超声造影评价失血性休克液体复苏肾血流灌注的实验研究

发布时间：2018-01-10 10:28

  本文关键词：超声造影评价失血性休克液体复苏肾血流灌注的实验研究　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 超声造影 定量分析 失血性休克 复苏 血流灌注

【摘要】：研究背景失血性休克(hemorrhogic shock,HS)是一种临床常见的急危重症,若不及时处理,可导致多器官功能障碍综合症,甚至死亡。复苏指南中提出关键是改善组织微循环血流灌注、维持良好的氧供。而在一些监测指标(如血压、心率)正常的情况下,仍可存在潜在的微循环灌注不足,且无法准确地反映某一器官的微循环情况。因此,早期有效的监测器官血流动力学变化,有利于指导治疗方案,改善病人的预后。超声造影(contrast-enhanced ultrasound,CEUS)因其安全性好、重复性高、实时和灵活等优点得到广泛应用,目前CEUS定量分析肾脏的微循环灌注技术已广泛应用于肾移植、肾慢性疾病及肿瘤性疾病的监测中,其对失血性休克液体复苏评估肾血流灌注具有潜在临床价值,但相关研究鲜有报道。目的通过动物实验探讨CEUS技术评估失血性休克液体复苏肾血流灌注的价值。材料与方法第一章:40只实验兔随机平均分为5组,随机选1组为正常对照组(T1组),余采用Wiggers改良法建立HS模型,随机选1组为休克组(T2组),其余按复苏时间分为复苏2h组(T3组)、复苏6h组(T4组)、复苏24h组(T5组),观察并记录如下各项指标:1、记录心电监护仪上MAP、HR、SaO2等基本生理指标;2、灰阶超声测量肾脏各径线,计算肾体积同时观察肾内结构及回声强度;3、彩色多普勒超声(CDFI)检测肾血管血流充盈状态;频谱多普勒(PW)检测各级肾动脉Vmax、Vmin及RI;4、行超声造影及定量分析各参数(曲线下面积(AUC)、达峰时间(TTP)、峰值强度(A)、上升支斜率(Grad)),并与病理结果相比较。第二章:24只实验兔随机平均分为3组,随机选择1组为正常对照组(N组),另两组建立非控制性失血性休克模型,再随机分为积极性液体复苏组(FR组)和限制性液体复苏组(HFR组),按设定的液体复苏方案治疗,在实验Omin、30min、90min、180min及6h监测以下指标:1、正常状态下的基础指标包括体重、MAP;2、两个液体复苏组的失血量及输液量;3、肾功能(BUN、Cr)、乳酸(LAC)含量及氧自由基检测(SOD、MDA);4、CEUS检查及定量分析各参数,并与细胞凋亡情况对比分析。结果第一章:1、各组实验兔基础指标均衡,具有可比性。T2组MAP、SaO2水平降低,HR、RR加快,差异有明显统计学意义(P0.01),表明失血性休克模型建立成功。复苏后上述指标逐渐恢复。2、复苏组体积稍增大,但各组差异均无统计学意义(P＞0.05)。3、CDFI示T2组各级肾动脉血流较前减少,亮度暗淡,复苏后肾动脉及分支恢复清晰明亮;PW示液体复苏后,肾各级血管Vmax及Vmin上升,RI降低。4、与T2组比较,T5组参数均有统计学差异(P0.05);与T3、T4组比较,T5组Grad有统计学差异(P0.05)。病理结果显示复苏组肾小管上皮细胞肿胀、血管充血减轻,病理改变逐渐得到恢复。第二章:1、各组兔基础体重及MAP均衡,具有可比性。2、FR组失血量及输液量均高于HFR组,输液量差异有统计学意义(P0.05);3、SOD持续降低,MDA持续升高,90minBUN、Cr、LAC后开始降低,HFR组恢复较好,6h时两复苏组差异有统计学意义(P0.05)。4、复苏后各液体复苏组A、AUC及Grad升高,TTP降低,两液体复苏组比较,90min时A、AUC、TTP有统计学差异(P0.05),180min时A值有统计学差异(P0.05),6h时各参数比较差异均有统计学意义(P0.05)。结论第一章:CEUS能监测控制性失血性休克复苏期肾微循环灌注的变化,认为Grad、AUC可作为敏感指标;第二章:1、限制性输液复苏与积极性液体复苏相比,可较好的改善肾血流灌注、减少氧自由基对细胞的损伤、改善肾功能、降低血乳酸浓度;2、BUN、Cr及LAC的变化与CEUS参数比较有明显延迟的现象,认为BUN、Cr及LAC在失血性休克及复苏早期对肾功能损害的反应不够敏感;3、CEUS技术能监测非控制性失血性休克液体复苏肾微循环灌注的变化,可为临床提高一种实时、无创监测肾血流灌注的新工具。但要分析肾血流灌注参数与时间的相关性,有待积累更多动物实验及临床经验。
[Abstract]:The research background of hemorrhagic shock (hemorrhogic shock HS) is a common clinical emergency, if untreated, can lead to multiple organ dysfunction syndrome, and even death. The recovery guide proposed in the key is to improve the microcirculation perfusion, maintain good oxygen supply. In some monitoring indicators (such as blood pressure, heart rate) under normal conditions, can exist microcirculation potential deficiencies, and can not accurately reflect the situation of an organ microcirculation. Therefore, effective monitoring organ hemodynamic changes in early, to guide treatment, improve the prognosis of patients with contrast-enhanced ultrasound. (contrast-enhanced ultrasound, CEUS) because of its good safety and repeatability high, real-time and flexible is widely used at present, CEUS quantitative analysis of renal microcirculation perfusion technique has been widely used in kidney transplantation, chronic kidney disease and tumor diseases The monitoring, which has potential clinical value in hemorrhagic shock resuscitation in evaluation of renal blood perfusion, but the related research is rarely reported. Through animal experimental evaluation of hemorrhagic shock and resuscitation of renal perfusion and explore the value of CEUS technology. Materials and methods: the first chapter of 40 experimental rabbits were randomly divided into 5 groups, randomly selected the 1 group was normal control group (group T1), more than HS model was established by modified Wiggers method, 1 groups were randomly selected for shock group (T2 group), the rest of the press recovery time is divided into recovery 2H group (T3 group), 6h group (group T4) recovery, recovery 24h group (group T5), and observe the record the following indicators: 1, recorded on the ECG monitor MAP, HR, SaO2 and other basic physiological indexes; 2, ultrasound measurement of kidney gray scale of the diameter, volume and observe the structure and calculation of kidney echo intensity in kidney; 3, color Doppler ultrasound (CDFI) detection of renal blood flow filling tube; Doppler spectrum (PW) the detection 绾ц偩鍔ㄨ剦Vmax,Vmin鍙奟I;4,琛岃秴澹伴，

本文编号：1404928