探讨地塞米松、维拉帕米联合持续低流量复灌注保护兔单侧睾丸不全缺血扭转复位后缺血再灌注损伤（IRI）的超声表现及相关机制。

30只健康成年雄性兔，随机分成对照组、地塞米松组（DS组）、维拉帕米组（VP组）、30 s持续低流量复灌注后处理组（H组）和联合处理组（L组），每组6只，在超声监控下制成单侧睾丸不全缺血模型。对照组直接完全复灌注，其他处理组分别于耳缘静脉注射地塞米松、维拉帕米、实行30 s持续低流量复灌注处理及3种方法的联合处理10 min后，完全复灌注。再灌注前和3 d后分别行超声造影，分析峰值强度（PI）、达峰时间（TTP）、平均通过时间（MTT）、曲线下面积（AUC）。3 d后取术侧睾丸组织检测睾丸丙二醛（MDA）含量、超氧化物歧化酶（SOD）活性、黄嘌呤氧化酶（XOD）活性及低氧诱导因子-1α（HIF-1α）蛋白含量。

再灌注前，各组术侧睾丸超声造影参数比较，差异均无统计学意义（F_PI=0.85、F_TTP=1.31、F_MTT=1.84、F_AUC=0.60，P值均>0.05）；超声造影时间-强度曲线呈现"慢进慢退"现象。再灌注3 d后，对照组术侧睾丸超声造影呈"快进慢退"现象，L组呈"同进同退"现象。术侧睾丸组织，各处理组MDA含量降低、SOD活性增高、XOD活性降低、HIF-1α蛋白含量增高，差异具有统计学意义（F_MDA=13.62、F_SOD=61.16、F_XOD=9.23、F_HIF-1α=57.64，P值均<0.01）；L组较H组，SOD活性升高、XOD活性降低（t=2.94、4.26，P值均<0.01），L组较DS组，XOD活性降低、HIF-1α蛋白含量增高（t=2.64，P<0.05；t=6.47，P<0.01），L组较VP组，HIF-1α蛋白含量增高，差异具有统计学意义（t=3.45，P<0.01）。

超声微泡造影可实时动态观察睾丸扭转复位后组织微循环变化，地塞米松、维拉帕米和持续低流量复灌注对睾丸不全扭转复位后IRI的干预效果不同，多种途径联合治疗IRI效果更好。

To explore the ultrasonic appearance and the relevant mechanism of combined treatments of dexamethasone, verapamil and continuous low flow reperfusion in protecting the unilateral testicular incomplete torsion ischemia-reperfusion injury in a rabbit model.

Thirty healthy adult male rabbits were randomly divided into control group, dexamethasone group (group DS), verapamil group (group VP), continuous 30 seconds low flow reperfusion group (group H) and combined treatment group (group L). Each group had 6 rabbits. The unilateral testicular incomplete ischemia model was made under the ultrasonic monitoring. The control group was reperfused immediately, while the other groups were given dexamethasone, verapamil, continuous 30 seconds low flow reperfusion and the combined treatment, respectively. They were reperfused completely after 10 minutes. Before reperfusion and 3 days later, the contrast-enhanced ultrasound was made respectively, and the peak intensity (PI), time to peak (TTP), mean transmit time (MTT) and area under curve (AUC) were analyzed. The levels of malonaldehyde (MDA), superoxide dismutase (SOD), xanthine oxidase (XOD) and hypoxia inducible factor-1α (HIF-1α) were tested after the operated testicular tissue removed 3 days later.

Before the reperfusion, ultrasonic parameters showed no statistical significance between groups (F_PI=0.85, F_TTP=1.31, F_MTT=1.84, F_AUC=0.60, all P>0.05); and time-peak curve had the same ?slow in and slow out? form. Three days after the reperfusion, the control group′s time-peak curve appeared ?fast in slow out?, while the L group′s was ?same in same out?. In each treatment group, the MDA was lower, SOD was higher, XOD was lower, HIF-1α was higher than control group. They were statistically significant (F_MDA=13.62, F_SOD=61.16, F_XOD=9.23, F_HIF-1α=57.64, all P<0.01). Compared with group H, group L′s SOD was higher and XOD was lower (t=2.938, 4.263, both P<0.01). Group L′s XOD was lower and HIF-1α was higher than group DS (t=2.64, P<0.05; t=6.47, P<0.01). Compared with group VP, Group L′s HIF-1α was higher, and they were statistically significant (t=3.45, P<0.01).

Contrast microbubble ultrasound can observe tissue microcirculation changes of testicular torsion/detorsion in real time. The dexamethasone, verapamil and continuous low flow reperfusion were different in the therapeutic effect of ischemia-reperfusion injury after testicular incomplete torsion/detorsion, and the combined treatment obtained a better curative effect.