超声造影联合微血管成像诊断腹部实质脏器活动性出血的实验研究  

Contrast-enhanced ultrasound combined with micro-flow imaging in the diagnosis of active bleeding from abdominal parenchymal organs:a experimental study

作　　者：韩鹏 梁舒媛 朱连华 姜波[1] 费翔[1] HAN Peng;LIANG Shuyuan;ZHU Lianhua;JIANG Bo;FEI Xiang(Department of Ultrasound,General Hospital of China,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心超声科,北京市100853

出　　处：《临床超声医学杂志》2021年第9期641-645,共5页Journal of Clinical Ultrasound in Medicine

基　　金：解放军总医院新技术新业务扶持项目(XYW-202105)。

摘　　要：目的建立体外活动性出血模型,探讨超声造影联合微血管成像(以下简称联合成像)在腹部实质性脏器活动性出血诊断及其定位中的应用价值。方法采用硅胶管模拟人工血管(内径分别为0.5 mm、1.0 mm)建立两种体外活动性出血模型:①水槽模型,将人工血管游离端置入水槽内,水槽内混有造影剂用于模拟增强后脏器实质;②组织损伤模型,使用自制小型撞击器在离体猪肝选定区域建立闭合型创伤灶,将人工血管游离端置入创伤灶内,用于模拟出血在创伤组织内的表现。造影剂通过与人工血管相连的注射泵注入,设定以5 ml/h为间隔,5~100 ml/h范围内共20种流量。通过注射泵注入造影剂溶液,启动超声造影和联合成像技术观察其对两种模型活动性出血的诊断与定位情况。结果①水槽模型中,超声造影未能诊断活动性出血;联合成像诊断和定位活动性出血的准确率均为62.50%(25/40);联合成像在0.5 mm与1.0 mm内径间的诊断准确率分别为85.00%(17/20)和40.00%(8/20),差异有统计学意义(χ^(2)=8.640,P=0.03)。②组织损伤模型中,超声造影诊断和定位活动性出血的准确率分别为77.50%(31/40)、62.50%(25/40),差异有统计学意(χ^(2)=19.355,P=0.000);联合成像诊断和定位活动性出血的准确率均为90.00%(36/40),均高于超声造影单独应用,差异均有统计学意义(χ^(2)=15.309、7.407,P=0.000、0.006)。③联合成像定位水槽模型与组织损伤模型活动性出血的准确率分别为62.50%(25/40)、90.00%(36/40),差异有统计学意义(χ^(2)=7.407,P=0.006)。结论联合成像诊断活动性出血的准确率较超声造影更高,且对活动性出血定位的判断优于超声造影,为今后相关动物实验和临床研究提供了一定的理论依据。Objective To explore the value of contrast-enhanced ultrasound combined with micro-flow imaging(referred to as joint imaging)in the diagnosis of active bleeding from abdominal parenchymal organs and the location of active bleeding by establishing an externally active bleeding model.Methods Artificial blood vessels were designed by silicone tubes(diameters of 0.5 mm and 1.0 mm)to establish two in vitro active bleeding models:①The tank model,where the free end of the artificial blood vessel was placed into a water tank containing contrast agent to simulate the enhanced organ parenchyma.②The tissue damage model,where a closed traumatic wound was established by a self-made small impactor in the selected area of the isolated pig liver,and the free end of the artificial blood vessel was placed into the traumatic lesion to simulate the performance of bleeding in the traumatic tissue.The contrast agent was injected using a syringe pump connected to the artificial blood vessel,and the flow rate was selected from a total of 20 flow rates within the range of 5~100 ml/h at an interval of 5 ml/h.The contrast agent solution was injected through the syringe pump,contrast-enhanced ultrasound and joint imaging technology were activated for observation of diagnosis and location of active bleeding.Results①In the tank model,the contrast-enhanced ultrasound failed to diagnose active bleeding(0/40),and the accuracy of joint imaging in diagnosing and locating active bleeding were both 62.50%(25/40).The diagnostic accuracy of joint imaging between the 0.5 mm and 1.0 mm diameter were 85.00%(17/20)and 40.00%(8/20),respectively,and the difference was statistically significant(χ^(2)=8.640,P=0.03).②In the tissue damage model,the accuracy of contrast-enhanced ultrasound in diagnosing and locating active bleeding were 77.50%(31/40)and 62.50%(25/40),respectively,and the difference was statistically significant(χ^(2)=19.355,P=0.000).The accuracy of joint imaging in the diagnosis and location of active bleeding were both 90.00%(36/40),w

关 键 词：超声检查 造影剂 微血管成像 活动性出血 创伤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R656[医药卫生—诊断学]