CAJ | 학술논문

目的监测失血性休克（HS）状态下脏器微循环灌注，对于HS的诊疗具有重要意义。本研究通过建立HS动物模型，应用超声造影（CEUS）检测动物模型肾血流灌注，探讨CEUS及时间-信号强度曲线（TIC）定量分析评估HS状态肾微循环灌注的价值。材料与方法以正常平均动脉压（100% MAP）作为健康对照，30只健康新西兰大耳白兔通过控制放血量建立定压型HS模型，分为3个等级：轻度休克（70% MAP）、中度休克（50% MAP）、重度休克（40% MAP）。对HS动物模型行CEUS检查，感兴趣区取样框置于肾皮质外层，生成TIC曲线并获得相关定量参数到达时间（AT）、达峰时间（TTP）、峰值强度（PI）、曲线下面积（AUC）。结果30只兔均成功建立HS模型，实验结束时27只存活，3只死于重度休克。TIC曲线上升陡直，迅速达到峰值，而后缓慢下降到基础水平，客观地反映了超声微泡在肾微循环灌注的渡越过程。从轻度休克开始，PI及AUC逐渐减小，差异有统计学意义（P<0.05）；AT、TTP在轻度休克时与正常状态相比，差异无统计学意义（P>0.05）；从中度休克开始，与正常状态及轻度休克相比，AT及TTP逐渐延长，差异有统计学意义（P<0.05）。结论 CEUS及TIC定量分析技术能快速、精确、敏感地评价不同休克等级的HS动物模型肾皮质血流灌注改变并进行量化，为定量评价HS状态脏器血流灌注提供一种新的无创性检查方法。
목적감측실혈성휴극（HS）상태하장기미순배관주，대우HS적진료구유중요의의。본연구통과건립HS동물모형，응용초성조영（CEUS）검측동물모형신혈류관주，탐토CEUS급시간-신호강도곡선（TIC）정량분석평고HS상태신미순배관주적개치。재료여방법이정상평균동맥압（100% MAP）작위건강대조，30지건강신서란대이백토통과공제방혈량건립정압형HS모형，분위3개등급：경도휴극（70% MAP）、중도휴극（50% MAP）、중도휴극（40% MAP）。대HS동물모형행CEUS검사，감흥취구취양광치우신피질외층，생성TIC곡선병획득상관정량삼수도체시간（AT）、체봉시간（TTP）、봉치강도（PI）、곡선하면적（AUC）。결과30지토균성공건립HS모형，실험결속시27지존활，3지사우중도휴극。TIC곡선상승두직，신속체도봉치，이후완만하강도기출수평，객관지반영료초성미포재신미순배관주적도월과정。종경도휴극개시，PI급AUC축점감소，차이유통계학의의（P<0.05）；AT、TTP재경도휴극시여정상상태상비，차이무통계학의의（P>0.05）；종중도휴극개시，여정상상태급경도휴극상비，AT급TTP축점연장，차이유통계학의의（P<0.05）。결론 CEUS급TIC정량분석기술능쾌속、정학、민감지평개불동휴극등급적HS동물모형신피질혈류관주개변병진행양화，위정량평개HS상태장기혈류관주제공일충신적무창성검사방법。
PurposeThe monitor of organ microcirculation is significant in the diagnosis and treatment of hemorrhagic shock (HS). We established an HS experimental model and evaluated it by contrast-enhanced ultrasound (CEUS), which aimed to evaluate the value of CEUS and time-intensity curve (TIC) in quantitative analysis of renal cortical microcirculation.Materials and Methods The experimental models of HS were established in 30 healthy New Zealand white rabbits by controlled exsanguinations and were divided into four groups according to the shock grade: normal (100% MAP), mild (70% MAP), moderate (50% MAP) and severe (40% MAP). The right kidneys of the experimental model were examined by CEUS. The corresponding parameters of the TIC such as arrival time (AT), time to peak (TTP), peak intensity (PI) and area under the curve (AUC) were measured with the TIC analysis software package when the region of interest was set in superficial of renal cortex.Results The model of HS were successfully established with 30 healthy New Zealand rabbits. Twenty-seven healthy New Zealand rabbits were alive at the end of the experiment, and three died of severe shock. The TIC rose steeply and reached the peak quickly, and then declined slowly to the baseline, which reflected the transition of microbubble in the region of interest. As the hemorrhagic shock model progressed from normal to mild, PI and AUC gradually decreased and the differences were significant (P<0.05); no significant changes were found in AT and TTP (P>0.05). AT and TTP gradually prolonged compared with normal and mild shock groups, and the differences were significant (P<0.05).Conclusion CEUS and TIC can quickly and accurately assess the renal perfusion changes of acute hemorrhagic shock model of animals in a quantitative way. It can be used as a new noninvasive monitoring tool in quantitative analysis of renal cortical microcirculation.