小型猪急性选择性肺血栓栓塞模型的建立及评价

Establishment and evaluation of acute pulmonary model in minipig

目的建立小型猪选择性左下肺动脉急性肺血栓栓塞症（APTE）模型。方法实验用小型猪8只，采用介入技术，选择性左下肺动脉定量、定性注入大团块自体新鲜静脉血栓，肺动脉造影确认左下肺动脉栓塞成功。监测血流动力学参数并行肺CT扫描和肺大体解剖，以对小型猪APTE模型进行评估。结果栓塞后即刻，平均肺动脉压（MPAP，mmHg，1mmHg=0．133kPa）和肺毛细血管压（PCWP，mmHg）测定值与基线值比较均显著升高，差异均有统计学意义（MPAP，42．0±3．4比20．2±3．0，PCWP：8±2比4±3，均P〈0．05），在栓塞后2h内各时间点测定值维持在较高水平。栓塞2h内右心输出量（CO）变化不显著。体循环收缩压（SAP，mmHg）和心率（次／min）在栓塞后测定值较基线值均显著升高，差异均有统计学意义（SAP：102±12比80±7，心率：119±22比86±14，均P=0．008）。肺动脉造影、肺CT成像和肺大体解剖均显示选择性左下肺定位建立APTE模型成功。结论本研究建立的小型猪急性APTE模型可行、可控、稳定，适用于APTE诊治相关的实验研究。

Objective To establish and evaluate an acute pulmonary embolism （APTE） model by selective thromboembolism of lower left pulmonary artery in minipig. Methods Through intervention technique, a guiding catheter was inserted via femoral vein into pulmonary artery. And quantitative autologous venous thrombus was injected into the selected lower left pulmonary arteries in 8 minipigs. Thus the intended APTE model was established by selective thromboembolism of lower left pulmonary artery. Hemodynamic parameters were monitored. And computed tomography （CT） and macroscopic dissection were performed to evaluate the minipig APTE model. Results The measurements of mean pulmonary artery pressure（ MPAP, mm Hg, 1 mm Hg = 0. 133 kPa）and pulmonary capillary wedge pressure （PCWP, mm Hg）immediately increased significantly after thromboembolism versus the baseline values （MPAP： 42.0 ± 3.4 vs 20.2 - 3.0, PCWP： 8 ± 2 vs 4 ± 3, both P 〈 0.05 ） and stayed at a higher level during the following 2 h. No significant difference existed between the value of cardiac output （CO） at 2 h post- thromboembolism and its baseline counterpart. Moreover, systemic arterial pressure （SAP, mm Hg）and heart rate （HR, beats/min） significantly increased after embolism versus the baseline values （SAP： 102 ± 12 vs 80 ±7, HR： 119 ±22 vs 86 ± 14, P =0.008）. Pulmonary arteriography, CT scan and gross anatomy all demonstrated that the selected lower left pulmonary arteries was successfully embolized. Conclusion The establishment of APTE model by selective thromboembolism of lower left pulmonary artery is feasible, well-controlled and stable in minipigs.