院前超声在救治创伤性脑出血动物模型中的应用

Feasibility of ultrasound application in pre-hospital treatment of traumatic cerebral hemorrhage in an animal model

目的建立创伤性脑出血动物模型,探讨便携式超声在创伤性脑出血院前救治中的应用价值。方法动物实验选取雌性五指山猪6只。制备创伤性脑出血动物模型成功后行超声引导下脑室置管术,记录开颅窗所需时间,手术前后动物的瞳孔直径、肢体活动情况以及生命体征,并对其进行数据分析。结果6只实验猪均建模成功,动物出现一侧瞳孔散大,对侧肢体瘫痪,建模成功率100%。使用微型电动开颅钻打开直径1 cm的颅窗需要(2.33±0.61)min。对实验动物行超声引导下脑室置管减颅压,减压后实验动物散大的瞳孔于(8.2±4.4)min逐渐回缩,肢体活动于(2.4±0.7)h后逐渐恢复。脑室置管减压后血压收缩压为(127.00±5.66)mmHg(1 mmHg=0.133 kPa),高于减压前的(103.33±3.33)mmHg(t=4.996,P=0.004);减压前心率减慢为(75.17±4.31)次/min,减压后2 h恢复至(90.17±3.76)次/min(t=5.839,P=0.002)。结论便携式超声应用于创伤性脑出血,有助于实现快速损伤控制,从而能够为后期救治争取时间并改善预后。便携式超声引导下救治具有可行性和实用性,为临床创伤性脑出血的院前救治提供了新思路。

Objective To explore the feasibility of portable ultrasound guided pre-hospital treatment of traumatic cerebral hemorrhage through animal experiments. Methods Six female Wuzhishan pigs were used in this study. Ultrasound-guided intraventricular catheterization was performed on the animals with traumatic cerebral hemorrhage. The time of small bone window craniotomy and the changes of signs before and after operation were recorded. Results Traumatic cerebral hemorrhage was successfully in six experimental pigs, with one pupil dilated and ipsilateral limbs paralyzed. The success rate of model establishment by this method was 100%. It took(2.33±0.61) minutes to make a bone window with a diameter of 1 cm with a micro-electric craniotomy drill. After decompression by ventricular catheterization guided by portable ultrasound in the animal models, the pupillary volume of the experimental animals was gradually retracted and the limb activity was gradually restored after(2.4±0.7) h. The systolic blood pressure [(127±5.66) mmHg] was higher than that before decompression [(103.33±3.33) mmHg; t=4.996, P=0.004], and the heart rate declined to(75.17±4.31) beats/min before decompression, and increased to(90.17±3.76) beats/min 2 h later(t=5.839, P=0.002). Conclusion Ventricular catheterization guided by portable ultrasound makes it feasible to control the injury rapidly in traumatic cerebral hemorrhage so as to save time for further surgical treatment and improve the prognosis. The feasibility and practicability of this method provide a new avenue for the pre-hospital clinical treatment of patients with traumatic cerebral hemorrhage.