肢体肌肉挤压伤的超声造影成像研究  

Study of contrast enhanced ultrasound on muscle crush injury to extremity

作　　者：吕发勤[1] 唐杰[1] 罗渝昆[1] 董正南[2] 武荣[1] 田江克[1] 谢霞[1] 

机构地区：[1]解放军总医院超声科,北京100853 [2]解放军总医院生化科,北京100853

出　　处：《中华超声影像学杂志》2013年第1期71-74,共4页Chinese Journal of Ultrasonography

基　　金：全军医药卫生科研专项基金（082036）;中国博士后科学基金（20080431357,200902678）

摘　　要：目的探讨肢体挤压伤所致局部肌肉损伤的超声造影（CEUS）成像特征。方法健康新西兰白兔28只，全身麻醉（前腿肌内注射，戊巴比妥钠30mg／kg）后使用专门制作的袖带气囊（充气后产生18．6kPa的压力）加压法于兔后腿制作肌肉挤压伤动物模型。其中23只兔成功建模并存活72h以上。于解压后30rain、2h、6h、24h、72h分别进行CEUS检查，观察造影灌注模式和强度变化；使用QLAB分析软件对兔左后腿肌肉挤压区与非挤压区绘制时间-强度曲线，测定CEUS参数值，比较CEUS与血清肌酸激酶和肌红蛋白测值的相关性。结果23只建模成功的白兔左后腿挤压伤面积为60cm^2,占体表面积的2．6％～3．0％。解压后不同时间点挤压区均呈快速增强，强度高于非挤压区；以非挤压区为对照，各观察时间点挤压区的时间-强度曲线呈速升缓降型，峰值前移；各观察时间点损伤区峰值强度（PI）与非损伤区有明显差异（P〈O．001）。ROC曲线显示，PI值能够准确诊断肢体肌肉挤压区。不同时间点PI值与血清肌酸激酶和肌红蛋白变化呈正相关，相关系数为0．833～0．996。结论CEUS显示肢体挤压伤后局部肌肉的微循环灌注明显增强，佐证了解压后存在缺血再灌注损伤，且提示了超声造影可能是诊断肢体肌肉挤压伤后微循环灌注异常有价值的方法。Objective To explore imaging feature of muscle crush injury of extremity on contrast enhanced ultrasound （CEUS） by an animal experiment. Methods Twenty-eight New Zealand rabbits were anesthetized by intramuscular pentobarbital sodium （30 mg/kg）. A special balloon cuff device was used to create left hind leg crush injury with a force of （18.6 kPa）. 23 of the 28 rabbits had crush injury of extremity and survived for 72 hours. CEUS evaluated infusion model and contrast intensity in crush region of hind leg at the 0.5,2,6,24 and 72 hour after the release of the crushing pressure. Peak intensity （PI） was analyzed by comparing with serum creatinekinase （CK） and myoglobin （MYO）. Results Twenty-three rabbits presented that the area of crushed region in left hind leg was 60 cm2 ,accounting for 2.6% - 3.0% of body surface area. In different time after decompression,the crushed regions showed rapid enhancement and the intensity was higher than that of no-crushed region. The time-intensity curves of crushed regions all appeared as fast wash-in and slow wash-out. PIs of rushed regions were higher obviously than those of nocrushed regions （ P〈0. 001）. ROC curves were employed in diagnosis value of PI for crushed region. And PIs showed positive correlation with CK and MYO and the correlation coefficient was 0. 833 - 0. 996. Conclusions CEUS presents that the micro-circulation perfusion of the crushed muscle increased obviously after the release of the crush pressure. PIs evaluated quantitatively the micro-circulation perfusion changes. It suggests a potential alternative for evaluating micro-circulation abnormality and ischemia reperfusion injury of the muscle crush injury to extremities.

关 键 词：超声检查 微气泡 四肢 挤压伤 

分 类 号：R445.1[医药卫生—影像医学与核医学]