摘要：
目的·評估超聲形成的聲學(xué)力能否減少心臟手術(shù)后進(jìn)入腦血管的微栓.方法·實(shí)驗(yàn)用小型豬7頭,3頭豬用于注射氣體微栓,3頭豬用于注射固體微栓,另1頭豬用于檢測超聲能量對于組織有無損傷.常規(guī)麻醉后游離并暴露右頸總動(dòng)脈、左心耳、升主動(dòng)脈和近端無名動(dòng)脈.于左心耳插入一根冷灌針頭,用于注射氣體微栓或固體微栓.將制作好的水囊超聲探頭置于升主動(dòng)脈與無名動(dòng)脈分叉處.另一超聲探頭置于右頸總動(dòng)脈用于檢測微拴.分別于關(guān)閉和開啟超聲能量后注射微栓混懸液10 mL(氣體或固體),各重復(fù)3次,觀察超聲屏蔽前后通過右頸總動(dòng)脈的微栓變化.對造影動(dòng)態(tài)圖像進(jìn)行時(shí)間-強(qiáng)度曲線分析.另取1頭豬,將水囊超聲探頭置于升主動(dòng)脈與無名動(dòng)脈分叉處,用同等強(qiáng)度的超聲能量輻射5 min,之后分別于超聲照射部位及非照射部位取少量主動(dòng)脈、氣管、食管組織,行蘇木精-伊紅染色(H-E染色).結(jié)果·超聲結(jié)果表明,在超聲能量輻射后注射微栓,右頸總動(dòng)脈內(nèi)關(guān)注區(qū)的超聲均值強(qiáng)度較未經(jīng)超聲能量輻射注射微栓時(shí)顯著下降.其中氣體微栓的超聲均值強(qiáng)度由未經(jīng)輻射的128.8±32.7降至輻射后的56.4±21.1(P=0.000);固體微栓的超聲均值強(qiáng)度由未經(jīng)輻射的109.8±19.9降至輻射后的75.4±21.9(P=0.000).超聲輻射部位與非超聲輻射部位的主動(dòng)脈、氣管、食管的組織結(jié)構(gòu)無明顯差異.結(jié)論·采用超聲輻射能夠有效屏蔽術(shù)中產(chǎn)生的微栓,減少隨血流進(jìn)入腦血管的微栓數(shù)目,可能有助于降低心臟外科手術(shù)后神經(jīng)系統(tǒng)并發(fā)癥的發(fā)生.%Objective·To evaluate if ultrasound acoustic force can reduce cerebrovascular micro-emboli after cardiac surgery. Methods·Seven pigs were used during the experiment, three for air emboli injection, three for solid emboli injection, and one for safety study. After anesthesia, right carotid artery, left atrial appendage, ascending aorta, and proximal innominate artery were exposed surgically. An intravenous catheter was inserted into left atrial appendage for injecting air or solid micro-emboli. The ultrasound transducer was placed at the bifurcation of the aorta and the innominate artery, with the sonic beacon toward the descending aorta. Micro-emboli through the right carotid artery were monitored by ultrasound transducer. Micro-emboli mixture (10 mL, air emboli or solid emboli) was injected with or without ultrasonic activation, each repeating three times. Micro-emboli through right carotid artery were measured under each condition. Ultrasonic time-intensity curves were performed and analyzed. For safety test, ultrasound with the same energy on a pig for 5 minutes was applied. The tissue samples were obtained for pathological evaluation from sonicated and non-sonicated areas of the aorta, trachea and the esophagus. Results·Ultrasonic time-intensity curve showed that the mean ultrasonic intensity of the right common carotid artery significantly decreased after ultrasonic activation. The intensity of air emboli reduced from 128.8±32.7 to 56.4±21.1 (P=0.000), while the intensity of solid emboli reduced from 109.8±19.9 to 75.4±21.9 (P=0.000). H-E staining of the surrounding tissues showed no differences between sonicated and non-sonicated areas of the aorta, trachea and the esophagus. Conclusion·Ultrasonic acoustic force can decrease the number of micro-emboli that enter the brain. Thus, it may lower the risk of postoperative neurological complications after cardiac surgery.
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