家兔急性肺损伤胸部超声与病理的相关性  

Correlation of Chest Ultrasound and Pathology in Rabbits with Acute Lung Injury

作　　者：闫丹丹[1] 张丹[1] 李燕东[1] 张岚[1] 孟焱[1] 翟林[1] 邢锦[1] 

机构地区：[1]首都医科大学附属复兴医院超声影像科,北京100038

出　　处：《中国医学影像学杂志》2015年第9期645-648,653,共5页Chinese Journal of Medical Imaging

摘　　要：目的急性肺损伤/急性呼吸窘迫综合征是一种临床常见危重症,本文探讨家兔急性肺损伤胸部弥漫性彗星尾征的病理基础及其对提示病理改变的价值。材料与方法将家兔双侧前胸壁分为上、下肺区,共4区;留取6只家兔每个肺区的正常胸部声像图。按0.1 ml/kg油酸注入后开始计时,动态观察每个肺区的彗星尾征并存储图像,直至1 h结束。按超声评分标准对胸部超声声像图表现进行评分;评估每个肺区的病理损伤程度,并分析与超声结果的相关性。结果 6只家兔全部成功复制急性肺损伤胸部弥漫性彗星尾征动物模型。油酸型动物模型胸部弥漫性彗星尾征的病理改变主要为弥漫性肺水肿、淤血及淤血性出血,4例可见坏死;肺水肿、淤血及淤血性出血的面积百分比自上而下呈逐渐增加的趋势,以双膈叶为著;胸部彗星尾征超声评分与病理损伤程度呈正相关(r=0.819,P<0.05)。结论急性肺损伤胸部弥漫性彗星尾征的组织学改变为肺水肿、淤血及淤血性出血;超声声像图显示的弥漫性彗星尾征的范围和密度,可以提示肺实质内损伤程度,对指导治疗及预后有重要意义。Purpose Acute lung injury/acute respiratory distress syndrome is a common severe disease,this paper aims to explore the pathological basis of diffuse comet-tail artifacts in rabbits with acute lung injury and evaluate the imaging value on pathological changes. Materials and Methods The bilateral anterior chest walls of the rabbits were divided into four zones,namely,left upper zone,right upper zone,left lower zone and right lower zone. The normal chest ultrasound images of the 6 rabbits were obtained. After oleic acid（0.1 ml/kg） was injected,the images of comet-tail artifact in the four lung zones were dynamically observed and stored for 1 hour. The chest ultrasound images were evaluated according to the ultrasound scores. The degree of pathological damage in each lung zone was assessed and analyzed in terms of the correlation with the ultrasound results. Results The animal model of acute lung injury with diffuse comet-tail artifacts was successfully made in all of the 6 rabbits. The main pathological changes of the animal model of oleic acid were diffuse pulmonary edema,congestion and congestive hemorrhage; necrosis was found in 4 rabbits. The area of pulmonary edema,congestion,and congestive hemorrhage increased gradually from top to bottom,and double diaphragm leaves were typical. A significant correlation was found between the ultrasound scores of comet-tail artifacts and the degrees of pathological damage（r=0.819,P〈0.05）. Conclusion The histological changes of chest diffuse comet-tail artifacts due to acute lung injury are pulmonary edema,congestion and congestive hemorrhage. The scope and density of diffuse comet-tail artifacts may indicate the degree of pulmonary parenchyma injury,which is important as reference to guide the treatment and prognosis.

关 键 词：呼吸窘迫综合征 成人 超声检查 多普勒 彩色 病理学 临床 疾病模型 动物 兔 

分 类 号：R-33[医药卫生] R445.1