急性大面积绵羊肺栓塞模型的建立及脑钠肽的变化

发布时间：2018-04-03 21:46

本文选题：肺栓塞　切入点：动物模型　出处：《天津医科大学》2007年硕士论文

【摘要】： 目的：肺栓塞(pulmonary embolism，PE)发病逐年增加，严重威胁着患者的健康和生命，特别是累及两叶以上的大面积肺栓塞，病死率高，许多患者在接受治疗前死亡。本实验旨在讨论：(1)经股静脉于绵羊肺动脉内置管直接注入自体血凝块是否优于既往经外周静脉注栓及球囊阻塞肺动脉的肺栓塞模型，从而准确、快速的制作大面积肺栓塞模型(2)大面积肺栓塞后，血气分析各项指标按栓塞时间变化的规律(3)脑钠肽(Brain natriuretic peptide，BNP)作为预示左心室功能不全的血管活性因子是否对右心室功能衰竭也存在提示作用，对早期大块形肺栓塞的诊断及预后的估计有无辅助作用。方法：选择健康绵羊18例，随机平均分为3组。1、2组为实验组，其中一组以自体血凝块利用介入技术建立右肺叶肺血栓栓塞动物模型，另一组以球囊阻塞肺动脉的方式建立模型，第3组为空白对照组，，所有动物均有创监测平均动脉压(MAP)、平均肺动脉压(MPAP)，中心静脉压(CVP)无创监测血氧饱和度(SaO_2)，实验组于肺栓塞模型建立前，之后0.5小时、1小时、2小时、4小时、6小时、8小时取静脉血，对照组亦观察8小时，于相应时段取血，离心取血浆测血浆BNP。比较3组血气分析中各项指标变化趋势，比较3组内及组间BNP水平变化，并对两种造模方法进行比较。所有统计数据采用spss13.0进行处理。结果：实验组(自体血栓组及气囊阻塞肺动脉组)的绵羊分别在注入自体血栓及球囊充气后准确建立急性右肺动脉栓塞模型，出现心率、呼吸频率加快，肺动脉压增高，其中自体血栓组6例在30min内血氧饱和度下降25％以上，PaO_2和SaO_2在0.5h内均下降至波谷，并持续至实验结束，与对照组有明显统计学差异。PC02在0.5 h内上升至高峰，此后缓慢下降，对照组无明显改变。而球囊阻塞肺动脉组PaO_2和SaO_2在0.5 h内下降至波谷后又逐渐上升，至1-2小时恢复正常。PA一度上升后也逐渐恢复正常。实验组动物血浆BNP水平均与PA相关，显著高于空白对照组，球囊阻塞肺动脉组在PA降至正常后BNP水平也有所回落。结论：使用介入的方法在X线引导下直接将自体血栓注入肺动脉可以快速建立大面积肺栓塞动物模型，准确性优于外周静脉注栓，且易于控制，较气囊阻塞肺动脉造模的方法更接近临床肺栓塞的病生理状况。BNP对于右心室功能的衰竭有提示作用可用于急性肺栓塞早期辅助诊断及预后的指标。
[Abstract]:Objective: the incidence of pulmonary embolism (PE) is increasing year by year, which seriously threatens the health and life of patients, especially the large area pulmonary embolism involving more than two lobes. The mortality rate of pulmonary embolism is high, and many patients die before treatment.The purpose of this study was to investigate whether the direct injection of autologous blood clots through femoral vein into sheep pulmonary artery is superior to the pulmonary embolism model of pulmonary artery occlusion by external venous embolization and balloon occlusion.Make a large area of pulmonary embolism model quickly) after large area pulmonary embolism,According to the regularity of embolization time, the indexes of blood gas analysis (BNPs) of brain natriuretic peptide (Brain natriuretic peptidine), as a predictor of left ventricular dysfunction (LVF), may also indicate the role of vasoactive factors in right ventricular failure (RVF).The diagnosis and prognosis of early massive pulmonary embolism are helpful or not.Methods: eighteen healthy sheep were randomly divided into 3 groups. One group was treated with autologous blood clot and interventional technique was used to establish the right pulmonary thromboembolism model, the other group established the model by balloon occlusion of pulmonary artery.The third group was a blank control group. All the animals had invasive monitoring of mean arterial pressure (map), mean pulmonary artery pressure (MPAPP), central venous pressure (CVP), and non-invasive monitoring of blood oxygen saturation (Sao). The experimental group was observed before the establishment of pulmonary embolism model.The venous blood was collected after 0.5 hours, 1 hour, 2 hours, 4 hours, 6 hours, and 8 hours, while the control group was observed for 8 hours, blood samples were taken at the corresponding time, plasma BNPs were measured by centrifugation.The change trend of each index in blood gas analysis of three groups was compared, the changes of BNP level in and between groups were compared, and the two modeling methods were compared.All statistical data were processed by spss13.0.Results: the acute right pulmonary artery embolism model was established accurately in the sheep of the experimental group (autothrombus group and balloon occlusion pulmonary artery group) after injecting autologous thrombus and balloon inflation respectively. Heart rate, respiratory rate and pulmonary artery pressure were increased.In autologous thrombus group, blood oxygen saturation decreased by more than 25% in 30min, PaO2 and SaO_2 decreased to trough within 0.5 h and lasted until the end of experiment. There was significant difference between autologous thrombus group and control group. PC02 increased to the peak within 0.5 h, and then decreased slowly.There was no obvious change in the control group.In the balloon occlusion group, PaO_2 and SaO_2 decreased to trough within 0. 5 h, and gradually increased after 1-2 h. PA returned to normal gradually after 1-2 h.Plasma BNP levels in the experimental group were significantly higher than those in the blank control group, and BNP levels in the pulmonary artery balloon occlusion group decreased after PA reached normal.Conclusion: the animal model of large area pulmonary embolism can be established quickly by injecting autologous thrombus into pulmonary artery under X-ray guidance by interventional method, which is more accurate than that of peripheral vein embolism, and is easy to control.Compared with the method of balloon occlusion, the method of pulmonary artery modeling is closer to the physiological condition of clinical pulmonary embolism. BNP can be used for early diagnosis and prognosis of acute pulmonary embolism.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R-332;R563.5

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