本文選題：休克 + 復(fù)蘇��； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景:失血性休克是以全身微循環(huán)血流量急劇銳減、細(xì)胞普遍缺氧和重要器官遭受損害為特征的一種病理過程,是臨床常見的急危重癥。失血性休克進(jìn)而引發(fā)的內(nèi)臟多器官功能不全是臨床上導(dǎo)致死亡的重要原因。失血性休克時機體代償機制啟動,導(dǎo)致內(nèi)臟多器官發(fā)生血流動力學(xué)異常,首先保證心、腦等器官灌注,肝臟受肝動脈及門靜脈雙重血供,休克時血流量減少顯著。失血性休克的治療要點是及時、有效地進(jìn)行液體復(fù)蘇,而其治愈效果還直接與治療過程采用的監(jiān)測手段和監(jiān)測指標(biāo)有緊密關(guān)系。超聲造影可以評價組織內(nèi)部血流灌注情況,在休克時組織灌注監(jiān)測中具有重大的應(yīng)用價值。本文擬建立兔失血性休克模型,并進(jìn)行液體復(fù)蘇,探討超聲造影定量分析技術(shù)在監(jiān)測兔失血性休克液體復(fù)蘇肝血流灌注中的應(yīng)用價值。目的:探討超聲造影在定量監(jiān)測失血性休克液體復(fù)蘇肝實質(zhì)血流灌注變化中的價值。材料與方法一實驗材料GE Logiq-E9超聲診斷儀,配備低機械指數(shù)超聲造影模式及TIC-Analysis軟件,9L-D探頭,頻率6-9MHz,動物心電監(jiān)護(hù)儀,超聲造影劑SonoVue,3%戊巴摘要比妥鈉,肝素鈉,乳酸鈉林格注射液,羥乙基淀粉注射液。二實驗方法實驗一:采用Wiggers改良法建立兔HS模型,采用膠體液(羥乙基淀粉)對動物模型進(jìn)行復(fù)蘇,無復(fù)蘇和復(fù)蘇1h、4h、24h后行常規(guī)肝超聲造影(CEUS)檢查。CEUS結(jié)束后采血檢測乳酸、ALT、AST,并取肝組織行病理檢查。同時對超聲造影的時間-強度曲線進(jìn)行分析。實驗二:采用Wiggers改良法建立兔HS模型,采用晶體液(乳酸鈉林格注射液)對動物模型進(jìn)行復(fù)蘇,無復(fù)蘇和復(fù)蘇1h、4h、24 h后行常規(guī)肝超聲造影(CEUS)檢查。CEUS結(jié)束后采血檢測乳酸、ALT、AST,并取肝組織行病理檢查。同時對超聲造影的時間-強度曲線進(jìn)行分析。結(jié)果實驗一:與正常對照組比較,休克組AT、TTP明顯延長,PI、AUC減低(P0.05);膠體液復(fù)蘇1 h組PI、AUC增加,AT減低(P0.05);與休克組比較,膠體液復(fù)蘇1 h組PI、AUC增加,AT減低(P0.05);膠體液復(fù)蘇4 h組、24 h組,各參數(shù)均有統(tǒng)計學(xué)意義(P0.05)。與正常對照組比較,休克組ALT、AST、LAC升高(P0.05);復(fù)蘇1h組、4h組,AST、LAC(P0.05)。與休克組比較,復(fù)蘇1h組AST(P0.05),正常對照組和復(fù)蘇各組LAC(P0.05)。實驗二:與正常對照組比較,休克組AT、TTP明顯延長,PI、AUC減低(P0.05);復(fù)蘇1 h組PI、AUC增加,AT減低(P0.05);與休克組比較,復(fù)蘇1 h組PI、AUC增加,AT減低(P0.05);復(fù)蘇4 h組、24 h組,各參數(shù)均有統(tǒng)計學(xué)意義(P0.05)。與正常對照組比較,休克組ALT、LAC升高(P0.05);復(fù)蘇1h組、4 h組,ALT、AST、LAC(P0.05)。與休克組比較,復(fù)蘇1h組ALT、AST升高(P0.05),復(fù)蘇4h組AST(P0.05),正常對照組和復(fù)蘇各組LAC(P0.05)。結(jié)論CEUS可定量評價失血性休克液體復(fù)蘇肝實質(zhì)血流灌注的改變,對臨床治療具有一定的參考價值。
[Abstract]:Background: hemorrhagic shock is a pathological process characterized by rapid decrease of systemic microcirculation blood flow, cell hypoxia and damage to important organs. The multiple organ insufficiency caused by hemorrhagic shock is an important cause of death. During hemorrhagic shock, the compensatory mechanism is initiated, which leads to the abnormal hemodynamics of multiple visceral organs. Firstly, the perfusion of the heart and brain organs, the hepatic artery and portal vein blood supply to the liver are ensured, and the blood flow decreases significantly during shock. The main point of the treatment of hemorrhagic shock is to carry out fluid resuscitation in time and effectively, and its curative effect is closely related to the monitoring method and monitoring index used in the course of treatment. Contrast-enhanced echocardiography (CEUs) can evaluate the blood flow perfusion in tissues, and has great application value in monitoring tissue perfusion during shock. A rabbit model of hemorrhagic shock was established and fluid resuscitation was carried out. The value of quantitative analysis of contrast-enhanced ultrasound in monitoring the hepatic blood perfusion of hemorrhagic shock fluid resuscitation in rabbits was discussed. Objective: to evaluate the value of contrast-enhanced ultrasonography in quantitative monitoring of hepatic parenchyma perfusion in hemorrhagic shock fluid resuscitation. Materials and methods one experimental material, GE Logiq-E9 ultrasound diagnostic instrument, was equipped with low mechanical index