不同机械指数超声联合微泡溶栓的应用进展

Advances in the Application of Ultrasound at Different Mechanical Indices Combined with Microbubbles for Thrombolysis

摘要: 文章系统综述了不同机械指数超声联合微泡造影剂在溶栓治疗中的应用现状与机制进展。超声通过机械效应与空化效应作用于微泡，可有效促进血栓溶解，其中机械指数是影响溶栓效率与安全性的关键参数。研究显示，低机械指数超声以稳定空化为主，适用于实时成像与微泡输注；高机械指数超声则能诱导瞬态空化，显著增强溶栓效果，尤其在急性心肌梗死和缺血性脑卒中模型中表现出良好的血管再通与组织灌注改善作用。然而，高机械指数可能伴随血管内皮损伤、微出血等风险，其临床安全性仍需深入评估。未来研究应着力于优化超声参数组合、开发靶向功能化微泡，并推动多模态影像引导下的个体化溶栓治疗，以实现该技术向临床的安全、高效转化。

Abstract: This review comprehensively summarizes the current applications and mechanistic insights into thrombolytic therapy utilizing ultrasound at different mechanical indices combined with microbubble contrast agents. Ultrasound exerts its thrombolytic effects primarily through mechanical and cavitation effects mediated by microbubbles, with the mechanical index (MI) being a pivotal parameter influencing both efficacy and safety. Evidence indicates that low-MI ultrasound, characterized by stable cavitation, is suitable for real-time imaging and microbubble infusion, whereas high-MI ultrasound induces inertial cavitation, significantly enhancing clot dissolution—particularly demonstrating favorable vascular recanalization and tissue perfusion improvement in models of acute myocardial infarction and ischemic stroke. Nevertheless, the potential risks associated with high-MI exposure, including vascular endothelial injury and micro-hemorrhage, warrant careful consideration and further safety evaluation. Future research should focus on optimizing the combination of ultrasound parameters, developing targeted, stimulus-responsive microbubbles, and advancing multimodal, image-guided, personalized thrombolytic strategies to achieve safe and efficient clinical translation.