaneous injection of hemostatic agents under the guidance of contrast-enhanced sonography（CEUS） in controlling hemorrhage from severe splenic trauma. Methods Eight patients with splenic traumas of grade Ⅲ, Ⅵ were consecutively enrolled in this study. Percutaneous injection of hemocoagulase atrox and α- cyanoacrylate was performed by CEUS-guidance in all patients. Ultrasound examination was performed at 1,3,7 and 14 days after focal injection. Vital signs and hemoglobin （Hb） level were recorded. Results After the injection, immediate CEUS demonstrated that active bleeding from the injury sites disappeared. From 30 minutes after the injection arterial blood pressure began to ascend （ P 〈0.05）,and heart rate decreased to the normal level after the treatment （ P 〈0.05）. Hb decreased at first and then gradually increased to the normal level. Conclusions Percutaneous injection of hemocoagulase atrox and α- cyanoacrylate under the guidance of CEUS can effectively control bleeding from a severe splenic trauma. CEUS can be helpful to the diagnosis of the suspected splenic trauma and to ensure hemostatic materials to be injected exactly into injury sites.

关 键 词：超声检查 微气泡 脾破裂 止血剂 

分 类 号：R686[医药卫生—骨科学]