本文關(guān)鍵詞： 超聲造影 骨骼肌 缺血再灌注 肌肉活力　出處：《川北醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討超聲造影(Contrast-enhanced Ultrasound,CEUS)參數(shù)在兔下肢骨骼肌缺血后再灌注4小時(shí)內(nèi)不同時(shí)間點(diǎn)的變化特點(diǎn)。方法:新西蘭大白兔22只,全身麻醉后,通過耳緣靜脈抽血兩毫升并維持該靜脈通道。隨機(jī)選擇一側(cè)下肢備皮,對(duì)該小腿后外側(cè)中上1/3橫截面最大處行超聲造影檢查;在檢查部位腓骨側(cè)皮下1cm處行穿刺活檢。用橡膠圈5個(gè)同時(shí)捆綁于膝關(guān)節(jié)水平,5 H后解除捆扎的橡膠圈;于再灌注即刻、1H、2 H各時(shí)間點(diǎn)按上述方法依次行耳緣靜脈采血、超聲造影、組織病理穿刺檢查;當(dāng)復(fù)灌4 H時(shí),靜脈采血、造影后,處死實(shí)驗(yàn)對(duì)象,并立即在雙側(cè)小腿中上分后外側(cè)分離各層組織結(jié)構(gòu)。觀察對(duì)比兩側(cè)肌組織解剖結(jié)構(gòu)的改變,按Scully提出的“4C”標(biāo)準(zhǔn)(Colour、Capacity of blood、Contractibility、Consistency)判斷骨骼肌損傷最重區(qū)域(比目魚肌區(qū))有無肌肉活力的喪失,分為有肌肉活力、無肌肉活力兩組。最后取上述組織塊行組織病理H-E染色,結(jié)果主要以肌細(xì)胞大小、肌間隙寬度、炎細(xì)胞的浸潤程度為標(biāo)準(zhǔn)進(jìn)行判讀。所有血液樣本經(jīng)離心后測定血漿中CK、LDH含量。超聲造影結(jié)果經(jīng)脫機(jī)分析得到相關(guān)參數(shù)指標(biāo)。結(jié)果:1.超聲造影:(1)組間比較:無肌肉活力組,缺血再灌注即刻API明顯小于有肌肉活力組(3.85±1.51d B對(duì)7.66±2.95d B),差異有統(tǒng)計(jì)學(xué)意義(P0.05);之后各時(shí)間點(diǎn)API呈逐步降低,并均有前者小于后者趨勢。但兩組在始增時(shí)間(arrive time,AT)、達(dá)峰時(shí)間(time to peak,TTP)、峰值強(qiáng)度(peak intensity,PI)、升支斜率(ascending slope,AS)、降支斜率(descending slope,DS)、降支減半時(shí)間(half time of descending,HT)、曲線下面積(area under the curve,AUC)、50%清除率(washing-out50%slope)方面比較,差異無統(tǒng)計(jì)學(xué)意義(均P0.05)。(2)組內(nèi)比較:(1)有肌肉活力組在缺血再灌注2 H時(shí)AT、TTP均明顯長于造模前,分別為13.80±3.53s、21.97±4.26s對(duì)10.87±3.66s、16.61±3.60s,差異有統(tǒng)計(jì)學(xué)意義(均P0.05),在再灌注2 H時(shí)AT較再灌注即刻也明顯延長(13.80±3.53 s對(duì)10.53±3.77 s),差異有統(tǒng)計(jì)學(xué)意義(P=0.004)。該組內(nèi)與造模前相比各時(shí)間點(diǎn)API均顯著減小,差異有統(tǒng)計(jì)學(xué)意義(均P0.05);缺血再灌注4H時(shí)與再灌注即刻相比,API明顯降低(5.00±2.79 d B對(duì)7.66±2.95d B),差異有統(tǒng)計(jì)學(xué)意義(P=0.001)。與造模前比較,復(fù)灌4H時(shí),PI也明顯降低(10.74±4.25d B對(duì)14.98±5.22d B),差異有統(tǒng)計(jì)學(xué)意義(P=0.004)。(2)無肌肉活力組缺血再灌注即刻與造模前相比,AT明顯延長(14.63±3.25s對(duì)12.46±2.43s),差異有統(tǒng)計(jì)學(xué)意義(P=0.002),再灌注4H時(shí)PI較造模前明顯降低(9.76±3.78 d B對(duì)13.32±3.06 d B),差異有統(tǒng)計(jì)學(xué)意義(P=0.003)。2.血漿酶學(xué)檢查結(jié)果:(1)CK在再灌注1H、2H、4H時(shí)在兩組間比較,無肌肉活力組較有肌肉活力組明顯升高(29172.13±10149.55 U/L對(duì)16857.10±5280.14 U/L、33450.50±9918.21對(duì)19502.70±7317.26 U/L、41212.75±12261.32對(duì)25169.10±7708.37 U/L),差異有統(tǒng)計(jì)學(xué)意義(均P0.05);CK在無肌肉活力組再灌注的各時(shí)間點(diǎn)兩兩比較均有統(tǒng)計(jì)學(xué)意義(均P0.05),且隨時(shí)間延長,CK不斷升高;(2)LDH在再灌注2H、4H時(shí)在兩組間比較,無肌肉活力組也明顯較有肌肉活力組升高(1366.45±654.96 U/L對(duì)642.09±193.80 U/L、1503.24±680.56 U/L對(duì)729.37±260.49 U/L),差異存在統(tǒng)計(jì)學(xué)意義(均P0.05);LDH在兩組內(nèi)各時(shí)間點(diǎn)與造模前相比,無活力組從再灌注2 H開始明顯升高(1366.45±654.96 U/L對(duì)110.55±21.45 U/L),差異有統(tǒng)計(jì)學(xué)意義(P=0.001),而有肌肉活力組從再灌注即刻就明顯上升(463.49±160.48U/L對(duì)163.81±91.68 U/L),差異有統(tǒng)計(jì)學(xué)意義(P=0.001)。3.