不同急性肺动脉高压模型的建立及其血流动力学转归的实验研究

Experimental study on the establishment and haemodynamic outcome of different acute pulmonary hypertension models

目的探讨葡聚糖法、缝线线段法和自体血栓法建立急性肺动脉高压模型的优劣及缝线线段法造成急性肺动脉高压的血流动力学变化。方法实验犬15只,随机分成葡聚糖法组、缝线线段法组和自体血栓法组,每组5只。通过心导管经肺动脉内注射葡聚糖、缝线线段、自体血栓建立相应急性肺动脉高压动物模型。心导管测量右心室收缩压评估各实验方法优劣,在缝线线段法组中通过测定心导管各压力指标,使用超声心动图测量容量指标研究血流动力学变化。结果葡聚糖法、缝线线段法在可重复性(稳定性)上优于自体血栓法(P<0.05),缝线线段法与葡聚糖法比较该测值差异无统计学意义(P>0.05)。急性肺动脉高压模型建立后,在肺动脉压中度增高、右室压力负荷中度增重时,右室和肺动脉扩张,主动脉收缩压略减低,心输出量轻度下降(P>0.05);重度肺动脉高压时,右室压力负荷重度增重,右室进一步扩张,左室内径及容量减少,心输出量严重降低(P<0.05)。结论缝线线段法是建立急性肺动脉高压动物模型及研究其血流动力学变化简便有效的方法。急性肺动脉高压时左右心室均有明显的血流动力学变化,可为急性肺栓塞的临床评估和治疗决策提供帮助。

Objectives To evaluate the advantages and disadvantages of different methods of establishing experimental dog models with acute pulmonary hypertension,and to evaluate the hemodynamic changes of pulmonary hypertension caused by the suture line method.Methods Fifteen anesthetized mongrel dogs were randomly divided into the glucan group,suture group and thrombosis group,five in each group.The injection of glucan,suture line and autologous blood clots through the pulmonary artery catheter established corresponding animal models of acute pulmonary embolism.The cardiac catheter indexes RVSP were measured to evaluate the advantages and disadvantages of the different experimental methods.The measured cardiac catheterization indexes and the capacity index measured by echocardiography were used to study hemodynamic changes in the suture line group.Results The glucan group and suture group showed more repeatability（stability） than that of thrombosis group（P0.05） and the suture group showed no more persistence than that of the glucan group（P0.05）.Moderate increasing of pulmonary artery pressure and right ventricle pressure load resulted in expansion of pulmonary artery and right ventricle,mild decrease of aortic systolic pressure and cardiac output（P0.05）.Severe pulmonary hypertension and right ventricle pressure load increase resulted in further expansion of the pulmonary artery and right ventricle,severe decrease of aortic systolic pressure and cardiac output（P0.05）.Conclusion The method using the suture line is simpler and more effective to establish the acute pulmonary hypertension model and research hemodynamic changes.Biventricular hemodynamic changes derived from acute pulmonary hypertension will be helpful for clinical evaluation and treatment of acute pulmonary embolism.