超声监测颈动-静脉分流实验猪慢性肺动脉高压形成

Experimental carotid-jugular shunting pulmonary hypertension in piglet monitored by ultrasound

目的探索利用超声监测颈动-静脉分流实验猪建模及慢性肺动脉高压形成的有效性和应用价值。方法51只巴马小型猪随机分实验组和假手术组，实验组45只行颈动脉-静脉端侧吻合术，术后高频超声探测颈动-静脉吻合口通畅情况，多普勒超声心动图定期监测三尖瓣反流（TR）、肺动脉瓣反流（PR）以估测肺动脉收缩压（SPAP）及平均压（MPAP），于实验终点与右心导管测压及肺组织病理检查对照。结果实验组32只猪术后存活至实验终点，27只猪吻合口通畅，形成有效左～右分流，总体建模成功率60％（27／45）。除建模2个月超声探测实验组与术前比较无明显差异外，随建模时间的延长，建模4、6、8、10、12、15、18个月，实验组新增TR及PR逐渐增多，SPAP、MPAP逐渐增高，与术前、建模后各观测时点间及假手术组比较差异有统计学意义（P〈0．05）。实验终点右心导管检查肺动脉压力显著增高，肺组织病理显示肺小血管中膜及内膜增厚，管腔狭窄。结论超声可评估颈动-静脉分流法肺动脉高压猪模型的建立并监测慢性肺动脉高压的形成，对于研究先天性心脏病合并肺动脉高压形成的自然病程及发展机制具有很好的应用价值。

Objective To investigate the availability and usefulness of echocardiography in piglet of experimental carotid-jugular shunting pulmonary hypertension. Methods Fifty one 1-month-old piglets were randomly divided into surgical shunt group（CA-JV, n = 45） and sham group（ n = 6）. In shunt group, left CA JV shunt was esteblished by end to side vascular anastomosis from left carotid artery to jugular vein. Piglets in sham group received a sham operation. Periodic hemodynamic evaluation of the carotid- jugular shunt and heart were performed by ultrasound examination post surgery. Tricuspid regurgitation and pulmonary regurgitation were monitored for evaluating pulmonary systolic pressure and mean pressure. Results In CA-JV group,32 piglets survived to end point of experiment and 27 maintained a persistent shunting （success rate 60% ）. Tricuspid regurgitation and pulmonary regurgitation occurred increasingly and pulmonary pressure had risen gradually since 4 months post-surgery （ P 〈 0.05）. Those were coincided with the results of right catheterization and pulmonary pathology. Conclusions Ultrasound can monitor experimental carotid jugular shunting pulmonary hypertension that shows practical value for further study in the mechanism and treatment of pulmonary hypertension due to increased pulmonary blood flow.