院前超声在救治创伤性脑出血动物模型中的应用

doi:10.3877/cma.j.issn.1672-6448.2019.12.014

中华医学超声杂志（电子版） ›› 2019, Vol. 16 ›› Issue (12) : 958 -962. doi: 10.3877/cma.j.issn.1672-6448.2019.12.014

所属专题：文献；

基础研究

院前超声在救治创伤性脑出血动物模型中的应用

刘义灏¹, 吴东东¹, 张霞¹, 孙正辉², 张家墅², 吴盛正³, 任柳琼³, 单雪霞³, 吕发勤³^,^†(

), 黎檀实¹^,^†(

)

^1. 100853　北京，中国人民解放军总医院第一医学中心急诊科
^2. 100853　北京，中国人民解放军总医院第一医学中心神经外科
^3. 572013　三亚，中国人民解放军总医院海南医院超声科

收稿日期:2019-08-23 出版日期:2019-12-01
通信作者: 吕发勤, 黎檀实
基金资助:
全军后勤科研目录重点项目(BWS14J041、BWS16C005); 军事医学创新专项(14CXZ005); 科技部"十三五"国家重点研发计划(2016YFC0105006)

Feasibility of ultrasound application in pre-hospital treatment of traumatic cerebral hemorrhage in an animal model

Yihao Liu¹, Dongdong Wu¹, Xia Zhang¹, Zhenghui Sun², Jiashu Zhang², Shengzheng Wu³, Liuqiong Ren³, Xuexia Shan³, Faqin Lyu³^,^†(), Tanshi Li¹^,^†()

^1. Department of Emergency Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
^2. Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
^3. Department of Ultrasound, Hainan Hospital, Chinese PLA General Hospital, Sanya 572013, China

Received:2019-08-23 Published:2019-12-01
Corresponding author: Faqin Lyu, Tanshi Li
About author:
Corresponding authors: Li Tanshi, Email:lts301@163.com
Lyu Faqin, Email: lvjin8912@163.com

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

刘义灏, 吴东东, 张霞, 孙正辉, 张家墅, 吴盛正, 任柳琼, 单雪霞, 吕发勤, 黎檀实. 院前超声在救治创伤性脑出血动物模型中的应用[J]. 中华医学超声杂志（电子版）, 2019, 16(12): 958-962.

Yihao Liu, Dongdong Wu, Xia Zhang, Zhenghui Sun, Jiashu Zhang, Shengzheng Wu, Liuqiong Ren, Xuexia Shan, Faqin Lyu, Tanshi Li. Feasibility of ultrasound application in pre-hospital treatment of traumatic cerebral hemorrhage in an animal model[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(12): 958-962.

目的

建立创伤性脑出血动物模型，探讨便携式超声在创伤性脑出血院前救治中的应用价值。

方法

动物实验选取雌性五指山猪6只。制备创伤性脑出血动物模型成功后行超声引导下脑室置管术，记录开颅窗所需时间，手术前后动物的瞳孔直径、肢体活动情况以及生命体征，并对其进行数据分析。

结果

6只实验猪均建模成功，动物出现一侧瞳孔散大，对侧肢体瘫痪，建模成功率100%。使用微型电动开颅钻打开直径1 cm的颅窗需要（2.33±0.61）min。对实验动物行超声引导下脑室置管减颅压，减压后实验动物散大的瞳孔于（8.2±4.4）min逐渐回缩，肢体活动于（2.4±0.7）h后逐渐恢复。脑室置管减压后血压收缩压为（127.00±5.66）mmHg（1 mmHg=0.133 kPa），高于减压前的（103.33±3.33）mmHg（t=4.996，P=0.004）；减压前心率减慢为（75.17±4.31）次/min，减压后2 h恢复至（90.17±3.76）次/min（t=5.839，P=0.002）。

结论

便携式超声应用于创伤性脑出血，有助于实现快速损伤控制，从而能够为后期救治争取时间并改善预后。便携式超声引导下救治具有可行性和实用性，为临床创伤性脑出血的院前救治提供了新思路。

关键词: 脑出血，创伤性, 院前急救, 超声检查，介入性, 动物实验

Objective

To explore the feasibility of portable ultrasound guided pre-hospital treatment of traumatic cerebral hemorrhage through animal experiments.