contrast-enhanced mode and TIC-Analysis software 9L-D probe, frequency 6-9MHz, animal ECG monitor, sonoVue3% pentobar Abstract sodium, heparin sodium, sodium lactate Ringer injection. Hydroxyethyl starch injection. Two experimental methods: the model of rabbit HS was established by Wiggers improved method, and the animal model was resuscitated by colloid solution (hydroxyethyl starch). After no resuscitation and resuscitation for 1 h and 4 h and 24 h after resuscitation, routine hepatic contrast echocardiography (CEUSS) was performed. Blood samples were collected after CEUs to detect lactic acid (alt) AST, and liver tissues were taken for pathological examination. At the same time, the time-intensity curve of contrast-enhanced ultrasound was analyzed. Experiment 2: the rabbit model of HS was established by Wiggers improved method, and the animal model was resuscitated by crystal solution (sodium lactate Ringer injection). No resuscitation and resuscitation were performed 24 hours after 1 hour of resuscitation. The blood samples were collected after CEUs and the liver tissues were taken for pathological examination. At the same time, the time-intensity curve of contrast-enhanced ultrasound was analyzed. Results: compared with the normal control group, the ATI TTP of shock group was significantly longer than that of the normal control group, the AUC of the shock group was significantly longer than that of the control group, the P0. 05% of the AUC of the colloid fluid resuscitation group increased after 1 h of colloid fluid resuscitation, and that of the 1 hour group of the colloid fluid resuscitation group increased the level of P0. 05% in the 1 hour group, and that of the 4 h group of colloid fluid resuscitation was 24 h. All the parameters were statistically significant (P 0.05). Compared with the normal control group, the alt of the shock group was higher than that of the control group (P 0.05), and that of the resuscitation group was 4 h after resuscitation. Compared with shock group, ASTX P0.05 in resuscitation group was compared with that in normal control group and resuscitation group. Experiment 2: compared with the normal control group, the ATI TTP of shock group was significantly longer than that of the normal control group (P 0.05); in the 1 hour resuscitation group, the AUC increased and the AT decreased P 0.05; compared with the shock group, the AUC increased at 1 h after resuscitation and decreased the level of AT P 0.05; in the 24 h group after 4 h resuscitation, the parameters were significantly higher than that in the 4 h group (P 0.05). Compared with the normal control group, the level of alt in the shock group was higher than that in the control group, and that in the resuscitation group was 4 h after resuscitation. Compared with the shock group, the alt of the resuscitation group increased P0.05A, the ASTV-P0.05 of the resuscitation group was higher than that of the resuscitation group, and the normal control group and the resuscitation group were treated with LACU P0.05a. Conclusion CEUS can quantitatively evaluate the changes of hepatic parenchyma perfusion in hemorrhagic shock fluid resuscitation.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R459.7

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