組織病理學(xué):(1)再灌注4H,無肌肉活力組較有肌肉活力組肌原纖維間隙分離更明顯,較多肌膜出現(xiàn)模糊不清,且中性粒細(xì)胞數(shù)目增多;(2)再灌注1H、2H組與造模前、再灌注即刻組相比,肌細(xì)胞稍腫脹,大小不一,肌間隙略增寬,肌原纖維溶解、斷裂增多,部分肌細(xì)胞中出現(xiàn)多個(gè)圓形空泡;而再灌注4H組與再灌注1H、2H組相比,肌原纖維溶解、斷裂更加突出,部分肌間隙開始出現(xiàn)中性粒細(xì)胞浸潤;(3)但造模前組與再灌注即刻組相比,再灌注1H組與再灌注2H組相比沒有觀察到顯著的區(qū)別。4.造影參數(shù)與酶學(xué)指標(biāo)相關(guān)性分析:有肌肉活力組再灌注1 H時(shí)TTP與LDH、CK呈線性正相關(guān),AS與LDH呈線性負(fù)相關(guān),相關(guān)系數(shù)r為,0.66、0.74、-0.67,均P0.05。無肌肉活力組造模前AUC、再灌注1H時(shí)AS、再灌注4H時(shí)AUC與CK均呈線性正相關(guān),相關(guān)系數(shù)r為,0.92、0.78、0.80,均P0.05。結(jié)論:超聲造影參數(shù)API、PI、AT、TTP對(duì)評(píng)價(jià)早期骨骼肌缺血再灌注后肌肉活力有重要參考價(jià)值。
[Abstract]:Objective: To investigate the effects of contrast-enhanced ultrasound (Contrast-enhanced Ultrasound, CEUS) changes at different time parameters in the lower limb of rabbit skeletal muscle ischemia reperfusion after 4 hours. Methods: 22 New Zealand white rabbits, after general anesthesia through ear vein blood two ml and maintain the vein channel. One side was randomly chosen for lower limb skin. The posterior lateral leg in 1/3 cross section at the maximum underwent contrast-enhanced ultrasound examination; in parts of the fibular lateral subcutaneous 1cm biopsy. With a rubber ring 5 and tied to knee level 5 H after the lifting of the bound rubber ring; from the beginning of reperfusion, 1H, 2 H each time point according to the above method in order for the ear vein blood, contrast-enhanced ultrasound, tissue pathology biopsy; when 4 H of reperfusion, the venous blood after angiography, were the experimental object, and immediately in the bilateral calf on the posterolateral separation layers. Comparative observation on both sides of the muscle group Fabric anatomical changes, proposed by Scully 4C standard (Colour Capacity of, blood, Contractibility, Consistency) to judge the skeletal muscle injury is the most serious area (soleus muscle area) with no loss of muscle activity, divided into muscle activity, no muscle activity in two groups. Finally, the tissue for pathology H-E staining results in muscle cell size, muscle gap width, the degree of infiltration of inflammatory cells in the interpretation standard. All blood samples after centrifugation, determination of plasma CK, LDH content. The results obtained by off-line analysis of contrast-enhanced ultrasound parameters. Results: 1. ultrasound contrast: (1) between the two groups: no muscle activity group, ischemia reperfusion immediate API was significantly lower than the muscle activity group (3.85 + 7.66 + 2.95d 1.51d B on B), the difference was statistically significant (P0.05); after each time point of API was gradually decreased, and were smaller than the latter trend. But in the two groups 濮嬪鏃墮棿(arrive time,AT),杈懼嘲鏃墮棿(time to peak,TTP),宄板，

本文編號(hào)：1459621