超声造影定量评估失血性休克肝微循环灌注的实验研究

Quantitative Evaluation of Hepatic Microcirculation Perfusion in Hemorrhagic Shock by Contrast-enhanced Ultrasound

目的研究超声造影(CEUS)定量分析技术评估急性失血性休克(HS)肝微循环灌注的价值,探讨CEUS定量分析对HS诊断及治疗的意义。材料与方法选择60只健康成年新西兰大耳白兔,雌雄不限,按完全随机法平均分为3组,分别建立轻、中、重度HS模型。建模前及建模稳定30 min分别行肝CEUS检查,并储存原始图像。CEUS结束后采血检测乳酸、肝功能,并取肝组织行病理检查。脱机分析到达时间(AT)、达峰时间(TTP)、上升时间(RT)、峰值强度(PI)、曲线下面积(AUC)。结果与建模前比较,轻度HS组AUC降低,差异有统计学意义(P<0.05);与建模前比较,中、重度HS组TTP、RT均延迟,PI、AUC均降低,差异有统计学意义(P<0.05);轻、中、重度HS各组间TTP、RT、PI、AUC差异有统计学意义(P<0.05);与建模前比较,重度HS模型组AT延迟,差异有统计学意义(P<0.05);与建模前比较,各组乳酸均显著升高,肝功能指标均发生不同程度的改变,肝细胞病理改变程度与HS病变程度密切相关。结论 CEUS可定量评估不同程度HS引发的肝微循环灌注改变。

Purpose To study the value of contrast-enhanced ultrasound （CEUS） quantitative technique in evaluating the perfusion of hepatic microcirculation in acute hemorrhagic shock （HS）, and to investigate the value of CEUS quantitative analysis in HS diagnosis and treatment. Materials and Methods Sixty healthy adult New Zealand white rabbits of either gender were randomly divided into three groups for establishing mild, moderate and severe HS models, respectively. Before modeling and 30 min after stable modeling, liver CEUS examination was performed, and the original images were stored. Blood test of lactic acid, liver function, and liver biopsy for pathological examination were conducted after CEUS. Finally, the arrival time （AT）, time to peak （TTP）, rising time （RT）, peak intensity （PI） and area under the curve （AUC） were analyzed offline. Results Compared with pre-modeling, AUC decreased in mild HS group （P〈0.05）; TTP and RT were delayed, but PI and AUC decreased in moderate and severe HS groups （all P〈0.05）; AT was delayed in severe HS group （P〈0.05）. The differences ofTTP, RT, PI and AUC between the groups of mild, moderate and severe HS were significant （P〈0.05）. Compared with pre-modeling, lactic acid in three HS groups increased significantly, the liver function indexes were changed to different degrees, and the degree of liver cell pathological changes was closely related to the degree of HS. Conclusion CEUS can quantitatively evaluate the changes of hepatic microcirculation induced by HS at different degrees.