Methods

Six female Wuzhishan pigs were used in this study. Ultrasound-guided intraventricular catheterization was performed on the animals with traumatic cerebral hemorrhage. The time of small bone window craniotomy and the changes of signs before and after operation were recorded.

Results

Traumatic cerebral hemorrhage was successfully in six experimental pigs, with one pupil dilated and ipsilateral limbs paralyzed. The success rate of model establishment by this method was 100%. It took (2.33±0.61) minutes to make a bone window with a diameter of 1 cm with a micro-electric craniotomy drill. After decompression by ventricular catheterization guided by portable ultrasound in the animal models, the pupillary volume of the experimental animals was gradually retracted and the limb activity was gradually restored after (2.4±0.7) h. The systolic blood pressure [(127±5.66) mmHg] was higher than that before decompression [(103.33±3.33) mmHg; t=4.996, P=0.004], and the heart rate declined to (75.17±4.31) beats/min before decompression, and increased to (90.17±3.76) beats/min 2 h later (t=5.839, P=0.002).

Conclusion

Ventricular catheterization guided by portable ultrasound makes it feasible to control the injury rapidly in traumatic cerebral hemorrhage so as to save time for further surgical treatment and improve the prognosis. The feasibility and practicability of this method provide a new avenue for the pre-hospital clinical treatment of patients with traumatic cerebral hemorrhage.

Key words: Brain hemorrhage, traumatic, Pre-hospital care, Ultrasonography, interventional, Animal experimentation

图1 创伤性脑出血猪动物模型的建立。图a为采用微型电动开颅钻在左侧冠状缝前5 mm、距矢状缝约15 mm处开颅窗；图b为颅窗直径约为1 cm；图c为通过留置针头用微量泵注血，注血量为2.5 ml

图2 创伤性脑出血动物模型在超声引导下行脑室置管术。图a为创伤性脑出血超声显示为脑室内偏高回声区，边界清楚，形态较规则，彩色多普勒示其内无血流信号（箭头所示）；图b为超声引导下穿刺针进入脑室偏高回声区（箭头所示为穿刺针针头）

[1]	林清松，康德智. 创伤性脑血管损伤[J/CD]. 中华神经创伤外科电子杂志, 2016, 2(3):178-180.
[2]	Gabbe BJ, Biostat GD, Lecky FE, et al. The effect of an organized trauma system on mortality in major trauma involving serious head injury: a comparison of the United Kingdom and victoria, australia [J]. Ann Surg, 2011, 253(1):138-143.
[3]	Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, et al. Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds [J]. J Neurotrauma, 2007, 24Suppl 1: S55-S58.
[4]	连美升，郑春烟，陈建芳,等. 协同式院前急救护理模式对急性脑出血患者初步救治时间及并发症的影响[J]. 中国卫生标准管理, 2017, 8(28): 161-163.
[5]	李强，江普查. 影响手术治疗高血压脑出血预后的相关因素分析(附168例报告) [J]. 中国临床神经外科杂志, 2012(9): 523-525.
[6]	Burke RE, Dorfman M, Chan SB, et al. Is emergent anti-hypertensive treatment beneficial in intracranial hemorrhage? [J]. J Emerg Med, 2005, 29(1): 9-13.
[7]	刘军. 脑出血急救患者院前治疗的疗效影响观察[J]. 当代医学, 2014(28): 100-101.
[8]	王涛. 院前急救与院内急救在高血压脑出血患者救治中的临床效果[J]. 中国实用神经疾病杂志, 2017, 20(9): 47-49.
[9]	Mckenney MG, Martin L, Lentz K, et al. 1,000 consecutive ultrasounds for blunt abdominal trauma [J]. J Trauma, 1996, 40(4): 611-612.
[10]	Slikkerveer J, Dijkmans PA, Sieswerda GT, et al. Ultrasound enhanced prehospital thrombolysis using microbubbles infusion in patients with acute ST elevation myocardial infarction: Rationale and design of the Sonolysis study [J]. Ultrasound Med Biol, 2008, 38(2): 247-252.
[11]	Chenaitia H, Squarcioni C, Marie BP, et al. Transcranial sonography in prehospital setting [J]. AmJ Emerg Med, 2011, 29(9): 1231-1233.

