核素示踪显像和护理监测家兔断肢再植术后血供的对比研究

Comparative Study of Na^(99m)TcO_4 Trace Imaging and Clinical Nursing Method on Observation of Blood Supply in Replanted Limb of Rabbits

目的:比较Na99mTcO4示踪显像(TTI)和临床护理方法(CNM)监测家兔断肢再植术后动脉血供的效能。方法:(1)40只健康成年家兔施行后肢断肢再植术后随机分为A、B两组。A组(n=25)术后20 min在伤口局部冷敷(<50℃)10 min后制备成血管危象(VC)动物模型,B组(n=15)局部热敷(40~45℃);C组为5只正常对照家兔。3组均由耳缘静脉注射Na99mTcO474 MBq 2min后行SPECT静态显像,计算并分析再植部分和正常肢对应部分的放射性摄取比值(T/NT)。根据术肢放射性聚集程度将显像结果分为0级(T/NT<0.25)、Ⅰ级(T/NT=0.25~0.65)和Ⅱ级(T/NT>0.65),将0级作为再植术后VC的定性和半定量诊断标准。(2)核医学医师和护理监测小组双盲判断术肢是否并发VC。(3)对TTI为0级的家兔进行手术探查,对TTI为Ⅰ、Ⅱ级的家兔随访7d。结果:(1)27只TTI为0级的家兔中有22只再植血管血栓形成,5只血管痉挛;18只Ⅰ、Ⅱ级家兔中有1只再植肢坏死,17只再植肢愈合良好。(2)A、B、C组TTI判断为VC者分别为25、2和0只,CNM判断为VC者分别为11、0、0只。TTI诊断VC的灵敏度(96.4%)明显高于CNM(39.3%)(P<0.01)。结论:TTI较CNM更能直观而准确地反映再植末端的血供状况,能早期无创性地监测断肢(指)再植术后VC的发生。

Objective： To compare the clinical effect of Na^99m TcO4 trace imaging （TTI） and clinical nursing method（CNM）on observation of blood supply in replanted limb of rabbits. Methods：（1） 40 healthy adult rabbits with replanted limb were divided into groups A（25 rabbits） and B（15 rabbits）. The vascular crisis（VC） model was established by localy frezzing（（5℃） for 10 minutes in group A, while localy warming was given in group B （40-45 ℃）. Static images were performed on each of rabbits in groups A, B and C （5 normal rabbits）, respectively. The radionuclide uptake of replanted limb/normal limb ratio（T/NT） was analyzed using region of interest analysis. O, Ⅰ and Ⅱ scales were classified according to their radionuclide distribution and T/NT （〈0.25, 0. 25-0. 65, 〉0. 65, respectively）. （2）The VC in 45 rabbits was evaluated double blindly by nuclear＂ doctors and assessing nurses. （3）The explorative operation was performed on each of replanted limbs with Oscales, other limbs were followed up 7 days. Results： （1）22 eases were confirmed with embolism among 27 eases of Oscales,5 with vascular stress. One replanted limb of other rabbits was confirmed with necrosis among 18 eases of Ⅰ and Ⅱ scales, 17 good healing. （2）25,2,0 eases in groups A,B and C were confirmed with VC by TTI, 11,0,0 eases by CNM. The sensitivity（96. 4%） in diagnosing VC by TTI was more higher than CNM（39. 3%） （X^2=20.9,P〈0.01）. Conclusion：The blood supply of rabbits with replanted limb could be reported more accurately and directly by TTI than CNM. TTI could play an important role in early and notraumatic diagnosing VC in patients with replanted finger or limb.