急性肺栓塞时左右心室压力容量关系变化的实验研究

Biventricular pressure-volume change in acute pulmonary embolism model

目的:建立急性肺栓塞(APE)动物模型,探讨急性肺栓塞时左右心室压力容量关系变化。方法:成年杂种犬7只,依据动物模型建立过程中不同时段和压力负荷程度分为肺栓塞前组、中度肺栓塞和重度肺栓塞3组,采用漂浮导管经肺动脉内注射缝线线段的方法建立中度APE和重度APE动物模型,并测量心导管压力指标;使用超声心动图声学定量技术获得同步容量指标;两者结合建立左右心室简易压力容量关系。结果:中度APE时,右室压力容量关系图明显向右上移位,面积扩大明显,环的形态由近似三角形向矩型转变;左室压力容量关系图则小幅度左下移位,形态无明显变化;重度APE时,右室压力容量关系图右上移位且面积缩小,形态不规则。左室压力容量关系图则较大幅度左下移位,面积缩小,形态不规则。结论:急性肺栓塞时左右心室压力容量关系变化是APE血流动力学变化和临床预后的理论基础,是探讨APE血流动力学变化的实用、简便、直观方法。

AIM： To establish the experimental acute pulmonary embolism（APE） model and observe the left and right ventricular pressure - volume relationship in different overload situations. METHODS ： The present study consisted of seven anesthetized mongrel dogs that were divided into the control group, moderate APE group and severe APE group according to the various phase and different pressure load during the experiment. APE model was induced by suture piece injection through right cardiac catheterization. The hemodynamic indexes were measured by the simultaneous cardiac catheterization and echocardiography. RESULTS： （1） In the group with moderate APE, the pressure -volume relationship of right ventricle tended to right - upward shift, the area of chart increased, the shape of chart transformed form triangle to rectangle. The mild parallel leftward shift, the area of chart decreased mildly and no change of chart shape was observed in the pressure - volume relationship of left ventricle. （2） In the group with severe APE, the chart of right ventricular pressure - volume relationship tended to right - upward shift continuously, the area of chart decreased. The chart of the left ventricle tended to left - downward shift and no change of chart shape was observed in the pressure - volume relationship of left ventricle, the area of chart decreased. The erose shape of charts was also found. CONCLUSION ： The chart of ventricular pressure - volume relationships is a practical and reliable method to evaluate left and right ventricular hemodynamic in APE. Pu