不同峰值负压脉冲超声联合微泡对脾创伤止血的作用研究

Efficacy of different peak negative pressure pulse ultrasounds combined with microvesicles on splenic trauma hemostasis

目的对比不同峰值负压超声联合微泡对脾创伤的止血效果。方法将15只家犬开腹建立脾创伤模型后,随机分为3组,治疗前记录各组10 s出血速率,然后经股静脉推注等量微泡后,分别以高(4785 k Pa)、中(3439 k Pa)、低(1785 k Pa)峰值负压脉冲超声辐照6 min,分别记录各组治疗后10 min总出血量。结果治疗前各组出血速率无统计学差异(P>0.05);治疗后,各组10 min总出血量均有统计学差异(P<0.01),其中高峰值负压组最少,中峰值负压组次之,低峰值负压组最多。治疗后,超声造影显示低峰值负压组治疗区造影浅表局部有充盈缺损,大部分辐照区仍有造影剂充填;中峰值负压组可见辐照区大部充盈缺损,局部可见零星造影剂灌注;高峰值负压组可见治疗区基本无造影剂充填,呈充盈缺损。结论高峰值负压脉冲超声联合微泡治疗脾出血更加快速、彻底。

Objective To compare the efficacy of different peak negative pressure pulse ultrasounds combined with microvesicles on splenic trauma hemostasis. Methods A total of 15 dogs with splenic trauma model established by abdomen surgery were randomly divided to three groups. The 10-second bleeding rate in each group was recorded before the treatment. The three groups were given equivalent microvesicles by intravenous bolus injection and received ultrasound wave irradiation at high, medium and low peak negative pressure pulses of 4785 kPa, 3439 kPa and 1785 kPa respectively for six minutes. The total amount of bleeding in each group 10 minutes after the treatment was recorded respectively, Results There was no difference in bleeding rate among the three groups before the treatment （P 〉 0.05）, but significant difference was found among the three groups in the total amount of bleeding 10 minutes after the treatment （P 〈 0.01）, the least in the high peak negative pressure group, followed by the medium peak negative pressure group, and the most in the low peak negative pressure group. After the treatment, CEUS showed that there was local filling defect on the radiography surface of low peak negative pressure group treatment area; there still was contrast agent filling in most irradiated site. Large filling defect was found in the irradiated site in the medium peak negative pressure group, with sporadic contrast agent perfusion locally found. There was basically no contrast agent filling in the treatment area in the high peak negative pressure group, showing filling defect. Conclusions High peak negative pressure pulse uhrasounds combined with microvesicles can stop splenorrhagia more rapidly and thoroughly.