DSA对小肠血液循环状况的评估价值

Value of DSA to Evaluate the State of the Small Intestinal Circulation

目的 探讨数字减影血管造影术 (DSA)对小肠血液循环状况的评估价值。方法 健康杂种犬 7只 ,随机分为三组 :正常组 (n =2 )、血管加压素组 (n =2 )和直动脉结扎组 (n =3 )。分别于正常状态、血管加压素作用状态 (静滴后 1h、滴注完毕后 3 0min及 2h)和直动脉结扎状态下行肠系膜前动脉和 (或 )小肠动脉造影 ,观察血管造影表现 ,并检测各种状态下实验肠段肠壁血液pH ,PO2 。 1周后切除实验肠段病检。结果 ( 1)正常组犬肠系膜前动脉造影示血管树显示完整 ,各级分支丰富 ,肠实质对比剂显影浓密。小肠动脉造影示血管弓、直动脉和肠壁内血管网显示清晰。造影前后 pH及PO2 值无明显差异 ,病检结果为正常。 ( 2 )血管加压素组犬于静滴血管加压素后肠系膜动脉分支收缩 ,肠实质对比剂显影变浅淡。停药后 3 0min分支收缩基本消失 ,但肠实质显影仍浅淡。停药 2h后完全恢复正常。各时间点pH及PO2 值无明显差异 ,病检结果正常。 ( 3 )直动脉结扎组结扎区对比剂显影密度明显减低 ,但见侧支供血。pH及PO2 值于结扎后 15min时明显降低 ,但于 1h时回升。病检示肠黏膜轻度缺血性损伤。结论 DSA可较全面、准确的显示各种状态下小肠血液循环的状况 ,并能明确显示缺血肠段侧支血供的有无。

Objective To study the value of DSA to evaluate the state of small intestinal circulation. Methods Seven dogs were divided into three groups.The normal group( n =2),vasopressin group( n =2) and vasa recta ligation group( n =3).Angiography was performed on the normal state,the effective state of vasopressin(1h after vasopressin infusion,30min and 2hr after the infusion ended) and the state of vasa recta ligation.Blood pH and PO 2 of the intestinal wall were measured on all groups.The tested parts of intestine were resected to observed the histologic changes a week later. Results (1)The branches of mesenteric arteries were rich, and the contrast developed strong in the intestinal wall in normal group. Blood pH and PO 2 of the intestinal wall was normal,so as the pathologic examination result.(2) All branches of mesenteric arteries contracted and the contrast developed lightly in the intestinal wall after vasopressin infusion.The branches contrasted recovered at 30min after infusion ended,but the contrast developed in the intestinal wall still slight .All manifestation of DSA recovered to normal 2hr after the infusion ended.Blood pH and PO 2 value of the intestinal wall had no significant difference before and after the infusion.The pathologic examination result was normal.(3) The contrast developed slightly significantly in the area of the vasa recta ligation,but the collorate presented soon.Blood pH and PO 2 of the ligated intestinal wall fell significantly 15min after ligation, and they all increased in an hour. The pathologic examination proved that there was mild mucosal ischemia. Conclusion DSA can demonstrated the different state of the circulation of the intestine,and can show the conditions of the collorate of the ischemia part of the intestine,too.