超声造影引导下局部注射止血剂治疗肾创伤出血短期疗效的实验研究

摘要

目的 研究超声造影引导下局部注射止血剂治疗肾创伤出血的短期疗效.方法 选取纯种新西兰大白兔25只,制备Ⅲ～Ⅳ级肾创伤动物模型,实验全程监测并维持平均动脉压70 mm Hg(1 mm Hg=0.133 kPa).实验动物随机分为2组,超声造影明确出血部位.凝血酶治疗组15只在超声造影引导下于创伤灶内注射凝血酶,对照组10只注射等量生理盐水.2组均于处理后5 min再次行超声造影检查.处理后1 h,常规超声测定肾包膜下血肿范围,随即处死动物后测定腹腔内游离液体量并行病理学检查.结果 治疗后1 h,凝血酶治疗组超声造影显示无活动性出血,对照组仍可见少量活动性出血.凝血酶治疗组肾包膜下血肿范围为(11±2) mm×(18±7) mm,对照组为(16±5) mm×(22±8) mm,无明显统计学差异;两组腹腔游离液体量分别约为(13±5) mL 及(76±11) mL,前者明显少于后者(P<0.05).剖腹探查见凝血酶治疗组创伤灶局部覆盖凝血块出血完全停止;对照组病灶局部见少许血凝块,伤口仍可见出血.结论 超声造影引导下注射止血剂能有效抑制肾创伤活动性出血,短期疗效较好.%Objective To explore the short-term effects of contrast-enhanced ultrasound guided hemocoagulase injection therapy in renal trauma models. Methods A total of 25 rabbits were induced as grade Ⅲ-Ⅳ renal trauma models by puncture. Mean blood pressure was monitored simultaneously and maintained at 70 mm Hg ( 1 mm Hg =0. 133 kPa ). Two groups including percutaneous hemostatic injection treatment in experiment group and percutaneous saline injection treatment in control group rnwere guided by contrast-enhanced ultrasonography. Subcapsular hematomas were assessed by regular ultrasonography 1 h after treatment, and hemorrhage volume was recorded and the specimens of lesion were harvested for histopathology after animal executed. Results In the control group, active bleeding still be existed with blood clots, while the active bleeding was stopped completely in the experiment group. No significance was found in the areas of subcapsular hematomas between 2 groups. The hemorrhage volume in the control group was significantly greater than those in treatment group ( 76 ±11 mL versus 13 ±5 mL, P ＜0. 05 ). Conclusion As the hemocoagulase injection can effectively stop bleeding in experimental models within a short time, the hemostatic agent could be regarded as a potential clinical treatment in renal trauma.