血管内超声观察应用不同血管活性药物兔主动脉管腔横截面积的变化

Changes of rabbit aorta lumen cross-sectional area due to various vasoactive drugs:Intravascular unltrasound observation

背景:血管内超声不但能精确地判断血管壁是否存在病变以及病变性质,也能准确地对血管功能进行直观地观察。目的:探讨血管内超声能否用于药物干预所致血管变化的评估。设计、时间及地点:观察性实验,于2006-03/09在首都医科大学附属北京朝阳医院心导管室完成。材料:25只新西兰大耳白兔,体质量2.5～3.5kg,麻醉后分别分离和穿刺股动脉及颈总动脉,置入5F鞘管。方法:将颈动脉处鞘管接压力换能器,在多导生理记录仪上监测血压及心电图。在X射线透视下,自股动脉处鞘管尾端插入20MHz超声导管至腹主动脉或胸主动脉处。稳定后,分别以2mL/kg自耳缘静脉给予不同浓度的乙酰胆碱,硝酸甘油,罂粟碱,在1min内推注完毕,而三磷酸腺苷给予"弹丸"注射。若血压和心率能够恢复至基线水平,则动物均给与上述药物。若血压和心率不能够恢复至基线水平,则停止药物的进一步应用,实验结束。每次给药前均使血压和心率恢复至接近基线水平。主要观察指标:推注过程中记录超声影像以及血压,心电图变化。回放超声影像,观察并测量血管直径及面积变化。结果:血管内超声可见兔大弹性血管管径及管腔面积减小时,血压随之下降。不同浓度的乙酰胆碱、硝酸甘油、罂粟碱以及三磷酸腺苷均可引起血管缩小,血压下降,与基础状态相比差异具有显著性意义(P<0.05,P<0.01)。结论:血管内超声能够非常直观形象地观察血管对各种药物的反应,尤其是血管活性药物对血管的作用,因而血管内超声可以用来筛选血管活性药物。

BACKGROUND： Intravascular ultrasound can not only be used to determine whether lesion exists or not and identify the quality of lesion on vessel wall precisely, but also can be applied to observe vessel function with a direct pattern accurately. OBJECTIVE： To approach whether intravascular ultrasound can be used to assess vascular changes due to drug intervention. DESIGN, TIME AND SETTING： The observational trial was conducted in the Cardiac Catheter Labaratory of Beijing Chaoyang Hospital, Capital University of Medical Sciences between March 2006 and September 2006. MATERIALS： Twenty-five New Zealand white rabbits, weighing 2.5-3.5 kg, after anaesthesia their femoral artery and common carotid artery were dissected and punctured and then put in a 5F sheath, respectively. METHODS： The sheath deployed in the carotid artery was connected with the pressure tranducer and the blood pressure and electrocardiogram were monitored on the multichannel physiologic recorder. With the help of X-ray fluoroscopy, a 20 MHz ultrasound catheter was inserted into abdominal or thoracic artery through the sheath deployed in the femoral artery. After the condition became stable, various concentrations of acetylcholine, nitroglycerin and papaverine were injected into vessel through auricular edge vein at the dose of 2 mL/kg within 1 minute. The adenosine triphosphate was given bolus injection. The blood pressure, electrocardiogram and intravascular ultrasound image were recorded simultaneously during injection. Rabbits, if their blood pressure and heart rate could return to baseline level, would be administrated all above drugs with various concentrations, if the blood pressure and heart rate could not return to baseline level, further drug administration would be stopped, then the study ended. The blood pressure and heart rate must return to baseline level before each administration. MAIN OUTCOME MEASURES： The blood pressure, electrocardiogram and intravascular ultrasound image were recorded simultaneously during injection. Ultrasound image was replayed and the vessel diameter and vessel area were measured. RESULTS： It was found that if the luminal diameter and luminal area of big elastic artery decreased, the corresponding blood pressure dropped. Various concentrations of acetylcholine, nitroglycerin, papaverine and adenosine triphosphate could all render the luminal diameter and luminal area decreased and blood pressure dropped. Comparing with the basal condition, the differences were statistically significant （P 〈 0.05, P 〈 0.01）. CONCLUSION： Intravascular ultrasound can be used to observe vessel reactions to various drugs, especially vasoactive drugs, consequently intravascular ultrasound can also be used to screen vasoactive drugs.