摘要
目的评价低频高能超声能量对体外血栓的溶解作用及对血管内急性血栓的疗效。方法应用ACOLYSISSYSTEMTM 超声溶栓仪 (40kHz,18W/cm2)消融20块新鲜血栓 ,显微镜下检查碎块大小 ,并与红细胞直径比较。通过导管技术对10例下肢动脉血栓患者行超声消融 ,比较手术前后栓塞相关血管 (infarction-relatedarteries,IRA)TIMI血流及下肢皮肤颜色、温度及足背动脉搏动情况。结果释放超声能量(138.5±22.2)s20块血栓肉眼观察完全溶解 ,溶解速度为(12.5±2.7)mg/s。碎片直径为(5.7±1.5)μm ,90 %小于红细胞直径 ,红细胞无损伤,呈散在分布。10例患者均有一支有大量血栓的IRA ,8例TIMI0级 ,2例为TIMI1级。经超声消融(242.3±19.01)s后 ,血栓均被溶解 ,TIMI均为3级 ,开通率为100% (10/10) ,血管内未再见有血栓影像 ,术中未见动脉痉挛、撕裂等改变。消融成功后2h内患侧下肢疼痛消失 ,皮肤颜色红润 ,皮温升高 ,足背动脉搏动恢复正常。结论低频高能超声可有效地溶解体外及血管内急性血栓 ,消融后产生的碎片不造成远端微小血管的栓塞 ,是治疗下肢动脉急性血栓的有效方法。
Objective To test if lowfrequency and high intensity ultrasound energy can dissolve thrombi in vitro and to examine the clinical feasibility of ultrasonic thrombolysis in totally occluded femoral arteries.Methods Venous blood of2ml was collected from volunteers to prepare20fresh human clots.They were exposed to lowfreˉquency and high intensity ultrasound energy(40kHz,18W/cm 2 ).The disruption rate of clots by ultrasound was examined in saline and diameter of fragments were analyzed.Low frequency and high intensity ultrasound was inˉtroduced via catheterization to treat10patients with acute femoral arterial embolization.Changes in imaging and blood flow in IRA,clinical manifestations,tissue temperatures of the skin and color of skin before and after the treatment were observed.Results20clots were completely dissolved in138.5±22.2s(dissolving speed12.5±2.7mg/s).Microscopic examination revealed that the diameter of fragments was5.7±1.5μm and90%of pieces smaller than that of red blood cells.At least one IRA with massive thrombosis was found in all the10patients with acute femoral arterial embolization.The repeated angiography at the end of ultrasonic thrombolysis showed no imˉage of thrombi again.IRA achieved grade III of TIMI blood flow in10patients(potency-recovering rate=100%).In2hours after the treatment,disappearance of chest pain,skin temperature rise were found in the10patients.Conclusions Lowfrequency and high intensity ultrasound can completely dissolve fresh thrombus in vitro and those in patients.Meanwhile,there are no serious complications in the process of dissolving.It can be used as a newapproach for treating acute peripheral arterial embolization.
