超声造影评价兔失血性休克复苏早期肾血流灌注及与肾功能的相关性

Evaluation of Renal Blood Perfusion in Early Resuscitation of Rabbit Model of Hemorrhagic Shock by Contrast-enhanced Ultrasonography and the Correlation with Renal Function

目的应用超声造影(Contrast-enhanced Ultrasound,CEUS)技术定量分析失血性休克(Hemorrhagic Shock,HS)复苏早期肾血流灌注的变化。方法将32只健康实验兔随机分为4组,随机选择1组为正常对照组,其余3组按照Wiggers改良法建立HS模型,选择1组为休克组,其余2组根据复苏时间的不同分为复苏2 h组、复苏6 h组;建立模型后行CEUS检查,观察肾皮质血流灌注情况,获取时间-强度曲线,对比各组峰值强度幅度(A)、达峰时间(Time to Peak,TTP)、曲线下面积(Area Under the Curve,AUC)、曲线上升支斜率(Gradient Between Start Frame to Peak Frame,Grad),并分析上述参数与肾功能及病理结果的相关性。结果与正常对照组比较,休克组TTP延长,A、AUC、Grad降低,差异有统计学意义(P<0.05),成功建立HS模型,肌酐(Creatinine,Cr)及尿素氮(Blood Urea Nitrogen,BUN)升高,提示肾功能受损。复苏2 h组A、AUC增加,Grad升高,TTP减少,BUN、Cr稍降低,与休克组比较差异有统计学意义(P<0.05),提示液体复苏后各参数逐渐恢复;但是与正常对照组比较,TTP、Grad、BUN、Cr仍有统计学意义(P<0.05);复苏6 h组与休克组比较,所有参数均有统计学差异(P<0.05),与正常对照组比较参数差异不显著,且AUC与实验室指标BUN、Cr的相关性最高,与病理结果相符。结论CEUS可定量分析失血性休克复苏早期肾皮质血流灌注改变,其中AUC可作为一项敏感指标,与肾功能指标相关性较好,可作为一种无创性的监测方法。

Objective To quantitatively analyze the changes in renal blood perfusion during early resuscitation of hemorrhagic shock(HS)by contrast-enhanced ultrasound(CEUS).Methods Thirty-two healthy experimental rabbits were randomly divided into 4 groups,1 group was randomly selected as the normal control group,the other three groups were used to establish the HS model according to the Wiggers modified method,of them,1 group was used as the shock group,the remaining 2 groups were divided into 2 h resuscitation group and 6 h resuscitation group according to the different resuscitation time.CEUS was used to observe the rabbits’renal perfusion and the perfusion parameters were recorded including amplitude of peak intensity(A),time to peak(TTP),area under the curve(AUC)and gradient between start frame to peak frame(Grad).The correlation between the above parameters and renal function and pathological results was analyzed.Results Compared with the normal control group,the TTP of the shock group had prolonged,the A,AUC and Grad decreased,the differences were statistically significant(P<0.05),the HS model was successfully established;Creatinine(Cr)and blood urea nitrogen(BUN)increased,which suggested that kidney function was impaired.In the 2 h resuscitation group,the A,AUC and Grad increased;TTP,BUN and Cr decreased slightly compared with the shock group,the difference was statistically significant(P<0.05),which indicated that the parameters gradually recovered after fluid resuscitation.However,compared with the normal control group,TTP,Grad,BUN and Cr were still statistically different(P<0.05).Compared the 6 h resuscitation group with the shock group,all parameters were statistically different(P<0.05),compared with the normal control group,the parameters were not significantly different,and the correlation between AUC and laboratory indicators(BUN and Cr)was the highest,which was consistent with the pathological results.Conclusion CEUS can quantitatively analyze the changes in renal cortex blood perfusion in the early stage of resuscitation from HS.AUC can be used as a sensitive indicator and has a good correlation with renal function indicators.CEUS can be used as a non-invasive monitoring method.