[1]	马骏, 王月香, 罗渝昆, 高菡静, 孟祥宇, 费翔, 肖静, 李文. 细微血流成像对肾挫裂伤诊断价值的动物实验研究[J]. 中华医学超声杂志（电子版）, 2022, 19(09): 994-998.
[2]	沈纵, 魏晨如, 朱邦晖, 包郁露, 伍国胜, 孙瑜. 间充质干细胞治疗吸入性损伤的动物实验研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(02): 180-183.
[3]	廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.
[4]	曾庆劲, 赵里汶, 吴宇轩, 贺需旗, 张兰霞, 余萱, 何娜, 郑荣琴, 李凯. 超声引导经皮热消融治疗邻近心脏的肝脏恶性肿瘤疗效分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(01): 49-54.
[5]	陈焕军, 颜时姣, 宋兴月, 陈瑜, 吕传柱. 我国大学生应急救护培训现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(04): 367-374.
[6]	倪争, 朱英华. 视频辅助调度员指导院外心肺复苏的研究进展[J]. 中华临床医师杂志(电子版), 2022, 16(09): 842-846.
[7]	杨露, 李斌, 曾艳, 欧阳艳红, 张娜, 周明, 张华. 医警联动机制在院前急救中的应用现状及研究对策[J]. 中华临床医师杂志(电子版), 2022, 16(09): 838-841.
[8]	徐德全, 张良, 侯利民. 新冠肺炎流行对院前急救的影响及应对策略[J]. 中华临床医师杂志(电子版), 2022, 16(09): 833-837.
[9]	谢靖芸, 李准. 院前急救对AMI患者治疗及预后影响的Meta分析[J]. 中华临床医师杂志(电子版), 2022, 16(09): 869-875.
[10]	王凯, 孙颖, 黄雷, 朱宗东, 牛良波, 陈世寅, 肖宁, 杜广刚, 袁荣霞, 王学杰, 贾克刚, 汪婷, 李鑫, 李璐, 孙明伟, 陈康, 王杰, 江华, 曾俊, 吕传柱. 5G+卫星融合通信技术应用于“9.16泸县地震”伤员院前救治效果分析[J]. 中华临床医师杂志(电子版), 2022, 16(09): 863-868.
[11]	杨阳, 田小溪, 杨彦龙, 付国强, 李立宏. 多发性创伤患者院前急救镇痛对预后的效果评估：一项单中心前瞻性随机对照研究[J]. 中华临床医师杂志(电子版), 2022, 16(09): 851-856.
[12]	熊鑫, 邓勇志. 基于血管内超声的机器学习在冠状动脉病变中的研究进展[J]. 中华诊断学电子杂志, 2023, 11(03): 153-157.
[13]	赵晨怡, 宁波, 董浩, 冯秀雪, 李惠凯, 柴宁莉, 令狐恩强. 便携式一次性大孔道胃镜与常规胃镜在止血和内镜黏膜下剥离术中的应用对比：一项随机对照动物实验[J]. 中华胃肠内镜电子杂志, 2023, 10(01): 14-19.
[14]	梅冬兰, 凌受毅, 梅冰, 邵光亮, 孙志辉. 院外自动心肺复苏机序贯骨髓腔输液在抢救呼吸心跳骤停患者中的应用价值[J]. 中华卫生应急电子杂志, 2023, 09(03): 159-162.
[15]	潘鑫, 王忻, 王超, 顾慧, 吴敏, 唐加波, 崔恒熙, 李政. 亚低温治疗在脑卒中院前急救中的应用[J]. 中华卫生应急电子杂志, 2023, 09(03): 155-158.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Feasibility of ultrasound application in pre-hospital treatment of traumatic cerebral hemorrhage in an animal model

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Feasibility of ultrasound application in pre-hospital treatment of traumatic cerebral hemorrhage in an animal model