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| 高空坠落冲击和水下爆炸冲击致比格犬脾损伤的超声表现和造影特点 |
| 张世奇1,许文慧2,李维卿2,黄彦栋1,张丹枫3,侯立军3,刘建湖4,黄禾菁1* |
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(1. 海军军医大学(第二军医大学)第二附属医院超声科, 上海 200003;
2. 海军军医大学(第二军医大学)第二附属医院病理科, 上海 200003;
3. 海军军医大学(第二军医大学)第二附属医院神经外科, 上海 200003;
4. 中国船舶科学研究中心, 无锡 214082
*通信作者) |
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| 摘要: |
| 目的 研究高空坠落冲击和水下爆炸冲击致脾脏的损伤情况及其二维超声和超声造影表现。方法 23只健康比格犬分入高空坠落冲击实验（13只）和水下爆炸冲击实验（10只）。利用自由落体高台装置和克级三硝基甲苯分别模拟比格犬高空坠落冲击损伤和水下爆炸冲击损伤，致伤后立刻对比格犬脾脏行超声检查，每小时复查1次，并对存活犬行超声造影检查。致伤后取死亡犬脾脏标本，观察大体损伤情况，并通过H-E染色观察组织的病理形态学改变及组织内细胞凋亡情况。结果 致伤后高空坠落冲击模型6 m、7 m、8 m和9 m组分别死亡6、2、1、1只，水下爆炸冲击模型中泅渡组和蛙人组分别死亡1、4只。高空坠落冲击模型二维超声检查显示，比格犬有脾破裂（脾实质连续性中断）、脾周积液、被膜下血肿、脾内大血肿、脾静脉回声增高、脾实质回声不均匀等表现；水下爆炸冲击模型二维超声检查显示，比格犬有脾静脉回声增高、脾实质回声不均匀表现，损伤程度较高空坠落冲击模型轻。脾超声造影示2种模型造影剂灌注表现大体分为4型，出现Ⅰ型（造影剂灌注出现局部大范围缺损）、Ⅱ型（造影剂灌注弥漫性缺损）、Ⅲ型（脾静脉内未见造影剂进入）造影表现的比格犬伤后均发生脾破裂。H-E染色结果显示，比格犬脾损伤后存在真性脾破裂、脾内弥漫性出血、脾内血肿/瘀斑、被膜下血肿/瘀斑、静脉内淤血等，与超声检查结果相吻合。结论 高空坠落引起的比格犬脾损伤较水下爆炸严重，常规超声诊断典型脾损伤的准确性较好，而超声造影对不典型脾损伤的评估更有优势且对于迟发性脾破裂具有一定的预判价值。 |
| 关键词: 冲击波 水下爆炸伤 高空坠落伤 超声检查 超声造影 |
| DOI：10.16781/j.CN31-2187/R.20240076 |
| 投稿时间：2024-01-27修订日期：2024-08-27 |
| 基金项目:军队后勤科研计划重点项目（AWS17J003）. |
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| Ultrasonographic features and contrast-enhanced characteristics of splenic injuries caused by high-altitude falling and underwater explosion in Beagle dogs |
| ZHANG Shiqi1,XU Wenhui2,LI Weiqing2,HUANG Yandong1,ZHANG Danfeng3,HOU Lijun3,LIU Jianhu4,HUANG Hejing1* |
(1. Department of Ultrasound, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200003, China;
2. Department of Pathology, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200003, China;
3. Department of Neurosurgery, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200003, China;
4. China Ship Scientific Research Center, Wuxi 214082, Jiangsu, China
*Corresponding author) |
| Abstract: |
| Objective To study the splenic injuries caused by high-altitude falling and underwater explosion and the 2-dimensional ultrasound and contrast-enhanced ultrasound (CEUS) characteristics. Methods Twenty-three healthy Beagle dogs were divided into high-altitude falling group (n=13) and underwater explosion group (n=10).Free-fall high-platform device and gram-grade trinitrotoluene were used to simulate high-altitude falling injury and underwater explosion injury in Beagle dogs, respectively.Ultrasound examination of the spleen was performed immediately after injury, with follow-up examinations every hour.CEUS examination was performed in surviving dogs.Spleen specimens were taken from deceased dogs after injury to observe gross injuries.Pathological changes in tissue morphology and cell apoptosis were observed by hematoxylin-eosin (H-E) staining. Results In the high-altitude falling model, 6, 2, 1, and 1 dogs died in the 6 m, 7 m, 8 m, and 9 m groups, respectively; in the underwater explosion model, 1 and 4 dogs died in the buoyancy and frogman groups, respectively.Two-dimensional ultrasound examination of the high-altitude falling model showed spleen rupture (disruption of splenic parenchymal structure), perisplenic fluid accumulation, subcapsular hematoma, intrasplenic hematoma, increased splenic vein echo, and uneven splenic parenchymal echo.Two-dimensional ultrasound examination of the underwater explosion model showed increased splenic vein echo and uneven splenic parenchymal echo, which were less serious compared with the high-altitude falling model.CEUS results indicated 4 major contrast patterns in both models.The Beagle dogs with type Ⅰ (large focal contrast defect), type Ⅱ (diffuse contrast defect), or type Ⅲ (no contrast agent entry into the splenic vein) contrast patterns all had splenic rupture after injury.H-E staining results showed true splenic rupture, diffuse intrasplenic hemorrhage, splenic hematoma/ecchymosis, subcapsular hematoma/ecchymosis, and venous congestion after spleen injury, which were consistent with the 2-dimensional ultrasound findings. Conclusion High-altitude falling causes more serious spleen injuries in Beagle dogs compared with underwater explosions.Routine ultrasound performs well in diagnosing typical splenic injuries, while CEUS has advantages in evaluating atypical splenic injuries and has good predictive ability for delayed splenic rupture. |
| Key words: shock wave underwater explosion injuries high-altitude falling injuries ultrasonography contrast-enhanced ultrasound |
