Experimental Study On Quantitative Evaluation Of Hepatic Microcirculation Perfusion In Hemorrhagic Shock By Contrast-enhanced Ultrasound

BackgroundHemorrhagic shock is a common acute and severe clinical disease,while theblood flow of microcirculation over the body is sharply reduced,cells are generally hypoxic damaged and vital organs are characterized by a pathological process.It is the most common cause of early trauma death.Early fluid resuscitation was the main therapy for uncontrolled traumatic hemorrhagic shock.At present,the main problem of the treatment is how to assess the organization perfusion effectively during the process.With the development of real and contrast ultrasound technique,it is possible for us to display small vessels by ultrasound,when contrast medium particles reachthe organs and tissues,its number can reflex imbue state of microcirculation.The liver is one of organs that subject to damage during the process of hemorrhagic shock,and the liver damage can further lead to systemic metabolic disorders,DIC,MODS,and eventually lead to death.Therefore,the monitoring of hemorrhagic shock during liver perfusion is crucial.This article focused on the establishment of a platform which can conveniently and accurately monitor the state of hemorrhagic shockandquantitatively evaluate hepatic microcirculation perfusion in hemorrhagic shock by contrast-enhanced ultrasound.With regard to this study:Purpose:To investigate the value of contrast-enhanced ultrasound(CEUS)in monitoring hepatic parenchymal perfusion quantitatively during the hemorrhagic shock(HS).Materials and Methods:Experimental materialsLOGIQ-E9 ultrasound diagnostic equipment,9L-D probe,SonoVue,3%pentobarbital sodium,normal saline,heparin sodium,intravenous catheter.MethodsPart one:CEUS was performed in 10 healthy rabbits with GE LOGIQ-E9 by using 6 different doses of SonoVue(0.05ml/kg、0.10ml/kg、0.15ml/kg、0.20 ml/kg、0.25ml/kg、0.30 ml/kg).The quantitative parameters of the time-intensity curve(TIC)were measured and statistically compared.Part two:We usedthe Wiggers’ Improvement Act,and exsanguinatethrough the common carotid artery in 60ratsdivided in 3 groups by complete random bisectionand keep the mean arterial pressure at the70%,50%and 40%normal level to establish the hemorrhagic shock rabbit model.CEUS examination was carried out before and 30 mins after the stable HS statefor each group,then the quantitative parameters of the time-intensity curve(TIC)were measured and statistically compared.Arterial blood was collected for blood lactic acid(LAC),AST and ALT test in each group.Finally,the rabbits were sacrificed and the liver tissues were taken for pathological examination.Part three:We used the Wiggers’ Improvement Act,and exsanguinatethrough the common carotid artery in 60ratsdivided in 3 groups by complete random bisectionand keep the mean arterial pressure at the 40%normal level for 1h,2h and 3h to establish the hemorrhagic shock rabbit model.CEUS examination was carried out before and after the establishment of the HS modelfor each group,then the quantitative parameters of the time-intensity curve(TIC)were measured and statistically compared.Arterial blood was collected for blood lactic acid(LAC),AST and ALT test in each group.Finally,the rabbits were sacrificed and the liver tissues were taken for pathological examination.Results:1.The parametersof TIC are influenced intensely by different doses of SonoVue.The dose of 0.10 ml/kg appears to be the optimal dosefor CEUS in examining liver of healthy rabbit.2.Compared with pre-modeling,for mild HS group,AUC decreased(P<0.05);for moderate and severe HS groups,TTP and RT were delayed,and PIand AUC decreased(P<0.05),with obvious differences between groups(P<0.05);for severe HS group,AT was delayed(P<0.05).Compared with pre-modeling,the lactic acid(LAC)in each groupincreased significantly,the liver function indexes were changed in different degrees,and the degree of liver cell pathological changes was closely related to the degree of HS3.Compared with pre-modeling,for severe HS group,PI and AUC were decreased;AT,TTP and RT were delayed,(P<0.05).PIand AUC showed significant differencebetween each time point(P<0.05);for TTP,RT and AT,the statistical differences were seen in different degrees.Compared with pre-modeling,the lactic acid(LAC)and the liver function indexes were increased significantly,and the liver cell pathological was also changedin different degrees.Conclusion:CEUS can quantitatively evaluate the changes of hepatic parenchymal perfusion during HS resuscitation,which has a certain reference value for clinical treatment.