超声造影对早期骨骼肌缺血再灌注后肌肉活力的评价
发布时间：2018-01-24 08:37
本文关键词： 超声造影 骨骼肌 缺血再灌注 肌肉活力 出处：《川北医学院》2017年硕士论文 论文类型：学位论文
【摘要】：目的:探讨超声造影(Contrast-enhanced Ultrasound,CEUS)参数在兔下肢骨骼肌缺血后再灌注4小时内不同时间点的变化特点。方法:新西兰大白兔22只,全身麻醉后,通过耳缘静脉抽血两毫升并维持该静脉通道。随机选择一侧下肢备皮,对该小腿后外侧中上1/3横截面最大处行超声造影检查;在检查部位腓骨侧皮下1cm处行穿刺活检。用橡胶圈5个同时捆绑于膝关节水平,5 H后解除捆扎的橡胶圈;于再灌注即刻、1H、2 H各时间点按上述方法依次行耳缘静脉采血、超声造影、组织病理穿刺检查;当复灌4 H时,静脉采血、造影后,处死实验对象,并立即在双侧小腿中上分后外侧分离各层组织结构。观察对比两侧肌组织解剖结构的改变,按Scully提出的“4C”标准(Colour、Capacity of blood、Contractibility、Consistency)判断骨骼肌损伤最重区域(比目鱼肌区)有无肌肉活力的丧失,分为有肌肉活力、无肌肉活力两组。最后取上述组织块行组织病理H-E染色,结果主要以肌细胞大小、肌间隙宽度、炎细胞的浸润程度为标准进行判读。所有血液样本经离心后测定血浆中CK、LDH含量。超声造影结果经脱机分析得到相关参数指标。结果:1.超声造影:(1)组间比较:无肌肉活力组,缺血再灌注即刻API明显小于有肌肉活力组(3.85±1.51d B对7.66±2.95d B),差异有统计学意义(P0.05);之后各时间点API呈逐步降低,并均有前者小于后者趋势。但两组在始增时间(arrive time,AT)、达峰时间(time to peak,TTP)、峰值强度(peak intensity,PI)、升支斜率(ascending slope,AS)、降支斜率(descending slope,DS)、降支减半时间(half time of descending,HT)、曲线下面积(area under the curve,AUC)、50%清除率(washing-out50%slope)方面比较,差异无统计学意义(均P0.05)。(2)组内比较:(1)有肌肉活力组在缺血再灌注2 H时AT、TTP均明显长于造模前,分别为13.80±3.53s、21.97±4.26s对10.87±3.66s、16.61±3.60s,差异有统计学意义(均P0.05),在再灌注2 H时AT较再灌注即刻也明显延长(13.80±3.53 s对10.53±3.77 s),差异有统计学意义(P=0.004)。该组内与造模前相比各时间点API均显著减小,差异有统计学意义(均P0.05);缺血再灌注4H时与再灌注即刻相比,API明显降低(5.00±2.79 d B对7.66±2.95d B),差异有统计学意义(P=0.001)。与造模前比较,复灌4H时,PI也明显降低(10.74±4.25d B对14.98±5.22d B),差异有统计学意义(P=0.004)。(2)无肌肉活力组缺血再灌注即刻与造模前相比,AT明显延长(14.63±3.25s对12.46±2.43s),差异有统计学意义(P=0.002),再灌注4H时PI较造模前明显降低(9.76±3.78 d B对13.32±3.06 d B),差异有统计学意义(P=0.003)。2.血浆酶学检查结果:(1)CK在再灌注1H、2H、4H时在两组间比较,无肌肉活力组较有肌肉活力组明显升高(29172.13±10149.55 U/L对16857.10±5280.14 U/L、33450.50±9918.21对19502.70±7317.26 U/L、41212.75±12261.32对25169.10±7708.37 U/L),差异有统计学意义(均P0.05);CK在无肌肉活力组再灌注的各时间点两两比较均有统计学意义(均P0.05),且随时间延长,CK不断升高;(2)LDH在再灌注2H、4H时在两组间比较,无肌肉活力组也明显较有肌肉活力组升高(1366.45±654.96 U/L对642.09±193.80 U/L、1503.24±680.56 U/L对729.37±260.49 U/L),差异存在统计学意义(均P0.05);LDH在两组内各时间点与造模前相比,无活力组从再灌注2 H开始明显升高(1366.45±654.96 U/L对110.55±21.45 U/L),差异有统计学意义(P=0.001),而有肌肉活力组从再灌注即刻就明显上升(463.49±160.48U/L对163.81±91.68 U/L),差异有统计学意义(P=0.001)。3.组织病理学:(1)再灌注4H,无肌肉活力组较有肌肉活力组肌原纤维间隙分离更明显,较多肌膜出现模糊不清,且中性粒细胞数目增多;(2)再灌注1H、2H组与造模前、再灌注即刻组相比,肌细胞稍肿胀,大小不一,肌间隙略增宽,肌原纤维溶解、断裂增多,部分肌细胞中出现多个圆形空泡;而再灌注4H组与再灌注1H、2H组相比,肌原纤维溶解、断裂更加突出,部分肌间隙开始出现中性粒细胞浸润;(3)但造模前组与再灌注即刻组相比,再灌注1H组与再灌注2H组相比没有观察到显著的区别。4.造影参数与酶学指标相关性分析:有肌肉活力组再灌注1 H时TTP与LDH、CK呈线性正相关,AS与LDH呈线性负相关,相关系数r为,0.66、0.74、-0.67,均P0.05。无肌肉活力组造模前AUC、再灌注1H时AS、再灌注4H时AUC与CK均呈线性正相关,相关系数r为,0.92、0.78、0.80,均P0.05。结论:超声造影参数API、PI、AT、TTP对评价早期骨骼肌缺血再灌注后肌肉活力有重要参考价值。
