脉冲式治疗超声联合微泡对家犬脾创伤止血作用的实验研究

Haemostatic effects induced by microbubble enhanced pulsed therapeutic ultrasound on splenic trauma

目的探讨脉冲式治疗超声联合微泡对脾创伤出血的止血作用。方法14只健康家犬随机分为3组，超声微泡组（MEUS组）6只，单纯超声组（TUS组）4只，单纯微泡组（MB组）4只。开腹切割脾建立脾破裂出血模型，测量初始出血速度。静脉缓慢推注凝血酶原复合物后，MEUS组用脉冲式超声治疗仪辐照伤口，同时静脉匀速推注微泡；TUS组超声治疗时静脉推注生理盐水；MB组超声治疗仪假照的同时静脉推注微泡。治疗完毕测量出血速度，观察止血效果，并进行超声造影评价。最后进行病理检查。结果治疗前各组出血速度无显著差异。治疗后MEUS组脾脏伤口仅缓慢渗血，出血速度显著低于TUS组和MB（P〈0．05）。MEUS组造影示治疗区造影增强缺损或者低灌注，病理见脾窦扩张充血、血小板聚集，出血和血栓形成。结论脉冲式超声联合微泡可损伤脾脏微小血管，阻断局部血液循环，可应用于脾脏创伤的止血治疗。

Objective To investigate the haemostatic effect of combining pulsed therapeutic ultrasound （TILTS） and microbubble （MB） on splenic trauma. Methods Forteen healthy dogs were divided into 3 groups. Six animals were treated by microbubble enhanced therapeutic ultrasound （MEUS）, the other eight animals were treated with TUS only （ n = 4） and the MB only （ n = 4） served as the controls. The spleens of all animals were surgically exposed and a 20 mm long, 5 mm deep incision was created on the spleens using scalpel. Human prothrombin complex （HPC） was slowly injected prior to the treatment. During the procedure, the initial bleeding rate and the bleeding rate after the treatment were calculated using gauze weighing. Contrast enhanced ultrasound （CEUS） was performed to assess the blocking effects of splenic circulation. The targeted spleens were harvested for pathological examination. Results There were no differences in initial bleeding rate before treatment. After treatment,in the MEUS group oozed blood was found and the bleeding rate were lower than that of the TUS and the MB groups （ P 〈0.05）. A nonenhanced or perfusion defect region was formed within the treated area. The histological results showed splenic sinus hyperemia, platelet aggregation and intravascular thrombosis. Conclusions Microbubbles enhanced pulsed therapeutic ultrasound can arrest the regional blood circulation of spleen by disrupting the microvasculature and this can be used in splenic heamostasis for treating spleen trauma.