本文關(guān)鍵詞：超聲造影評(píng)價(jià)失血性休克液體復(fù)蘇腎血流灌注的實(shí)驗(yàn)研究　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 超聲造影 定量分析 失血性休克 復(fù)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(shí)處理,可導(dǎo)致多器官功能障礙綜合癥,甚至死亡。復(fù)蘇指南中提出關(guān)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(cè)指標(biāo)(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(wú)法準(zhǔn)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(cè)器官血流動(dòng)力學(xué)變化,有利于指導(dǎo)治療方案,改善病人的預(yù)后。超聲造影(contrast-enhanced ultrasound,CEUS)因其安全性好、重復(fù)性高、實(shí)時(shí)和靈活等優(yōu)點(diǎn)得到廣泛應(yīng)用,目前CEUS定量分析腎臟的微循環(huán)灌注技術(shù)已廣泛應(yīng)用于腎移植、腎慢性疾病及腫瘤性疾病的監(jiān)測(cè)中,其對(duì)失血性休克液體復(fù)蘇評(píng)估腎血流灌注具有潛在臨床價(jià)值,但相關(guān)研究鮮有報(bào)道。目的通過(guò)動(dòng)物實(shí)驗(yàn)探討CEUS技術(shù)評(píng)估失血性休克液體復(fù)蘇腎血流灌注的價(jià)值。材料與方法第一章:40只實(shí)驗(yàn)兔隨機(jī)平均分為5組,隨機(jī)選1組為正常對(duì)照組(T1組),余采用Wiggers改良法建立HS模型,隨機(jī)選1組為休克組(T2組),其余按復(fù)蘇時(shí)間分為復(fù)蘇2h組(T3組)、復(fù)蘇6h組(T4組)、復(fù)蘇24h組(T5組),觀察并記錄如下各項(xiàng)指標(biāo):1、記錄心電監(jiān)護(hù)儀上MAP、HR、SaO2等基本生理指標(biāo);2、灰階超聲測(cè)量腎臟各徑線,計(jì)算腎體積同時(shí)觀察腎內(nèi)結(jié)構(gòu)及回聲強(qiáng)度;3、彩色多普勒超聲(CDFI)檢測(cè)腎血管血流充盈狀態(tài);頻譜多普勒(PW)檢測(cè)各級(jí)腎動(dòng)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(dá)峰時(shí)間(TTP)、峰值強(qiáng)度(A)、上升支斜率(Grad)),并與病理結(jié)果相比較。第二章:24只實(shí)驗(yàn)兔隨機(jī)平均分為3組,隨機(jī)選擇1組為正常對(duì)照組(N組),另兩組建立非控制性失血性休克模型,再隨機(jī)分為積極性液體復(fù)蘇組(FR組)和限制性液體復(fù)蘇組(HFR組),按設(shè)定的液體復(fù)蘇方案治療,在實(shí)驗(yàn)Omin、30min、90min、180min及6h監(jiān)測(cè)以下指標(biāo):1、正常狀態(tài)下的基礎(chǔ)指標(biāo)包括體重、MAP;2、兩個(gè)液體復(fù)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(cè)(SOD、MDA);4、CEUS檢查及定量分析各參數(shù),并與細(xì)胞凋亡情況對(duì)比分析。結(jié)果第一章:1、各組實(shí)驗(yàn)兔基礎(chǔ)指標(biāo)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(jì)學(xué)意義(P0.01),表明失血性休克模型建立成功。復(fù)蘇后上述指標(biāo)逐漸恢復(fù)。2、復(fù)蘇組體積稍增大,但各組差異均無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。3、CDFI示T2組各級(jí)腎動(dòng)脈血流較前減少,亮度暗淡,復(fù)蘇后腎動(dòng)脈及分支恢復(fù)清晰明亮;PW示液體復(fù)蘇后,腎各級(jí)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(jì)學(xué)差異(P0.05);與T3、T4組比較,T5組Grad有統(tǒng)計(jì)學(xué)差異(P0.05)。病理結(jié)果顯示復(fù)蘇組腎小管上皮細(xì)胞腫脹、血管充血減輕,病理改變逐漸得到恢復(fù)。第二章:1、各組兔基礎(chǔ)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(jì)學(xué)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(fù)較好,6h時(shí)兩復(fù)蘇組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4、復(fù)蘇后各液體復(fù)蘇組A、AUC及Grad升高,TTP降低,兩液體復(fù)蘇組比較,90min時(shí)A、AUC、TTP有統(tǒng)計(jì)學(xué)差異(P0.05),180min時(shí)A值有統(tǒng)計(jì)學(xué)差異(P0.05),6h時(shí)各參數(shù)比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論第一章:CEUS能監(jiān)測(cè)控制性失血性休克復(fù)蘇期腎微循環(huán)灌注的變化,認(rèn)為Grad、AUC可作為敏感指標(biāo);第二章:1、限制性輸液復(fù)蘇與積極性液體復(fù)蘇相比,可較好的改善腎血流灌注、減少氧自由基對(duì)細(xì)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(rèn)為BUN、Cr及LAC在失血性休克及復(fù)蘇早期對(duì)腎功能損害的反應(yīng)不夠敏感;3、CEUS技術(shù)能監(jiān)測(cè)非控制性失血性休克液體復(fù)蘇腎微循環(huán)灌注的變化,可為臨床提高一種實(shí)時(shí)、無(wú)創(chuàng)監(jiān)測(cè)腎血流灌注的新工具。但要分析腎血流灌注參數(shù)與時(shí)間的相關(guān)性,有待積累更多動(dòng)物實(shí)驗(yàn)及臨床經(jīng)驗(yàn)。
[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?qiáng)RI;4,琛岃秴澹伴，

本文編號(hào)：1404928