微泡增强的超声空化对脾创伤的止血作用  

Haemostatic Effects of Micro-bubbles Enhanced Ultrasound on Splenic Trauma

作　　者：钟渝[1] 区文财[2] 封建立[1] 柳建华[2] 刘政[3] 

机构地区：[1]解放军第324医院肾内科,重庆400020 [2]广州医学院附属广州市第一人民医院功能检查科,广东广州510180 [3]第三军医大学新桥医院超声科,重庆400037

出　　处：《中国医学影像学杂志》2016年第6期407-409,413,共4页Chinese Journal of Medical Imaging

基　　金：成都军区医学科学技术研究计划项目(C14022);重庆市基础与前沿计划项目(cstc2013jcy A0913)

摘　　要：目的超声空化治疗犬脾破裂出血效果较差,本研究拟探讨采用改进声学参数的超声联合微泡实现快速脾创伤止血的可行性。材料与方法 15只家犬随机分为超声微泡组、单纯超声组和假照组,每组5只。所有实验动物均开腹暴露脾区行超声造影,建立脾切割伤模型,测量初始出血速度后立即开始治疗,超声微泡组经股静脉推注微泡联合超声辐照,单纯超声组以生理盐水代替微泡,假照组为超声假照。治疗后记录各组实验动物10 min总出血量,再次行超声造影并行病理学检查。结果15只实验动物均成功建立脾切割伤模型。治疗前各组实验动物出血速度比较,差异无统计学意义(P>0.05)。治疗后超声微泡组实验动物脾切口干燥,无渗血,出血速度显著低于单纯超声组和微泡组,差异有统计学意义(P<0.01)。超声微泡组造影示辐照脾区几乎无造影剂灌注,充盈缺损明显;单纯超声组、超声微泡组血流灌注良好,未见明显充盈缺损;病理见超声微泡组脾窦扩张充血、出血,血小板聚集及血栓形成,单纯超声组、超声微泡组脾窦大小均匀,脾索结构清楚、排列整齐。结论优化参数的超声空化有效实现了犬脾破裂止血。Purpose Previous studies find that ultrasound cavitation was not complete and efficient to be applied to dogs＇ spleen rupture hemorrhage. This study aims to explore the haemostatic effects of micro-bubble enhanced the optimized acoustic parameters of ultrasound on dogs＇ splenic trauma. Materials and Methods Fifteen dogs with spleen trauma were randomly assigned to sham group（n=5）, microbubble-enhanced ultrasound（MB＋US） group（n=5） and the ultrasound（US） group（n=5）. Contrast enhanced ultrasonography was performed on every dog before and after treatment to quantify spleens blood perfusion. Pathological examination was performed immediately after treatment on three randomly selected dogs in every group. Results There was no difference in initial bleeding rate before treatment（P〈0.05）. After treatment, the bleeding scores and the 10-min haemorrhagic volumes dropped significantly in the US＋MB group compared to those in the controls（P〈0.01）. A non-enhanced or perfusion defect region was formed within the treated area in the US＋MB group while no filling defect was found in the US group and the sham group. The histological results showed splenic sinus hyperemia, platelet aggregation and intravascular thrombosis in the US＋MB group; splenic cords＇ size was arranged closely in the US group and the sham group. Conclusion Micro-bubbles enhanced ultrasound after adjusting parameter is an effective hemostasis for spleen rupture hemorrhage on dogs.

关 键 词：脾疾病 创伤和损伤 超声疗法 造影剂 止血 病理学 外科 疾病模型 动物 狗 

分 类 号：R33[医药卫生—人体生理学] R445.1[医药卫生—基础医学]