| 摘要: |
| 目的 通过建立体外活动性出血模型探讨超声造影联合微血管成像（“双微成像”）技术在诊断腹部实质脏器活动性出血以及明确活动性出血位置中的应用价值。方法 采用硅胶管模拟人工血管（管径为0.5、1.0mm）建立两种体外活动性出血模型：①水槽模型：将人工血管游离端置入水槽内，水槽内混有超声造影剂用于模拟增强后脏器实质；②组织损伤模型：使用自制小型撞击器在离体猪肝选定区域建立闭合型创伤灶，将人工血管游离端置入创伤灶内，用于模拟出血在创伤组织内的表现。造影剂通过与人工血管相连的注射泵注入，流量选取以5ml/h为间隔在5-100ml/h范围内共20种流量。通过注射泵注入造影剂溶液，分别启动超声造影和“双微成像”技术进行观察，根据诊断及定位活动性出血的标准由两名医师采用盲法独立完成读图。计量资料用均数±标准差（\bar{x}±s）表示，计数资料采用χ2检验。结果 1.水槽模型中，超声造影未能诊断活动性出血（0/40）；“双微成像”诊断和定位活动性出血的准确度均为62.50%（25/40）。2.组织损伤模型中，超声造影诊断和定位活动性出血的准确度分别为77.50%（31/40）、62.50%（25/40），差异有统计学意 (χ2=19.355,p=0.000）。“双微成像”诊断和定位活动性出血的准确度均为90.00%（36/40），二者均高于超声造影的准确度，差异有统计学意义（χ2=15.309，p=0.000；χ2=7.407，p=0.006）。3.水槽模型和组织损伤模型中，“双微成像”定位活动性出血的准确度分别为62.50%（25/40）、90.00%（36/40），差异具有统计学意义（χ2=7.407，p=0.006）。结论 超声造影联合微血管成像技术（“双微成像”）与超声造影相比不仅提高了诊断活动性出血的准确度，对活动性出血定位的判断亦优于超声造影。 |
| 关键词: 活动性出血，创伤，微血管成像，超声造影，超声 |
| DOI： |
| 投稿时间：2021-03-25修订日期：2021-04-10 |
| 基金项目: |
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| In Vitro Study Investigating the Diagnostic Value of Contrast-enhanced Ultrasound Combined with Micro-Flow Imaging Technology for Detecting Active Abdominal Parenchymal Hemorrhages |
| hanpeng,liangshuyuan,feixiang,zhulianhua,jiangbo |
| (Chinese PLA General Hospital) |
| Abstract: |
| Objectives: We aimed to explore the value of contrast-enhanced ultrasound combined with micro-flow imaging technology (MFI) ( referred to as “dual micro-imaging”) for the diagnosis of active bleeding from abdominal parenchymal organs. We also wanted to explore the location of active bleeding by establishing an externally active bleeding model by combining these two techniques. Methods: Artificial blood vessels were designed using silicone tubes (diameters of 0.5/1.0mm) to establish two in vitro active bleeding models: ① The tank model, where the free end of the artificial blood vessel was placed into a water tank containing ultrasound contrast agent used to simulate the enhanced organ parenchyma; ② The tissue damage model, where a closed traumatic wound was established by a self-made small impactor in the selected area of the isolated pig liver and the free end of the artificial blood vessel was placed into the traumatic lesion to simulate the performance of bleeding in the traumatic tissue. The contrast agent was injected using a syringe pump connected to the artificial blood vessel and the flow rate was selected from a total of 20 flow rates within the range of 5-100ml/h at an interval of 5ml/h. The contrast agent solution was injected through the syringe pump and contrast-enhanced ultrasound and "dual micro-imaging" technology were activated for observation. According to the criteria for diagnosing and locating active bleeding, two physicians used a double-blind method to independently complete readings of the images. Measurement data were normally presented as mean ± standard deviation (\bar{x}\ ± s) and a paired t-test was used to compare groups. Finally, a chi-square test was used to analyze count data. Results: 1. In the tank model, the contrast-enhanced ultrasound failed to diagnose active bleeding (0/40) and the accuracy of "dual micro-imaging" in diagnosing and locating active bleeding was 62.50% (25/40). 2. In the tissue damage model, the accuracy of contrast-enhanced ultrasound in diagnosing and locating active bleeding was 77.50% (31/40) and 62.50% (25/40), respectively, and this difference was statistically significant (χ2=19.355, p=0.000). The accuracy of "dual micro-imaging" in the diagnosis and location of active bleeding was 90.00% (36/40) for both and the difference of accuracy compared with contrast-enhanced ultrasound was statistically significant (χ2=15.309, p=0.000; χ2=7.407, p= 0.006). 3. In the tank and the tissue damage models, the accuracy of "dual micro-imaging" in locating active bleeding was 62.50% (25/40) and 90.00% (36/40), respectively, and this difference was statistically significant (χ2=7.407, p=0.006 ).Conclusions: Compared with contrast-enhanced ultrasound, contrast-enhanced ultrasound combined with micro-flow imaging technology (dual micro-imaging) not only improves the accuracy for diagnosing active bleeding, but also improves identifying the location of active bleeding. |
| Key words: Active bleeding, Trauma, Micro-flow imaging technology, Contrast-enhanced ultrasonography, Ultrasonography |
