肢体枪弹伤致心脏间接损伤后心功能改变的超声研究

目的 :应用超声技术阐明肢体枪弹伤致心脏间接损伤后的心功能改变。方法 :2 3只猪随机分为致伤组 18只 ,对照组 5只 ,采用高速弹射击致伤组后肢。致伤组致伤前后均接受传统超声心动图的整体心功能检测及多普勒组织成像的局部心功能检测 ,并且伤后均作心脏病理检查 ,以心肌出现组织学改变为心脏间接损伤发生标准 ,致伤组有 10只发生损伤 （列为效应组 ） ,另外 8只无损伤发生 （列为非效应组 ）。结果 :非效应组致伤前后左室整体或局部舒张及收缩功能均无差异 （P>0 .0 5 ）。效应组致伤前后左室整体或局部收缩功能无变化 （P>0 .0 5 ） ,而伤后局部舒张功能降低 （P<0 .0 1或 P<0 .0 5 ）。效应组致伤前后整体舒张功能也无变化 （P>0 .0 5 ） ,但逐例分析伤后效应组有 4例整体舒张功能降低 ,平均每例舒张功能受累的心肌节段数目为 6个 ,而效应组中另外 6例整体舒张功能正常者每例仅累及 2 .1个心肌节段。结论 :1应用传统超声心动图并结合多普勒组织成像可以全面、客观评价枪弹伤后心功能改变。 2肢体枪弹伤致心脏损伤后 ,首先出现舒张功能 （整体或局部 ）下降 ,而收缩功能可仍属正常。 3整体舒张功能的降低可能与舒张功能低下的心肌节段数目有关。而当整体舒张功能正常时 ,也可能已存在有局部舒张功能的降低

Ultrasound study of the changes in ventricular function after heart impairment following gunshot wound in the limb

AIM: To evaluate the heart function after heart impairment following a gunshot wound in the limb with compound ultrasound. METHODS: 23 pigs were divided into the wound group ( n =18) and the control group ( n =5). The wound group were further divided into two groups: the effected group ( n =10) and none effected ( n =8) according to the myocardial histological changes after high velocity gunshot wound in single thigh. All the animals in the wound group were studied for global and regional heart functions with traditional echocardiography and Doppler Tissue Imagine (DTI) before and after the gunshots. RESULTS:In the none effected group,no changes were found in the global and regional ventricular functions, not only the diastolic, but also the systolic, before and after gunshot ( P >0.05). The global or regional systolic functions in the effected group showed no changes either( P >0.05), the regional diastolic dysfunction was found in the effected group( P <0.01 or P <0.05). Though the global diastolic function in the effected group did not decrease after the gunshots ( P >0.05), individual animal analysis showed global diastolic dysfunction in 4 pigs. In these 4 pigs ,the number of myocardial segments with impaired diastolic function averaged 6, thus the other 6 pigs in the effected group averaged 2.1. CONCLUSION: The changes in heart function following a gunshot can be evaluated thoroughly and objectively with traditional echocardiography and DTI. The diastolic function of heart is firstly impaired while the systolic function may be normal after heart impairment following a gunshot in the limb. The global diastolic dysfunction probably correlates with the number of myocardial segments with impaired diastolic function, sometimes when global diastolic function is still normal, the regional diastolic function may have been impaired.