犬多发性肺动脉微小血栓栓塞的病理及呼吸循环功能改变

The pathology of and the cardio-pulmonary functional changes in acute multiple pulmonary microthromboembolism in a canine model

目的 了解多发性肺动脉微小血栓栓塞在犬动物模型中对肺组织形态、循环功能、呼吸功能和凝血纤溶指标的影响。方法 健康成年杂种犬 13只 ,随机分为 2组 ,栓塞组 7只 ,对照组 6只。取自体血 10ml制成 1～ 2mm大小血栓 ,给栓塞组动物 1次注入 30 0个微小血栓 ,检测栓塞前、栓塞即刻、30min、1h和 2h ,血流动力学和氧动力学的变化。结果 肺栓塞后即刻出现肺动脉压 (PAP)明显升高 ,1h后下降。对通气功能影响不大。D 二聚体 (D dimer)在 30min后开始升高。病理可见肺出血、肺实变和微小动脉血栓形成。结论 肺动脉微小血栓栓塞可引起肺组织水肿、出血和肺动脉内血栓形成 ,并在栓塞早期引起肺动脉高压。但对通气功能的影响不明显 ,D dimer在微小血栓栓塞早期即有明显变化。

Objective To evaluate the effect of acute multiple pulmonary microthromboembolism on circulation,ventilation, lung histology,and the coagulatory and fibrinolytic functions. Methods Thirteen dogs were studied,7 in the embolism group and 6 in the control group. 10 ml of blood was withdrawn from each animal. Thrombi were formed and cut into pieces of 1 mm to 2 mm in size.The thrombi were counted, and 300 thrombi were infused at one time back to the same animal.PAP,PAWP,VO_2,DO_2,D-dimer,protein C,protein S were measured before and immediately,30 min,1 hour,2 hour after embolism.Results PAP was increased immediately after embolisation,and then decreased at 1 hour. The level of D-dimer was elevated at an early stage. Pulmonary hemorrhage, consolidation and microembolism were observed.Conclusions Multiple microthromboembolism caused lung injury and thrombosis. PAP was increased at the early stage, but ventilation was not affected .The level of D-dimer changed at the early stage of thromboembolism.