微泡增强的超声空化治疗肝创伤出血  

Microbubble-enhanced non-focused ultrasound treatment of posttraumatic liver hemorrhage

作　　者：田猛[1] 赵大威[1] 毕洁[1] 杜鹏[1] 何佳颖[1] 李陶[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所超声科,重庆400042

出　　处：《中华创伤杂志》2016年第7期650-654,共5页Chinese Journal of Trauma

基　　金：国家自然科学基金（81271586）;重庆市自然科学基金（CSTC2012jjB10034）

摘　　要：目的观察微泡增强的超声空化对肝创伤出血的治疗效果。方法20只健康新西兰大白兔建立肝创伤出血模型，按随机数值表法分为对照组、单纯微泡组（微泡组）、超声微泡组（超微组）、肝素化超声微泡组（肝素化超微组），每组5只。检测各组凝血酶时间（啊）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）等凝血指标，以及血栓弹力图的凝血反应时间（R值）和反应血凝块力学强度（A值）。通过测量治疗前、后出血面积评价各组止血效果。取肝脏组织行HE染色，观察各组组织学病理改变。结果肝素化超微组的TT[（25．8±11．3）s]、APTT[（58．7±18．7）s]均较其他组明显延长（P〈0．05）。与对照组比较，其余三组的FIB均较低，但差异无统计学意义（P〉0．05）。各组胛比较差异均无统计学意义（P〉0．05）。肝素化超微组R值[（78．3±5．1）min]和A值[（0．13±0．05）mm]与其余三组比较差异均有统计学意义（P〈0．05），其余三组内比较差异均无统计学意义（P〉0．05）。超微组和肝素化超微组治疗后出血面积分别为（0．8．4-0．7）cm^2、（2．2±1．3）cm^2，较对照组[（5．7±0．6）cm^2]和微泡组[（5．3±0．6）cm^2]显著缩小（P〈0．05），且肝素化超微组较超微组增加更明显（P〈0．05）。HE染色显示，超微组和肝素化超微组肝细胞明显水肿并压迫肝窦、汇管区血管和中央静脉，血管内有明显血液瘀滞。结论微泡增强的超声空化能够对肝创伤出血起到有效的止血作用。Objective To investigate the effect of microbubble-enhanced non-focused ultrasound on posttraumatic liver hemorrhage. Methods Twenty healthy New Zealand white rabbits with posttraumatic liver hemorrhage were divided into control group, microbubble group, ultrasound with microbubble group, and heparin with ultrasound and microbubble group according to the random number table, with five rabbits per group. Thrombin time （TT）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （FIB）, and coagulation reaction time （R value） and mechanical strength （A value ） of the thrombelastogram were detected. Pre- and post- treatment bleeding were measured to evaluate the hemostatic effect. Liver specimens were harvested to perform histopathological study with HE staining. Results TT [ （ 25.8 ± 11.3 ） s ] and APIT [ （58.7 ± 18.7 ） s ] in heparin with ultrasound and microbubble group showed significant prolongation compared with other three groups （ P 〈 0. 05 ）. Control group showed higher FIB than other three groups, but the differences were insignificant （ P 〉 0.05 ）. PT did not differ significantly among groups （ P 〉 0.05 ）. R value [ （ 78.3 ± 5.1 ） rain ] and A value [ （ 0.13 ± 0.05 ） mini in heparin with ultrasound and microbubble group differed significantly from these in other three groups （ P 〈 0.05 ）, and there were no significant differences between other three groups （ P 〉 0.05 ）. After treatment, bleeding area in heparin with ultrasound and microbubble group [ （2.2 ± 1.3 ） cm^2 ] was increased when compared to ultrasound with microbubble group [ （0.8 ± 0.7 ） cm^2 ] （ P 〈 0.05 ）, but both were lower than that in control group [ （5.7 ± 0.6） cm^2 ] and microbubble group [ （5.3 ± 0.6） cm^2 ] （ P 〈 0.05）. HE staining showed significant hepatic cell edema in ultrasound with microbubble group and heparin with ultrasound and microbubble group that compressed hepatic sinus, blood vessels in the p

关 键 词：肝 止血 超声处理 

分 类 号：R657.3[医药卫生—外科学]