多层螺旋CT灌注成像评价伊达拉奉防治肺栓塞缺血-再灌注损伤疗效的实验研究

目的 探讨多层螺旋CT灌注成像用于评价伊达拉奉防治肺柃塞缺血-再灌注损伤(PTE-IRI)疗效的价值.方法 杂种犬20只,用球囊栓塞犬的右肺下叶动脉4 h,然后再撤除球囊,使血流再灌注4 h,制备PTE-IRI模型.根据实验动物是否用伊达拉奉和应用的时间,用数字表法将实验动物随机分为4组,每组5只,即A组:缺血时和再灌注时均不用伊达拉奉;B组:缺血时用伊达拉奉,再灌注时不用;C组:缺血时和再灌注时均用伊达拉奉;D组:缺血时不用伊达拉奉,再灌注时用.每组又分为缺血前、缺血4 h和冉灌注4 h 3个时间点,分别在这些时间点进行肺部CT平扫及CT灌注扫描.测量右肺下叶局部肺实质的血流量(BF)、血容量(BV)和平均通过时间(MTT),并采用方差分析的方法对其进行比较.结果 实验动物再灌注4 h CT检查主要表现为右肺下叶的肺水肿.(1)右肺CT灌注扫描组间比较:再灌注4 h A、B、C、D组的BF分别是(259.4±15.7)、(293.7±7.9)、(379.4±14.5)、(382.5±16.6)ml·min-1·100 g-1,MTT分别是(3.1±0.2)、(2.6±0.2)、(2.2±0.1)、(1.9±0.2)s;除C组和D组间的BF和MTT差异无统计学意义外(P值均＞0.05),其他各组间BF和MTY差异均有统计学意义(P值均＜0.01);各组间BV差异均无统计学意义(P值均＞0.05).(2)组内比较:A组和B组缺血前和再灌注4 h间的BF缺血前A组为(397.2±19.2)ml·min-1·100 g-1,B组为(393.2±16.1)ml·min-1·100 g-1]和MTT缺血前A组为(1.8±0.1)s,B组为(1.8±0.2)s]差异均有统计学意义(P值均＜0.01);缺血前和再灌注4 h A组BV分别为(12.0±0.9)、(12.2±1.0)ml/100 g,B组分别为(11.9±1.5)、(12.2±1.3)ml/100 g,差异均尤统计学意义(P值均＞0.05);C和D组缺血前和再灌注4 h间的BF、MTT、BV差异均无统计学意义(P值均＞0.05).结论 伊达拉奉可减轻肺栓塞缺血.再灌注损伤的程度,多层螺旋CT灌注成像可用于其效果的评价.

The multi-slice CT perfusion imaging in evaluating the prevention and treatment by edaravone on lung ischemia-reperfusion injury after pulmonary thromboembolism

Objective To evaluate the multi-slice CT perfusion imaging in investigating whether edaravone can prevent and treat pulmonary thromboembolism ischemia-reperfusion injury(PTE-IRI).Methods Twenty mongrel canines were included.A Swan-Ganz catheter wag introduced into the right internal jugular vein using the Seldinger technique,and then was inserted into the pulmonary artery.Balloon occlusion of the right inferior lobe pulmonary artery for 4 h was followed by removing catheter and 4 h of reperfusion.Animals were divided into four groups of A(no edaravone during ischenmia and reperfusion),B(edaravone used only during ischemia),C(edaravone used during both ischemia and reperfusion)and D group(edaravone used only during reperfusion)(n=5 per group).Every group was divided into three time points including before ischemia,4 h after ischemia and 4 h after reperfusion.CT scan and CT perfusionwere performed at the three time points.The blood flow(BF),blood volume(BV)and mean transit time (MTT)of the bilateral inferior regional lung parenchyma were measured with the software of perfusion 3.Results CT examination showed pulmonary edema in the right inferior lung lobe at 4 h after reperfusion.(1)The BF and MTT of A,B,C and D group were(259.4±15.7)ml·min-1·100 g-1,(293.7±7.9)ml·min-1·100 g-1,(379.4±14.5)ml·min-1·100 g-1,(382.5±16.6)ml·min-1·100 g-1]and(3.1±0.2)s,(2.6±0.2)s,(2.2±0.1)s,(1.9±0.2)s]respectively at 4 h after reperfusion.The BF and MTT were statistically difierent(P＜0.01)between groups(A and B,A and C,A and D,B and C,B and D)except between group C and D(the P value＞0.05)at 4 h after reperfusion,but the BV was not statistically different between groups(P＞0.05).(2)The BF(397.2±19.2)ml·min-1·100 g-1and(259.4±15.7)ml·min-1·100 g-1in group A,(393.2±16.1)ml·min-1·100 g-1and(293.7±7.9)ml·min-1·100 g-1 in group B]and MTT(1.8±0.1)8 and (3.1±0.2)s in group A,(1.8±0.2)s and(2.6±0.2)s in group B]were statistically different(P＜0.01),but the BV(12.0±0.9)ml/100 g and(12.2±1.0)ml/100 g in group A,(11.9±1.5)ml/100 g and(12.2±1.3)ml/100 g in group B]were not different(P＞0.05)between groups before ischemia and 4 h after ischemia.The BF.MTT and BV were not statistically significant between before ischemia and4 h after reperfusion in group C and D(P＞0.05).Conclusions Edaravone can attenuate the degree of the PTE IRI.Multi-slice CT perfusion imaging can evaluate effect.