超声造影对肢体肌肉挤压伤诊断价值的实验研究

Value of contrast-enhanced ultrasound on assessment of limb muscle crush injury： an animal experiment

目的探讨定量超声造影对肢体肌肉挤压伤的检测价值。方法选取120只健康新西兰兔，随机分为对照组8只、左后肢挤压2h组56只和挤压4h组56只，对两实验组在解压后0．5h、2h、6h、24h、3d、7d、14d及对照组行超声造影检测，应用QLAB软件定量分析峰值强度（PI）、曲线下面积（Auc）、升支斜率（As）、降支斜率（DS）4个造影参数，并与生化及病理检测结果进行比较分析。结果实验组损伤骨骼肌超声造影与对照组相比有显著差异，表现为早期快速增强，时间强度曲线为速升缓降型，在4个造影参数中，各组间PI与AUC在各个时间点差异均有显著统计学意义（P〈0．01），且挤压4h组PI及AUC明显高于挤压2h组（P〈0．01），AS和DS在实验组与对照组间差异有显著统计学意义（P〈0．01），但在实验组各时间点间无明显差异（P〉0．05），PI、AUC与肌酸肌酶、乳酸脱氢酶、丙二醛、髓过氧化物酶相关性好（P〈0．01）。各参数在解压后第6、24h达峰值，在解压后第7、14d逐步恢复到正常范围。结论超声造影可有效检测肢体肌肉挤压伤并监测损伤的动态变化，PI、AUC诊断价值较大。超声造影可能在各种自然及人为灾害造成的肌肉挤压伤的现场及院前诊断中发挥重要作用。

Objective To explore the diagnostic value of quantitative contrast-enhanced ultrasonography（CEUS） for crush injury in the hind limb muscle of rabbits. Methods A totle of 120 New Zealand white rabbits were randomized to receive compression on the left hind limb for either 2 h（ n = 56） or 4 h（ n = 56） to induce muscle crush injury,another 8 animals were not injured and served as normal controls. CEUS parameters such as peak intensity（PI）, area under eurve（AUC）, ascending slop （AS） and descending slop（DS） were measured at 0.5 h,2 h,6 h,24 h,3 d,7 d, 14 d after decompression. Results Compared with the uninjured muscle,reperfusion of the injured muscles showed early and high enhancement in CEUS. The time-intensity curve showed a trend of rapid lift and gradual drop. The PI and AUC values differed significantly among the three groups and were positively correlated with serum and tissue biomarkers. Rabbits of the 4 h compression group showed significantly higher PI and AUC values compared with the 2 h compression group at each time points. Conclusions CEUS can effectively detect muscle crush injury and monitor dynamic changes of the injured muscle in rabbits.PI and AUC are promising diagnostic parameters for this disease. CEUS might play an important role in the pre-hospital and bedside settings for the diagnosis of muscle crush injury.