[Abstract]:Objective: To investigate the effects of contrast-enhanced ultrasound (Contrast-enhanced Ultrasound, CEUS) changes at different time parameters in the lower limb of rabbit skeletal muscle ischemia reperfusion after 4 hours. Methods: 22 New Zealand white rabbits, after general anesthesia through ear vein blood two ml and maintain the vein channel. One side was randomly chosen for lower limb skin. The posterior lateral leg in 1/3 cross section at the maximum underwent contrast-enhanced ultrasound examination; in parts of the fibular lateral subcutaneous 1cm biopsy. With a rubber ring 5 and tied to knee level 5 H after the lifting of the bound rubber ring; from the beginning of reperfusion, 1H, 2 H each time point according to the above method in order for the ear vein blood, contrast-enhanced ultrasound, tissue pathology biopsy; when 4 H of reperfusion, the venous blood after angiography, were the experimental object, and immediately in the bilateral calf on the posterolateral separation layers. Comparative observation on both sides of the muscle group Fabric anatomical changes, proposed by Scully 4C standard (Colour Capacity of, blood, Contractibility, Consistency) to judge the skeletal muscle injury is the most serious area (soleus muscle area) with no loss of muscle activity, divided into muscle activity, no muscle activity in two groups. Finally, the tissue for pathology H-E staining results in muscle cell size, muscle gap width, the degree of infiltration of inflammatory cells in the interpretation standard. All blood samples after centrifugation, determination of plasma CK, LDH content. The results obtained by off-line analysis of contrast-enhanced ultrasound parameters. Results: 1. ultrasound contrast: (1) between the two groups: no muscle activity group, ischemia reperfusion immediate API was significantly lower than the muscle activity group (3.85 + 7.66 + 2.95d 1.51d B on B), the difference was statistically significant (P0.05); after each time point of API was gradually decreased, and were smaller than the latter trend. But in the two groups 濮嬪鏃堕棿(arrive time,AT),杈惧嘲鏃堕棿(time to peak,TTP),宄板，
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