急性肺栓塞时心肌血流灌注的变化

目的观察急性肺栓塞（APE）后冠状动脉血流量及心脏肌钙蛋白T（cTnT）与肌红蛋白（Mb）含量变化，探讨心肌血流灌注在急性肺栓塞继发心肌损伤机制中的作用。方法通过介入方法经导管注入自体血栓选择性栓塞肺动脉，建立不同栓塞面积的急性肺栓塞动物模型。监测栓前、栓后5、30min，1、2h冠状动脉血流量变化及栓后4h血清cTnT与Mb含量。结果急性肺栓塞后血清cTnT与Mb含量升高。急性肺栓塞导致冠状动脉血流量显著下降，肺血管栓塞后15～30min降至最低值，30min后趋于平稳。右冠血流量下降程度与肺栓塞面积有显著相关性。结论冠状动脉血流量减少及血清心肌结构蛋白含量升高为急性肺栓塞继发心肌缺血改变提供了直接证据。急性心肌缺血严重影响急性肺栓塞的预后。

Chianges of myocardial perfusion in acute pulmonary embolism

To observe the changes of the serum cardiac troponin T (cTnT) and myo-globin (Mb) and the change of coronary flow (CF) after acute pulmonary embolism (APE), and to investigate the effect of myocardial perfusion on myocardial injury due to APE. Methods With cardiac catheterization, autologous thrombus was injected respectively into right total pulmonary artery and right lower pulmonary artery to establish different embolism-ares animal models. The parameters of coronary flow before and at 5 min, 30 min, 1 h, 2 h after embolization were recorded and compared, and the concentrations of serum cTnT and Mb at 4th h after embolization were determined. Results The concentrations of serum cTnT and Mb were increased after APE. APE resulted in the significantly decreased coronary and mean CF dropped to the lowest value at 15-30 min after injection of thrombus. Reduction of CF in right coronary artery correlated to the area of pulmonary vascular obstruction. Conclusion Reduction of CF and elevation of myocardial structural protein indicated directly the presence of myocardial ischemia due to APE. It was suggested that myocardial ischemia is an important cause and a powerful predictor of bad-prognosis in APE.