本文關鍵詞：超聲造影評價失血性休克液體復蘇腎血流灌注的實驗研究　出處：《南方醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 超聲造影 定量分析 失血性休克 復蘇 血流灌注

【摘要】：研究背景失血性休克(hemorrhogic shock,HS)是一種臨床常見的急危重癥,若不及時處理,可導致多器官功能障礙綜合癥,甚至死亡。復蘇指南中提出關鍵是改善組織微循環(huán)血流灌注、維持良好的氧供。而在一些監(jiān)測指標(如血壓、心率)正常的情況下,仍可存在潛在的微循環(huán)灌注不足,且無法準確地反映某一器官的微循環(huán)情況。因此,早期有效的監(jiān)測器官血流動力學變化,有利于指導治療方案,改善病人的預后。超聲造影(contrast-enhanced ultrasound,CEUS)因其安全性好、重復性高、實時和靈活等優(yōu)點得到廣泛應用,目前CEUS定量分析腎臟的微循環(huán)灌注技術已廣泛應用于腎移植、腎慢性疾病及腫瘤性疾病的監(jiān)測中,其對失血性休克液體復蘇評估腎血流灌注具有潛在臨床價值,但相關研究鮮有報道。目的通過動物實驗探討CEUS技術評估失血性休克液體復蘇腎血流灌注的價值。材料與方法第一章:40只實驗兔隨機平均分為5組,隨機選1組為正常對照組(T1組),余采用Wiggers改良法建立HS模型,隨機選1組為休克組(T2組),其余按復蘇時間分為復蘇2h組(T3組)、復蘇6h組(T4組)、復蘇24h組(T5組),觀察并記錄如下各項指標:1、記錄心電監(jiān)護儀上MAP、HR、SaO2等基本生理指標;2、灰階超聲測量腎臟各徑線,計算腎體積同時觀察腎內結構及回聲強度;3、彩色多普勒超聲(CDFI)檢測腎血管血流充盈狀態(tài);頻譜多普勒(PW)檢測各級腎動脈Vmax、Vmin及RI;4、行超聲造影及定量分析各參數(shù)(曲線下面積(AUC)、達峰時間(TTP)、峰值強度(A)、上升支斜率(Grad)),并與病理結果相比較。第二章:24只實驗兔隨機平均分為3組,隨機選擇1組為正常對照組(N組),另兩組建立非控制性失血性休克模型,再隨機分為積極性液體復蘇組(FR組)和限制性液體復蘇組(HFR組),按設定的液體復蘇方案治療,在實驗Omin、30min、90min、180min及6h監(jiān)測以下指標:1、正常狀態(tài)下的基礎指標包括體重、MAP;2、兩個液體復蘇組的失血量及輸液量;3、腎功能(BUN、Cr)、乳酸(LAC)含量及氧自由基檢測(SOD、MDA);4、CEUS檢查及定量分析各參數(shù),并與細胞凋亡情況對比分析。結果第一章:1、各組實驗兔基礎指標均衡,具有可比性。T2組MAP、SaO2水平降低,HR、RR加快,差異有明顯統(tǒng)計學意義(P0.01),表明失血性休克模型建立成功。復蘇后上述指標逐漸恢復。2、復蘇組體積稍增大,但各組差異均無統(tǒng)計學意義(P＞0.05)。3、CDFI示T2組各級腎動脈血流較前減少,亮度暗淡,復蘇后腎動脈及分支恢復清晰明亮;PW示液體復蘇后,腎各級血管Vmax及Vmin上升,RI降低。4、與T2組比較,T5組參數(shù)均有統(tǒng)計學差異(P0.05);與T3、T4組比較,T5組Grad有統(tǒng)計學差異(P0.05)。病理結果顯示復蘇組腎小管上皮細胞腫脹、血管充血減輕,病理改變逐漸得到恢復。第二章:1、各組兔基礎體重及MAP均衡,具有可比性。2、FR組失血量及輸液量均高于HFR組,輸液量差異有統(tǒng)計學意義(P0.05);3、SOD持續(xù)降低,MDA持續(xù)升高,90minBUN、Cr、LAC后開始降低,HFR組恢復較好,6h時兩復蘇組差異有統(tǒng)計學意義(P0.05)。4、復蘇后各液體復蘇組A、AUC及Grad升高,TTP降低,兩液體復蘇組比較,90min時A、AUC、TTP有統(tǒng)計學差異(P0.05),180min時A值有統(tǒng)計學差異(P0.05),6h時各參數(shù)比較差異均有統(tǒng)計學意義(P0.05)。結論第一章:CEUS能監(jiān)測控制性失血性休克復蘇期腎微循環(huán)灌注的變化,認為Grad、AUC可作為敏感指標;第二章:1、限制性輸液復蘇與積極性液體復蘇相比,可較好的改善腎血流灌注、減少氧自由基對細胞的損傷、改善腎功能、降低血乳酸濃度;2、BUN、Cr及LAC的變化與CEUS參數(shù)比較有明顯延遲的現(xiàn)象,認為BUN、Cr及LAC在失血性休克及復蘇早期對腎功能損害的反應不夠敏感;3、CEUS技術能監(jiān)測非控制性失血性休克液體復蘇腎微循環(huán)灌注的變化,可為臨床提高一種實時、無創(chuàng)監(jiān)測腎血流灌注的新工具。但要分析腎血流灌注參數(shù)與時間的相關性,有待積累更多動物實驗及臨床經驗。
[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 綰ц偩鍔ㄨ剦Vmax,Vmin鍙奟I;4,琛岃秴澹伴，

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