Quantitative Analysis Of Hepatic Blood Flow In Rabbits With Hemorrhagic Shock During Fluid Resuscitation By Contrast-enhanced Ultrasound

BackgroundHemorrhagic shock is a common acute and severe clinical disease,while the blood flow of microcirculation over the body is sharply reduced,cells are generally hypoxic damaged and vital organs are characterized by a pathological process.Multiple organ dysfunction caused by hemorrhagic shock is a main cause of death.When acute hemorrhagic shock happens,the body organisms employ many kinds of compensatory mechanism to maintain perfusion,especially for the heart and the brain.Liver has two blood supplies-portal venous system and hepatic arterial systemprone to blood supply drastically reduced or interrupted,so that the corresponding hepatocyte will be undering serious and sustained acute ischemia.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.This article focused on the establishment of a platform which can conveniently and accurately monitor the state of hemorrhagic shock and its application in monitoring hepatic parenchymal perfusion quantitatively during the fluid resuscitation of hemorrhagic shock.With regard to this study:Purpose:To investigate the value of contrast-enhanced ultrasound(CEUS)in monitoring hepatic parenchymal perfusion quantitatively during the recovery period of 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,sodium lactate ringer's injection,hydroxyethyl starch injection.MethodsPart one:We used the Wiggers Improvement Act,and exsanguinate to establish the hemorrhagic shock rabbit model.Then colloidal solution(hydroxyethyl starch))was applied for recovery of the animal model,CEUS examination was carried out 1h,4h and 24h after recovery,HS without recovery and normal rabbit were also included.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 two:We used the Wiggers Improvement Act,and exsanguinate to establish the hemorrhagic shock rabbit model,then crystalloid solution(sodium lactate Ringer's injection)was applied for recovery of the animal model.CEUS examination was carried out 1h,4h and 24h after recovery,HS without recovery and normal rabbit were also included.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:Part one:Compared with the normal control group,AT and TTP of shock group were significantly prolonged,and PI and AUC decreased(P<0.05).In resuscitation groups,for 1h group,PI and AUC increased,and AT decreased(P<0.05).Compared with shock group,for 1h group,PI and AUC increased,and AT decreased(P<0.05);for 4h and 24h group,all parameters were statistically significant(P<0.05).Compared with the normal control group,the levels of ALT,AST and LAC in the shock group were significantly higher than those in the control group(P<0.05).Compared with the shock group,AB(P<0.05),LAC(P<0.05)in the normal control group and the resuscitation group.Part two:Compared with the normal control group,AT and TTP of shock group were significantly prolonged,and PI and AUC decreased(P<0.05).In resuscitation groups,for 1h group,PI and AUC increased,and AT decreased(P<0.05).Compared with shock group,for 1h group,PI and AUC increased,and AT decreased(P<0.05);for 4h and 24h group,all parameters were statistically significant(P<0.05).Compared with the normal control group,the levels of ALT and LAC in the shock group were significantly higher than those in the control group(P<0.05).Compared with the shock group,ALT and AST were increased in the recovery group(P<0.05),AST(P<0.05),LAC(P<0.05)in the normal control group and the resuscitation group.Conclusion:CEUS can quantitatively evaluate the changes of hepatic parenchymal perfusion during HS resuscitation,which has a certain reference value for clinical treatment.