超声造影定量分析失血性休克液体复苏肝血流灌注变化的实验研究

发布时间：2018-04-27 23:55

本文选题：休克 + 复苏　；参考：《南方医科大学》2017年硕士论文

【摘要】：研究背景:失血性休克是以全身微循环血流量急剧锐减、细胞普遍缺氧和重要器官遭受损害为特征的一种病理过程,是临床常见的急危重症。失血性休克进而引发的内脏多器官功能不全是临床上导致死亡的重要原因。失血性休克时机体代偿机制启动,导致内脏多器官发生血流动力学异常,首先保证心、脑等器官灌注,肝脏受肝动脉及门静脉双重血供,休克时血流量减少显著。失血性休克的治疗要点是及时、有效地进行液体复苏,而其治愈效果还直接与治疗过程采用的监测手段和监测指标有紧密关系。超声造影可以评价组织内部血流灌注情况,在休克时组织灌注监测中具有重大的应用价值。本文拟建立兔失血性休克模型,并进行液体复苏,探讨超声造影定量分析技术在监测兔失血性休克液体复苏肝血流灌注中的应用价值。目的:探讨超声造影在定量监测失血性休克液体复苏肝实质血流灌注变化中的价值。材料与方法一实验材料GE Logiq-E9超声诊断仪,配备低机械指数超声造影模式及TIC-Analysis软件,9L-D探头,频率6-9MHz,动物心电监护仪,超声造影剂SonoVue,3%戊巴摘要比妥钠,肝素钠,乳酸钠林格注射液,羟乙基淀粉注射液。二实验方法实验一:采用Wiggers改良法建立兔HS模型,采用胶体液(羟乙基淀粉)对动物模型进行复苏,无复苏和复苏1h、4h、24h后行常规肝超声造影(CEUS)检查。CEUS结束后采血检测乳酸、ALT、AST,并取肝组织行病理检查。同时对超声造影的时间-强度曲线进行分析。实验二:采用Wiggers改良法建立兔HS模型,采用晶体液(乳酸钠林格注射液)对动物模型进行复苏,无复苏和复苏1h、4h、24 h后行常规肝超声造影(CEUS)检查。CEUS结束后采血检测乳酸、ALT、AST,并取肝组织行病理检查。同时对超声造影的时间-强度曲线进行分析。结果实验一:与正常对照组比较,休克组AT、TTP明显延长,PI、AUC减低(P0.05);胶体液复苏1 h组PI、AUC增加,AT减低(P0.05);与休克组比较,胶体液复苏1 h组PI、AUC增加,AT减低(P0.05);胶体液复苏4 h组、24 h组,各参数均有统计学意义(P0.05)。与正常对照组比较,休克组ALT、AST、LAC升高(P0.05);复苏1h组、4h组,AST、LAC(P0.05)。与休克组比较,复苏1h组AST(P0.05),正常对照组和复苏各组LAC(P0.05)。实验二:与正常对照组比较,休克组AT、TTP明显延长,PI、AUC减低(P0.05);复苏1 h组PI、AUC增加,AT减低(P0.05);与休克组比较,复苏1 h组PI、AUC增加,AT减低(P0.05);复苏4 h组、24 h组,各参数均有统计学意义(P0.05)。与正常对照组比较,休克组ALT、LAC升高(P0.05);复苏1h组、4 h组,ALT、AST、LAC(P0.05)。与休克组比较,复苏1h组ALT、AST升高(P0.05),复苏4h组AST(P0.05),正常对照组和复苏各组LAC(P0.05)。结论CEUS可定量评价失血性休克液体复苏肝实质血流灌注的改变,对临床治疗具有一定的参考价值。
[Abstract]:Background: hemorrhagic shock is a pathological process characterized by rapid decrease of systemic microcirculation blood flow, cell hypoxia and damage to important organs. The multiple organ insufficiency caused by hemorrhagic shock is an important cause of death. During hemorrhagic shock, the compensatory mechanism is initiated, which leads to the abnormal hemodynamics of multiple visceral organs. Firstly, the perfusion of the heart and brain organs, the hepatic artery and portal vein blood supply to the liver are ensured, and the blood flow decreases significantly during shock. The main point of the treatment of hemorrhagic shock is to carry out fluid resuscitation in time and effectively, and its curative effect is closely related to the monitoring method and monitoring index used in the course of treatment. Contrast-enhanced echocardiography (CEUs) can evaluate the blood flow perfusion in tissues, and has great application value in monitoring tissue perfusion during shock. A rabbit model of hemorrhagic shock was established and fluid resuscitation was carried out. The value of quantitative analysis of contrast-enhanced ultrasound in monitoring the hepatic blood perfusion of hemorrhagic shock fluid resuscitation in rabbits was discussed. Objective: to evaluate the value of contrast-enhanced ultrasonography in quantitative monitoring of hepatic parenchyma perfusion in hemorrhagic shock fluid resuscitation. Materials and methods one experimental material, GE Logiq-E9 ultrasound diagnostic instrument, was equipped with low mechanical index contrast-enhanced mode and TIC-Analysis software 9L-D probe, frequency 6-9MHz, animal ECG monitor, sonoVue3% pentobar Abstract