高空坠落冲击和水下爆炸冲击致比格犬脾损伤的超声表现和造影特点  

Ultrasonographic features and contrast-enhanced characteristics of splenic injuries caused by high-altitude falling and underwater explosion in Beagle dogs

作　　者：张世奇 许文慧 李维卿 黄彦栋 张丹枫 侯立军 刘建湖[4] 黄禾菁 ZHANG Shiqi;XU Wenhui;LI Weiqing;HUANG Yandong;ZHANG Danfeng;HOU Lijun;LIU Jianhu;HUANG Hejing(Department of Ultrasound,The Second Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200003,China;Department of Pathology,The Second Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200003,China;Department of Neurosurgery,The Second Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200003,China;China Ship Scientific Research Center,Wuxi 214082,Jiangsu,China)

机构地区：[1]海军军医大学(第二军医大学)第二附属医院超声科,上海200003 [2]海军军医大学(第二军医大学)第二附属医院病理科,上海200003 [3]海军军医大学(第二军医大学)第二附属医院神经外科,上海200003 [4]中国船舶科学研究中心,无锡214082

出　　处：《海军军医大学学报》2024年第12期1561-1568,共8页Academic Journal of Naval Medical University

基　　金：军队后勤科研计划重点项目(AWS17J003)。

摘　　要：目的研究高空坠落冲击和水下爆炸冲击致脾脏的损伤情况及其二维超声和超声造影表现。方法23只健康比格犬分入高空坠落冲击实验(13只)和水下爆炸冲击实验(10只)。利用自由落体高台装置和克级三硝基甲苯分别模拟比格犬高空坠落冲击损伤和水下爆炸冲击损伤,致伤后立刻对比格犬脾脏行超声检查,每小时复查1次,并对存活犬行超声造影检查。致伤后取死亡犬脾脏标本,观察大体损伤情况,并通过H-E染色观察组织的病理形态学改变及组织内细胞凋亡情况。结果致伤后高空坠落冲击模型6 m、7 m、8 m和9 m组分别死亡6、2、1、1只,水下爆炸冲击模型中泅渡组和蛙人组分别死亡1、4只。高空坠落冲击模型二维超声检查显示,比格犬有脾破裂(脾实质连续性中断)、脾周积液、被膜下血肿、脾内大血肿、脾静脉回声增高、脾实质回声不均匀等表现;水下爆炸冲击模型二维超声检查显示,比格犬有脾静脉回声增高、脾实质回声不均匀表现,损伤程度较高空坠落冲击模型轻。脾超声造影示2种模型造影剂灌注表现大体分为4型,出现Ⅰ型(造影剂灌注出现局部大范围缺损)、Ⅱ型(造影剂灌注弥漫性缺损)、Ⅲ型(脾静脉内未见造影剂进入)造影表现的比格犬伤后均发生脾破裂。H-E染色结果显示,比格犬脾损伤后存在真性脾破裂、脾内弥漫性出血、脾内血肿/瘀斑、被膜下血肿/瘀斑、静脉内淤血等,与超声检查结果相吻合。结论高空坠落引起的比格犬脾损伤较水下爆炸严重,常规超声诊断典型脾损伤的准确性较好,而超声造影对不典型脾损伤的评估更有优势且对于迟发性脾破裂具有一定的预判价值。Objective To study the splenic injuries caused by high-altitude falling and underwater explosion and the 2-dimensional ultrasound and contrast-enhanced ultrasound(CEUS)characteristics.Methods Twenty-three healthy Beagle dogs were divided into high-altitude falling group(n=13)and underwater explosion group(n=10).Free-fall high-platform device and gram-grade trinitrotoluene were used to simulate high-altitude falling injury and underwater explosion injury in Beagle dogs,respectively.Ultrasound examination of the spleen was performed immediately after injury,with follow-up examinations every hour.CEUS examination was performed in surviving dogs.Spleen specimens were taken from deceased dogs after injury to observe gross injuries.Pathological changes in tissue morphology and cell apoptosis were observed by hematoxylin-eosin(H-E)staining.Results In the high-altitude falling model,6,2,1,and 1 dogs died in the 6 m,7 m,8 m,and 9 m groups,respectively;in the underwater explosion model,1 and 4 dogs died in the buoyancy and frogman groups,respectively.Two-dimensional ultrasound examination of the high-altitude falling model showed spleen rupture(disruption of splenic parenchymal structure),perisplenic fluid accumulation,subcapsular hematoma,intrasplenic hematoma,increased splenic vein echo,and uneven splenic parenchymal echo.Two-dimensional ultrasound examination of the underwater explosion model showed increased splenic vein echo and uneven splenic parenchymal echo,which were less serious compared with the high-altitude falling model.CEUS results indicated 4 major contrast patterns in both models.The Beagle dogs with typeⅠ(large focal contrast defect),typeⅡ(diffuse contrast defect),or typeⅢ(no contrast agent entry into the splenic vein)contrast patterns all had splenic rupture after injury.H-E staining results showed true splenic rupture,diffuse intrasplenic hemorrhage,splenic hematoma/ecchymosis,subcapsular hematoma/ecchymosis,and venous congestion after spleen injury,which were consistent with the 2-dimensional ult

关 键 词：冲击波 水下爆炸伤 高空坠落伤 超声检查 超声造影 

分 类 号：R835[医药卫生—航空、航天与航海医学]