摘要
目的探讨超声造影(contrast-enhanced ultrasound,CEUS)在糖尿病创面治疗中的作用。方法收集2021年4月–2022年7月间在我院做过创面超声造影检查的27例糖尿病患者临床资料。26例为糖尿病足溃疡患者,其中5例在住院期间做了截肢手术;1例为臀部溃疡患者。27例患者平均年龄(64.08±12.57)岁;空腹血糖3.36~34.61 mmol/L,平均(10.62±8.77)mmol/L;糖化血红蛋白5.80%~10.70%,平均7.96%±1.50%。采用Philips EPIQ7超声诊断仪,L9-3线阵探头,频率3~9 MHz。首先用常规超声检查患者溃疡处,观察有无异常回声。再经肘部静脉注射造影剂SonoVue(Bracco公司)2.4 mL,寻找病变区有无积液/脓、窦道或死腔,同时采集图像。结果27例患者中除5例为截肢残端外,22例患者创面0.16~215 cm2,均伴有窦道形成。10例患者在治疗过程中进行超声检查,常规超声检查阳性率为50%(5/10),发现创面深面积液/脓及假性动脉瘤;CEUS检查阳性率为100%(10/10),在常规超声未查出异常的5例患者溃疡深面发现了较大的窦道或死腔。上述27例患者,其中17例在出院前进行了超声复查创面深部窦道、死腔等愈合情况:常规超声复查未发现伤口深面窦道,CEUS发现10例患者创面深部较小的死腔或窦道,常规超声及CEUS检查均发现1例患者截肢残端存在少量积液;而其余6例复查患者,常规超声及CUES检查均未发现创面深部窦道等异常情况,创面完全愈合。结论通过CEUS检测糖尿病创面微血管灌注,可在治疗过程中观察窦道范围,出院前观察窦道是否痊愈或仍有死腔,为糖尿病创面治疗临床决策提供参考依据。
Objective To investigate the role of contrast-enhanced ultrasound(CEUS)in the treatment of diabetic ulcers.Methods The clinical data of 27 diabetic patients,who underwent CEUS examination of their ulcers in our hospital between April 2021 and July 2022 were collected.Among them,26 patients suffered from diabetic foot ulcers,5 of whom underwent amputation during hospitalization,and one patient suffered from hip ulcer.The 27 patients’mean age was(64.08±12.57)years.Fasting blood glucose levels of the patients were 3.36-34.61 mmol/L,with a mean of(10.62±8.77)mmol/L.Their glycosylated hemoglobin levels were 5.80%-10.70%,with an average of 7.96%±1.50%.Philips EPIQ7 ultrasound system with L9-3 linear probe of 3-9 MHz was used.First,the patients’ulcers were examined with conventional ultrasound to observe for abnormal echo.Then,2.4 mL SonoVue(Bracco,Italy),a contrast agent,was injected intravenously through the elbow to look for effusion/pus,sinus tract,or dead space in the lesion area,and images were acquired.Results Among the 27 patients,except for 5 with amputation stumps,22 patients had wound areas ranging from 0.16 cm2 to 215 cm~2,all being accompanied by sinus tract formation.Ten patients underwent ultrasound examination during their treatment.The positive rate of the results of conventional ultrasound was 50%(5/10)for identifying effusion/pus and pseudoaneurysm in the deep area of ulcers,while the positive rate of CEUS results was 100%(10/10).In addition to the lesions found by conventional ultrasound,CEUS also found large sinus tracts or dead spaces in the deep surface of ulcers in 5 additional patients.Of the 27 patients,17 underwent ultrasound examination of the healing status of sinus tracts and dead spaces in the deep areas of ulcers before discharge.No sinus tracts in the deep areas of the ulcers were found by conventional ultrasound.However,relatively small dead spaces or sinus tracts in the deep areas of the ulcers were found in 10 patients by CEUS.Conventional ultrasound and CEUS found that 1 patient had a small amount of fluid in the amputation stump.In the remaining 6 patients,no deep sinus tracts in the ulcers were found by either conventional ultrasound or CUES,and the ulcers healed completely.Conclusion By examining microvascular perfusion in diabetic wounds with CEUS,we can observe the extent of sinus tracts during treatment and whether the sinus tracts have healed or whether there are still dead spaces before patient discharge,which provides support for clinical decision-making concerning the treatment of diabetic ulcers.
作者
韩丽娜
文晓蓉
高赟
陈大伟
王椿
冉兴无
HAN Li-na;WEN Xiao-rong;GAO Yun;CHEN Da-wei;WANG Chun;RAN Xing-wu(Department of Ultrasound Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Endocrinology,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2023年第1期171-175,共5页
Journal of Sichuan University(Medical Sciences)
基金
四川大学华西医院卓越发展1-3-5项目工程(No.ZYGD18025)资助
关键词
超声造影
糖尿病足溃疡
糖尿病创面
微血管灌注
Contrast-enhanced ultrasound
Diabetic foot ulcer
Diabetic wound
Microvascular perfusion
