犬体内带钛镍记忆合金支架的人工血管移植可行性及心功能的评估分析

The feasibility of artificial blood vessel transplantation in dogs with titanium nickel memory alloy stent and evaluation of cardiac function

目的 探讨带钛镍记忆合金支架的人工血管将犬升主动脉、主动脉弓及降主动脉合为一体进行移植的可行性及移植后血浆N氨基末端脑钠肽前体（NT-pro BNP）、血清中门冬氨酸氨基转移酶（AST）和肌酸激酶（CK）的变化对心力衰竭的预判价值。方法 选取23只15 kg以上的成年杂种犬,在全麻深低温停循环及上腔静脉逆行灌注的条件下进行全胸主动脉带钛镍记忆合金支架人工血管移植,记录犬术中生理参数、手术时间、生存期、分析死亡原因。观察术后不同时间血浆NT-pro BNP、血清AST、CK浓度与心力衰竭的关系。结果 全组23条成年杂种犬30 d总生存率为65.2%（15/23）;手术时间约（174.6±27.0）min;生存期在30 d之内的犬,自开胸后至人工血管吻合完成所需时间明显长于生存期超过30 d的犬;人工血管移植术后24~48 h,NT-pro BNP、AST、CK的浓度平均达到高峰,随着生存期的延长,浓度逐渐降低,但在犬死亡前1~3 d各指标的浓度达到最高值。结论 带钛镍记忆合金支架的人工血管进行全胸主动脉移植的方法可行;人工血管吻合时间越短,对生理参数及心、肝肾功能影响越小;检测NT-pro BNP、AST、CK的浓度变化可预判犬人工血管移植术后心力衰竭的程度。

Objective To investigate the feasibility of artificial blood vessel with titanium nickel memory alloy stent graft in the dog＇s ascending aorta,aortic arch and descending aorta,assessment on the anticipating value of the plasma N- terminal pro brain natriuretic peptide（ NT pro BNP） precursors,serum aspartate aminotransferase（ AST） and creatine kinase（ CK） on heart failure. Methods From March 2015 to May2014,Selecting 23 15 kg or more adult hybrid dogs. Under the condition of deep hypothermia circulatory arrest and retrograde perfusion of the superior vena cava,all thoracic aortic vascular grafts were performed. The physiological parameters,operation time,survival time and death cause were recorded. To investigate the relationship between plasma NT- pro BNP,AST,CK concentration and heart failure at different time after operation. Results The overall survival rate was 65. 2%（ 15 /23） of 23 adult hybrid dogs in the whole group. Operation time was about（ 174. 6 ±27. 0） min. The survival period of the dog in the 30 d,which the time of the artificial blood vessel anastomosis was significantly longer than that of over 30 d. 24 ~ 48 h after artificial blood vessel transplantation,NT- pro BNP,AST and CK concentrations reached the highest level. With the extension of survival time,the concentration of above three index gradually decreased,but the concentration of the index of the dog reached the highest value 1 ~ 3 d before death. Conclusion Method of artificial blood vessel with titanium nickel memory alloy stent for the whole thoracic aortic transplantation is feasible. The shorter time of artificial blood vessel anastomosis,the smaller the impact on the physiological parameters,the function of heart,liver and kidney. The concentration of NT- pro BNP,AST and CK can be estimated to the extent of heart failure after artificial blood vessel transplantation.