Assesment On Vascular Perfusion In Transplated Liver With Acute Rejection By Color Doppler And Contrast-enhanced Ultrasonography

ObjectivesNew enhanced ultrasound technology is a quantum jump in image medical domain consisted of neotype acoustic contrast agent and new visualization technology recent years. It brings great helps to madical research, clinical diagnosis and treatment. Exploratory researches on it develop extensively and achieve plentifully in many medical fields. It can real-time display and quantitatively analyze the perfusion objective by using neotype microbubble as tracer agent of red blood cell, to unite to make use of ultaharmonic contrast imaging of recent to development to stand up and the analytical technique of acoustic densitometry. Liver transplantation is only availability method to cure hepatocirrhosis, liver tumour and terminal liver's sickness. (1)To evaluate the clinical value of Pulse inversion harmonic (PIH) contrast and QLAB by comparing perfusion of liver transplantation. (2)To evaluate the value of intermittent Pulse inversion harmonic (PIH) and QLAB in perfusion of acut liver transplantation rejection.Methods 20 healthy Banna's pigs are selected, that the old is five or six months and the weight range in 10Kg to 15Kg. We divide them into the provider and the receiver, then operated the original liver replanting. The patients had been forbade to eat 24 hours and to drink 12 hours before surgery. Foundation anaesthesia appearance next a windpipe puts to take care of the machine to control the breath, the vein give vecuronium, the ketamine and stabilize maintenance anaesthesia. The intravenous injection heparin 5 Us/ kg goes the heparin to turn. Take the belly to slice exact center, ascend from down the xiphoid process next, descend to the disgrace bone consociation, swim to leave the liver for week ligaments, dissect common bile duct, liver artery, inferior vena cava. After the liver cooling, the surface takes out the liver after present the even and yellow white, being place in 4℃s to take the ice physiology brine quickly, going to be provided for liver to fix whole. Each piping move provide the liver into is subjected to the body belly cavity after fix wholely, carrying to sew up to fit together the liver top and bottom inferior vena cavaand a veins continuously, openning a vein, after liver next bottom the inferior vena cava put the blood 100 mls clip again to shut, open the liver top and bottom inferior vena cava immediately, the be over has no liver period. Use hot brine in order to transplant the liver and belly cavity internal organs machines to reply, the liver color is rosy, the stomach and intestines color is turned into by the dark red normal. Sew up fit together the liver next bottom the inferiorvena cava, open the liver next bottom the inferior vena cava, check each blood vessel to fit together. Sew up to fit together the liver artery, sew up to keep on the heparin brine to flush to take care of the inferior vena cava in the process, the blood bolts the formation after prevent°froming the surgery. With the diameter about a tube method of the 3 mms carry to fit together the manager of gall bladder. Use hot brine to soak the belly cavity internal organs machine again and again, raise the body temperature of the pig to the satisfied level. In liver descend place the cigarette to lead to flow to take care of a, the pass stomach. Adopt the oneself does to check against in front and back, surgery front, the surgery observes each bio-chemical index sign of serum closely behind, with normal matched control in be of front of surgery; After the surgery the 1 d did not take place the conduct and actions of reject the reaction to reject to respond the set not; After the surgery the 7 ds appears the conduct and actions acute that the acute rejects the reaction to reject to respond the set( the nasty row set). Hereat three time orders to go the thick needle liver substance to live the check, examining a patient to be the standard of gold with the pathology. The acute that transplants the liver is rejected the general occurrence in 7-14 ds, the pathologic confirmation transplants the liver occurrence the acute rejects the reaction. Succeed to set up the pig acute rejects to respond 8 of model,. ( the surgery dies 1 on that day behind, dying the reason as impatient pulmonary edema, the surgery dies 1 the second day behind, dying the reason to fit together a people for the manager of amphibolic fistula) The super voice of the company iU22 of Philip examines a patient the instrument, the L3.5-5 stretch forward( the frequency 3.5-5 MHzs), the Pulse inversion harmonic to be like the way( shoot the frequency 2.1 MHzs, receive the frequency 4.2 MHzs), experimenting to keep the machine index number, compress to increase the benefit in expiation of etc. condition with time each time constant, build under condition of visualization the machine index number(MI) establishes to 0.07. After the surgery front and surgerys after the 1 d, surgery the 7 ds carries on was learn by the vein voice to build the visualization be like, and in it accept a check in front and back 24 hs, measurement the animal model serum various bio-chemical index signs. Experiment the animal takes the left side half to lie, choosing the right and ex- leaf of liver after a cross section of rib conduct and actions observation slice the noodles, first make super voice of normal regulations sweep to check, obtain the satisfaction to slice to face, stretch forward to fix motionless, turn to go in to build the condition of visualization, build the of Ultrasound Contrast Agents after the vein 0.02/ kg/ml weight regiment note the whole fluorine to show, connect it flush the piping with the 2 ml physiology brine, collect synchronously keep keep both start infuse into go to inject 3 minutes of continuous dynamic state voice is like the diagram, pressing this to repeat once. Go the thick needle liver substance to live the check and send the pathologic check after experimenting the be over. Picture analysis: Copy the original dynamic state picture that the iU22 instrument hard drive save, leave the machine computer analysis. ( also can analyze on the instrument)Open the QLAB analysis software, the interested in area(ROI) place in in accordance with the voice the bunch the perpendicular liver substance inside, and keep same depth, position and scope basically. Dilimit the interested in area hour should avert from the bigger blood vessel, to reduce the influence to the TIC. ROI should as far as possible big, in order to reduce the sampling error margin. Choose the gamma regression draws up to match the way, drawing up to match a TIC time- strength curve, acquiring the following parameter with this: The①curve rising pays the inclined rate(A); The curve of②descends to pay the inclined rate(Alpha) beginning of③to start the DB(C)④curve rising beginning to start time(t(0)) curve of⑤to accumulate( the Area under the curve, AUC) the⑥to reach the peak absolute value DB( the Derived peak intensity, DPI)⑦to reach time of peak below( the Time to peak, TTP)Result(1)Normal matched control, reject the set and the nasty row a TIC parameters to compare not: Build the movie queen nasty row set and did not transplant more ex- and normal transplant AUC to descend( P＜0.05) obviously, but the parameter A, Alpha, C, t(0), DPI did not see the obvious difference. (P＞0.05)The nasty row a peak value obvious low in don't before transplant and normal transplantation liver set. (2)Normal matched control, reject the set and the nasty row sets to analyze the result comparison not: The nasty row set compares with normal matched control, the difference of the ALT, AST, TBIL, IBIL, DBIL all shows the covariance of prominence to learn the meaning(P＜0.05), the rest and bio-chemical index sign difference all did not statistics to learn the meaning; (P＞0.05) Reject the set to compare with normal matched control not, the above-mentioned bio-chemical index sign difference all did not statistics to learn the meaning. (P＞0.05)ConclusionThe voice learn to build the visualization shows the notability to raise to organize the structure and tiny and circulating cognition degrees towards transplanting the liver at towards transplanting the liver of monitor,, and improved the voice of the liver to learn the picture, infusing to note to the blood of the liver also gradually from settle sex alignment fixed amount research(1) this experiment enunciation to was learn by the vein voice to build the pulse of visualization antimutually the wave of Pulse inversion harmonic to be like the technique combine a the voice learn the metered technique is to prognosticate the different body transplantation liver blood to infuse to note of valid examination means. (2)The parameter of TIC that this kind method acquisition get measures to the metered estimate the occurrence that the different body transplants the liver to reject contain higher value. Have good applied foreground towards transplanting after the liver trasplantation surgery behind the diagnosis of the nasty row.