sodium, heparin sodium, sodium lactate Ringer injection. Hydroxyethyl starch injection. Two experimental methods: the model of rabbit HS was established by Wiggers improved method, and the animal model was resuscitated by colloid solution (hydroxyethyl starch). After no resuscitation and resuscitation for 1 h and 4 h and 24 h after resuscitation, routine hepatic contrast echocardiography (CEUSS) was performed. Blood samples were collected after CEUs to detect lactic acid (alt) AST, and liver tissues were taken for pathological examination. At the same time, the time-intensity curve of contrast-enhanced ultrasound was analyzed. Experiment 2: the rabbit model of HS was established by Wiggers improved method, and the animal model was resuscitated by crystal solution (sodium lactate Ringer injection). No resuscitation and resuscitation were performed 24 hours after 1 hour of resuscitation. The blood samples were collected after CEUs and the liver tissues were taken for pathological examination. At the same time, the time-intensity curve of contrast-enhanced ultrasound was analyzed. Results: compared with the normal control group, the ATI TTP of shock group was significantly longer than that of the normal control group, the AUC of the shock group was significantly longer than that of the control group, the P0. 05% of the AUC of the colloid fluid resuscitation group increased after 1 h of colloid fluid resuscitation, and that of the 1 hour group of the colloid fluid resuscitation group increased the level of P0. 05% in the 1 hour group, and that of the 4 h group of colloid fluid resuscitation was 24 h. All the parameters were statistically significant (P 0.05). Compared with the normal control group, the alt of the shock group was higher than that of the control group (P 0.05), and that of the resuscitation group was 4 h after resuscitation. Compared with shock group, ASTX P0.05 in resuscitation group was compared with that in normal control group and resuscitation group. Experiment 2: compared with the normal control group, the ATI TTP of shock group was significantly longer than that of the normal control group (P 0.05); in the 1 hour resuscitation group, the AUC increased and the AT decreased P 0.05; compared with the shock group, the AUC increased at 1 h after resuscitation and decreased the level of AT P 0.05; in the 24 h group after 4 h resuscitation, the parameters were significantly higher than that in the 4 h group (P 0.05). Compared with the normal control group, the level of alt in the shock group was higher than that in the control group, and that in the resuscitation group was 4 h after resuscitation. Compared with the shock group, the alt of the resuscitation group increased P0.05A, the ASTV-P0.05 of the resuscitation group was higher than that of the resuscitation group, and the normal control group and the resuscitation group were treated with LACU P0.05a. Conclusion CEUS can quantitatively evaluate the changes of hepatic parenchyma perfusion in hemorrhagic shock fluid resuscitation.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R459.7

【参考文献】