实时三维超声造影评估兔闭合性肾外伤活动性出血  

Real-time Three-dimensional Contrast-enhanced Ultrasound for Evaluation of Blunt Renal Trauma Hemorrhage: a Rabbit Experiment

作　　者：付刚 许瑞雪[2] 李婷[2] 周群芳[2] 梁艳 熊跃毅 李叶阔[2] 

机构地区：[1]武警河北总队医院介入科,河北石家庄050081 [2]广州军区广州总医院超声科,广东广州510010 [3]武警云南总队医院特检科,云南昆明650111

出　　处：《中国医学影像学杂志》2013年第10期733-736,共4页Chinese Journal of Medical Imaging

基　　金：全军医学科研"十二五"计划课题项目(CWS12J076);广东省科技计划项目(2011B080701019;2012B031800309)

摘　　要：目的探讨实时三维超声造影(RT3D-CEUS)评估闭合性肾外伤活动性出血的价值。材料与方法 9只健康新西兰兔随机平均分为3组,全身肝素化后,采用自制小型撞击器分别以77.2 N(A组)、106.2 N(B组)、135.1 N(C组)3种力度撞击,制作闭合性肾外伤活动性出血模型。撞击前后20 min内分别行灰阶超声(US)、彩色多普勒血流显像(CDFI)和RT3D-CEUS检查,以RT3D-CEUS所含的A平面为二维超声造影(2D-CEUS)进行比较。动物血压降至40 mmHg以下时,处死实验兔,进行病理检查。将US、CDFI、2D-CEUS、RT3D-CEUS检查结果与病理结果进行对照。结果 9只兔肾均发生损伤,损伤级别随撞击力增加而加重,A组1例为Ⅰ级;2例为Ⅱ级;B组3例均为Ⅲ级;C组1例为Ⅲ级,2例为Ⅳ级。US见伤肾包膜下出现无回声,量逐渐增多,但无法直接显示肾活动性出血的部位和范围。CDFI见1例肾活动性出血。2D-CEUS清晰地显示了实验兔伤肾的活动性出血信号。RT3D-CEUS实时、立体、逼真地显示了实验兔伤肾的活动性出血,其分布范围越广,进入休克状态的时间越短。结论 RT3D-CEUS可以实时、立体、逼真地显示闭合性肾外伤活动性出血,并可以根据出血信号分布的范围初步判断出血的严重程度。Purpose To investigate the value of real-time three-dimensional contrast- enhanced ultrasound （RT3D-CEUS） for the evaluation of blunt renal trauma hemorrhage. Materials and Methods Nine healthy New Zealand white rabbits were randomly divided into three groups, and after heparinization, the models of ongoing hemorrhage of blunt renal trauma were developed by self-made minitype striker in the three groups with different force levels： 77.2 N （group A）, 106.2 N （group B）, 135.1 N （group C）. All rabbits were performed ultrasonography （US）, color Doppler flow imaging （CDFI） and RT3D- CEUS before and after strike （within 20 minutes）. The results achieved by US, CDFI, 2D-CEUS （A-plane results in RT3D-CEUS） and RT3D-CEUS were compared with each other, and further compared with the pathological results of the execuied animals alter blood pressure decreased lower than 40 mmHg. Results All rabbits showed traumatic renal lesions and it proved that the bigger the force the heavier the injury （group A： 1 case of level Ⅰ, 2 cases of level Ⅱ ; group B： 3 cases of level Ⅲ; group C： 1 case of level Ⅲ, 2 cases of level Ⅳ）. After strike, US identified the presence of increasing hematoma under the capsule but could not detect active bleeding. In CDFI, only 1 case was detected ongoing hemorrhage. 2D-CEUS clearly presented the bleeding in all cases. RT3D-CEUS presented a vivid real-time and stereoscopical image of active hemorrhage in all cases and also showed that the wider the bleeding area was shorter than the shock duration time. Conclusion RT3D-CEUS can present a real-time dynamic bleeding and locate headstream of blood in renal trauma vividly and stereoscopically, and can be used to preliminarily evaluate the degree of ongoing hemorrhage in traumatic kidney.

关 键 词：肾疾病 创伤和损伤 出血 超声检查 多普勒 彩色 成像 三维 造影剂 疾病模型 动物 兔 

分 类 号：R-33[医药卫生] R445.1