新西兰大白兔急性尿路梗阻继发的肺部CT表现

发布时间：2019-05-21 22:36

【摘要】： 目的：通过动物实验建立急性尿路梗阻模型,了解急性尿路梗阻后实验动物肺部所表现的影像学特点及病理改变,并结合相关化验检查,分析发生原因,为临床认识急性尿路梗阻后肺改变提供资料,旨在为临床医生提供诊断依据。方法：选取常规肺部CT扫描无异常之新西兰大白兔30只,随机分为对照组,单侧输尿管梗阻组(单侧组)及双侧输尿管梗阻组(双侧组),术后第2天始行胸部高分辨CT扫描及血肌酐(Cr)、尿素氮(BUN)和心钠素(ANP)检查,至双侧组动物完全死亡时结束。实验中及实验结束后取实验动物肺组织进行病理学检查。结果： 1、单侧组动物CT、病理及血BUN、Cr与ANP检测值与对照组相比均无差异： (1)胸部CT示双侧肺野透亮度正常,肺纹理走行自然,未见异常密度灶；纵膈窗未见胸膜增厚、胸腔积液及心包积液； (2)病理切片于肺泡切面见两种肺泡上皮细胞和肺泡间隔内的毛细血管。肺组织结构正常,肺泡间隔无水肿及炎细胞浸润等表现； (3)单侧组血BUN、Cr与ANP检测值分别于术后0d、2d、4d与对照组相比差异无统计学意义(P0.05)。 2、双侧组动物CT、病理及血BUN、Cr及ANP检测值与对照组相比具有显著差异： (1)CT胸部高分辨表现呈多样性,主要包括肺透亮度下降,间质性肺水肿,肺泡性肺水肿,心包积液及胸腔积液等； (2)双侧组动物肺部主要病理基础包括仅肺泡间隔增宽；肺泡上皮细胞稀疏,肺泡间隔及肺泡腔中均匀粉染的水肿液；血管扩张及充血,炎细胞浸润等； (3)分别于术后2d,4d对双侧组血中BUN、Cr及ANP与对照组进行对比,结果显示具有两组间差异具有统计学意义(P0.05)；术后0d对照组与双侧组相比差异无统计学差异(P0.05)； (4)双侧组肺部CT表现总体趋势是由肺透亮度下降发展成为间质性肺水肿再发展成为肺泡性肺水肿,胸腔积液及心包积液可与肺部表现相伴出现,也可单独出现于各种表现之后；各种表现与血BUN和Cr最高频率值出现时相具有一定的一致性。结论：单侧尿路梗阻不引起血Cr、BUN、ANP改变及肺高分辨CT和病理异常表现；双侧尿路梗阻后肺部CT表现,病理表现及血Cr、BUN、ANP值出现明显异常；发病机制主要与钠水潴留,循环血量增加,大量毒素聚积有关。据此可知,若双侧尿路梗阻时合并肺部改变应首先考虑肺水肿；而单侧尿路梗阻时若同时合并肺部改变则不以肺水肿为首要病因。
[Abstract]:Objective: to establish the model of acute urinary tract obstruction through animal experiment, to understand the imaging features and pathological changes of lungs in experimental animals after acute urinary tract obstruction, and to analyze the causes of acute urinary tract obstruction combined with related laboratory examination. To provide data for clinical understanding of lung changes after acute urinary tract obstruction in order to provide diagnostic basis for clinicians. Methods: 30 New Zealand white rabbits without abnormal pulmonary CT scan were randomly divided into control group, unilateral ureter obstruction group (unilateral group) and bilateral ureter obstruction group (bilateral group). Chest high resolution CT scan, serum creatinine (Cr), urea nitrogen (BUN) and atrial natriuretic peptide (ANP) were performed on the 2nd day after operation, and ended when the animals in the bilateral group died completely. The lung tissue of the experimental animals was taken for pathological examination during and after the experiment. Results: 1. There was no difference in CT, pathology and blood BUN,Cr and ANP between the unilateral group and the control group: (1) chest CT showed that the transmittance of bilateral lung field was normal, the lung texture was natural, and no abnormal density foci were found. No pleura thickening, pleural effusion and pericardial fluid were found in the mediastinal window. (2) two kinds of alveolar epithelial cells and capillaries in the alveolar septum were found in the alveolar section. The structure of lung tissue was normal, there was no edema in alveolar septum and inflammatory cell infiltration. (3) the detection values of BUN,Cr and ANP in unilateral group were 0 d, 2 d and 4 d after operation, respectively, and there was no significant difference between the two groups (P 0.05). 2. The pathological changes of CT, and the values of BUN,Cr and ANP in blood of the bilateral group were significantly different from those of the control group: (1) the chest high resolution of CT was diverse, including the decrease of lung transmittance and interstitial pulmonary edema. Alveolar pulmonary edema, pericardial effusions and pleural effusions, etc. (2) the main pathological basis of the lungs in the bilateral group included only the widening of alveolar septum, sparse alveolar epithelial cells, evenly powdered edematous fluid in alveolar septum and alveolar cavity, vasodilation and hyperemia, inflammatory cell infiltration, etc. (3) on the 2nd and 4th day after operation, the blood BUN,Cr and ANP in the bilateral group were compared with those in the control group, and the results showed that there was significant difference between the two groups (P 0.05). There was no significant difference between the control group and the bilateral group 0 days after operation (P 0.05). (4) in the bilateral group, the overall trend of pulmonary CT findings was from the decrease of pulmonary transmittance to the development of interstitial pulmonary edema and then to alveolar pulmonary edema, and pleural effusion and pericardial effusion could be accompanied by pulmonary manifestations. It can also appear alone after all kinds of performance; All kinds of manifestations were consistent with the highest frequency values of blood BUN and Cr. Conclusion: unilateral urinary tract obstruction does not cause blood Cr,BUN,ANP changes, lung high resolution CT and pathological abnormalities, but there are obvious abnormalities in pulmonary CT findings, pathological findings and blood Cr,BUN, ANP values after bilateral urinary tract obstruction. The pathogenesis is mainly related to sodium and water retention, the increase of circulating blood volume and the accumulation of a large number of toxins. According to this, pulmonary edema should be considered first if bilateral urinary tract obstruction is complicated with pulmonary change, while pulmonary edema should not be the primary cause if unilateral urinary tract obstruction is complicated with pulmonary change at the same time.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R-332

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