聂文畅,刘健

• 1:北京大学人民医院心血管内科

摘要(Abstract)：

超声溶栓技术依赖于超声波在血流中的空化效应——即超声束在血流中促进微气泡产生、破裂，进而激发的局部冲击力。前期基础研究初步证实了超声对不同类型血栓的溶解能力，结合微泡对比剂使用可增强空化效应，在经颅多普勒超声中用作缺血性卒中患者的血运重建治疗。近些年已有临床研究表明，经胸高机械指数超声联合微泡对比剂溶栓治疗在ST段抬高型心肌梗死（STEMI）患者中可改善即刻心肌灌注和远期心肌重塑。这一结论为改善STEMI患者的预后提供了新思路，也对技术本身赋以展望。本文将从高机械指数超声联合微泡对比剂溶栓在STEMI患者中的应用方法、溶栓机制、现状和展望方面阐释超声溶栓技术的研究进展，以期提高临床认识，使STEMI患者获益。

关键词(KeyWords)： 高机械指数超声;微泡对比剂;ST段抬高型心肌梗死

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金重点项目（11832003）;; 北京大学人民医院研究与发展基金临床研究培育项目（RDL2020-11）

作者(Author): 聂文畅,刘健

参考文献(References)：

• [1] Nazer B,Gerstenfeld EP,Hata A,et al.Cardiovascular applications of therapeutic ultrasound[J].J Interv Card Electrophysiol,2014,39(3):287-294.
• [2]Christian Kollmann.Diagnostic ultrasound Imaging:Inside out[J].Ultraschall Med,2004,25(6):407.
• [3]Medel R,Crowley RW,McKisic MS,et al.Sonothrombolysis:an emerging modality for the management of stroke[J].Neurosurgery,2009,65(5):979-993.
• [4]Mathias W Jr,Tsutsui JM,Tavares BG,et al.Sonothrombolysis in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention[J].J Am Coll Cardiol,2019,73(22):2832-2842.
• [5]IEC 60601-2-37:Medical electrical equipment-Part2-37:particular requirements for the basic safety and essential performance of ultrasonic medical diagnostic and monitoring equipment.2015[C/OL].(2015-06)[2022-04-17].https://www.antpedia.com.
• [6]周刚,何培忠,寿文德,等.超声诊断设备的热指数、机械指数的定义和测量方法[J].声学技术,2004,23(S2):87-92.
• [7]Kutty S,Wu J,Hammel JM,et al.Microbubble mediated thrombus dissolution with diagnostic ultrasound for the treatment of chronic venous thrombi[J].PLoS ONE,2012,7(12):e51453.
• [8] Pacella JJ,Brands J,Schnatz FG,et al.Treatment of microvascular micro-embolization using microbubbles and longtone-burst ultrasound:an in vivo study[J].Ultrasound Med Biol,2015,41(2):456-464.
• [9] Doelare SAN,Jean Pierre DM,Nederhoed JH,et al.Microbubbles and ultrasound accelerated thrombolysis for peripheral arterial occlusions:the outcomes of a single arm phaseⅡtrial[J].Eur J Vasc Endovasc Surg,2021,62(3):463-468.
• [10]Unger E,Porter T,Lindner J,et al.Cardiovascular drug delivery with ultrasound and microbubbles[J].Adv Drug DelivRev,2014,72:110-126.
• [11]聂新斌,张德浩,颜伟城.功能型微泡材料的研究进展[J].化工学报,2021,72(8):3984-3996.
• [12]Roos ST,Juffermans LJM,van Royen N,et al.Unexpected high incidence of coronary vasoconstriction in the reduction of micro vascular injury using sonolysis(ROMIUS)trial[J].Ultrasound Med Biol,2016,42(8):1919-1928.
• [13]Li H,Lu Y,Sun Y,et al.Diagnostic ultrasound and microbubbles treatment improves outcomes of coronary no-reflow in canine models by sonothrombolysis[J].Crit Care Med,2018,46(9):e912-e920.
• [14]Lindner JR.Therapeutic contrast echocardiography:bubbles become medicine.[J].J Am Coll Cardiol,2019,73(22):2843-2845.
• [15]Aguiar MOD.Tavares BG,Tsutsui JM,et al.Sonothrombolysis improves myocardial dynamics and micro vascular obstruction preventing left ventricular remodeling in patients with ST elevation myocardial infarction[J].Circ Cardiovasc Imaging,2020,13(4):e009536.
• [16]Menees DS,Peterson ED,Wang Y,et al.Door-to-balloon time and mortality among patients undergoing primary PCI[J].N Engl J Med,2013,369(10):901-909.
• [17]Niccoli G,Scalone G,Lerman A,et al.Coronary micro vascular obstruction in acute myocardial infarction[J].Eur Heart J,2016,379(13):1024-1033.
• [18]Kim JS,Kim J,Choi D,et al.Efficacy of high-dose atorvastatin loading before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction:the STATIN STEMI trial[J].JACC Cardiovasc Interv,2010,3(3):332-339.
• [19] Petronio AS,De Carlo M,Ciabatti N,et al.Left ventricular remodeling after primary coronary angioplasty in patients treated with abciximab or intracoronary adenosine[J].Am Heart J,2005,150(5):1015.
• [20] Ross AM,Gibbons RJ,Stone GW,et al.A randomized,double-blinder,placebo-controlled multicenter trial of adenosine as an adjunct to reperfusion in the treatment of acute myocardial infarction(AMISTAD-Ⅱ)[J].J Am Coll Cardiol,2005,45(11):1775-1780.
• [21]Tsutsui JM,Elhendy A,Anderson JR,et al.Prognostic value of dobutamine stress myocardial contrast perfusion echocardiography[J].Circulation,2005,112(10):1444-1450.
• [22]Mott B,Ammi AY,Le DE,et al.Therapeutic ultrasound increases myocardial blood flow in ischemic myocardium and cardiac endothelial cells:results of in vivo and in vitro experiments[J].J Am Soc Echocardiogr,2019,32(9):1151-1160.
• [23]Suchkova VN,Baggs RB,Sahni SK,et al.Ultrasound improves tissue perfusion in ischemic tissue through a nitric oxide dependent mechanism[J].Thromb Haemost,2002,88(5):865-870.
• [24]邹青钦,秦对.超声激励微泡空化对周围组织的力学效应分析[J].医用生物力学,2021,36(S1):416.
• [25]El Kadi S,Porter TR,van Rossum AC,et al.Sonothrombolysis in the ambulance for ST-elevation myocardial infarction:rationale and protocol[J].Neth Heart J,2021,29(6):330-337.
• [26]Wu J.Shear stress in cells generated by ultrasound[J].Prog Biophys Mol Biol,2007,93(1-3):363-373.
• [27] Brüβler J,Strehlow B,Becker A,et al.Nanoscaled ultrasound contrast agents for enhanced sonothrombolysis[J].Colloids Surf B Biointerfaces,2018,172:728-733.