CAJ | 학술논문

目的探讨肢体挤压伤所致局部肌肉损伤的超声造影(CEUS)成像特征.方法健康新西兰白兔28只,全身麻醉(前腿肌内注射,戊巴比妥钠30 mg/kg)后使用专门制作的袖带气囊(充气后产生18.6 kPa的压力)加压法于兔后腿制作肌肉挤压伤动物模型.其中23只兔成功建模并存活72 h以上.于解压后30 min、2h、6h、24 h、72 h分别进行CEUS检查,观察造影灌注模式和强度变化；使用QLAB分析软件对兔左后腿肌肉挤压区与非挤压区绘制时间-强度曲线,测定CEUS参数值,比较CEUS与血清肌酸激酶和肌红蛋白测值的相关性. 结果 23只建模成功的白兔左后腿挤压伤面积为60cm2,占体表面积的2.6％～3.0％.解压后不同时间点挤压区均呈快速增强,强度高于非挤压区；以非挤压区为对照,各观察时间点挤压区的时间-强度曲线呈速升缓降型,峰值前移；各观察时间点损伤区峰值强度(PI)与非损伤区有明显差异(P＜0.001).ROC曲线显示,PI值能够准确诊断肢体肌肉挤压区.不同时间点PI值与血清肌酸激酶和肌红蛋白变化呈正相关,相关系数为0.833～0.996.结论 CEUS显示肢体挤压伤后局部肌肉的微循环灌注明显增强,佐证了解压后存在缺血再灌注损伤,且提示了超声造影可能是诊断肢体肌肉挤压伤后微循环灌注异常有价值的方法.
목적 탐토지체제압상소치국부기육손상적초성조영(CEUS)성상특정.방법 건강신서란백토28지,전신마취(전퇴기내주사,무파비타납30 mg/kg)후사용전문제작적수대기낭(충기후산생18.6 kPa적압력)가압법우토후퇴제작기육제압상동물모형.기중23지토성공건모병존활72 h이상.우해압후30 min、2h、6h、24 h、72 h분별진행CEUS검사,관찰조영관주모식화강도변화；사용QLAB분석연건대토좌후퇴기육제압구여비제압구회제시간-강도곡선,측정CEUS삼수치,비교CEUS여혈청기산격매화기홍단백측치적상관성. 결과 23지건모성공적백토좌후퇴제압상면적위60cm2,점체표면적적2.6％～3.0％.해압후불동시간점제압구균정쾌속증강,강도고우비제압구；이비제압구위대조,각관찰시간점제압구적시간-강도곡선정속승완강형,봉치전이；각관찰시간점손상구봉치강도(PI)여비손상구유명현차이(P＜0.001).ROC곡선현시,PI치능구준학진단지체기육제압구.불동시간점PI치여혈청기산격매화기홍단백변화정정상관,상관계수위0.833～0.996.결론 CEUS현시지체제압상후국부기육적미순배관주명현증강,좌증료해압후존재결혈재관주손상,차제시료초성조영가능시진단지체기육제압상후미순배관주이상유개치적방법.
Objective To explore imaging feature of muscle crush injury of extremity on contrast enhanced ultrasound (CEUS) by an animal experiment.Methods Twenty-eight New Zealand rabbits were anesthetized by intramuscular pentobarbital sodium (30 mg/kg).A special balloon cuff device was used to create left hind leg crush injury with a force of (18.6 kPa).23 of the 28 rabbits had crush injury of extremity and survived for 72 hours.CEUS evaluated infusion model and contrast intensity in crush region of hind leg at the 0.5,2,6,24 and 72 hour after the release of the crushing pressure.Peak intensity (PI) was analyzed by comparing with serum creatinekinase (CK) and myoglobin (MYO).Results Twenty-three rabbits presented that the area of crushed region in left hind leg was 60 cm2,accounting for 2.6％-3.0％ of body surface area.In different time after decompression,the crushed regions showed rapid enhancement and the intensity was higher than that of no-crushed region.The time-intensity curves of crushed regions all appeared as fast wash-in and slow wash-out.PIs of rushed regions were higher obviously than those of nocrushed regions (P ＜0.001).ROC curves were employed in diagnosis value of PI for crushed region.And PIs showed positive correlation with CK and MYO and the correlation coefficient was 0.833-0.996.Conclusions CEUS presents that the micro-circulation perfusion of the crushed muscle increased obviously after the release of the crush pressure.PIs evaluated quantitatively the micro-circulation perfusion changes.It suggests a potential alternative for evaluating micro-circulation abnormality and ischemia reperfusion injury of the muscle crush injury to extremities.