肺栓塞时肺灌注显像与肺动脉造影对比动物实验研究

目的 :通过肺栓塞 (PE)动物模型的建立 ,评价肺灌注显像对肺栓塞诊断及疗效观察中的价值。方法 :计算机随机编号 ,取中国实验用小型猪 8头 ,平均体重 16 1± 1 4kg ;建立模型前均行肺灌注显像及选择性肺动脉造影 (CPA) ,取自体猪血 2～ 5ml制血栓 ,通过右心导管将栓子加压注入肺动脉 ;建立PE模型。建立模型后及溶栓治疗后均行肺灌注显像及CPA ,前后采集条件一致。结果 :8头猪造模前CPA均正常 ,肺灌注显像 1例左肺放射性分布不均 ,肺灌注显像特异性 87 5 % (1 8)。 7例存活的模型猪 ,5例造模成功 ,2例不明显 ;以单侧肺观察 ,肺灌注显像与肺动脉造影对比 ,肺灌注显像诊断PE灵敏度 10 0 % ,准确率 90 %。 1例肺动脉造影正常 ,肺灌注显像为亚肺段栓塞 ,与尸检肉眼病理所见一致 ,溶栓后恢复正常血流灌注 ;如果以溶栓治疗有效为标准则准确率增至 10 0 %。溶栓疗效观察肺灌注显像与肺动脉造影二者结果一致。 1例CPA溶通 ,肺灌注显像部分改善 ,尸检证实为部分坏死、实变。结论 :肺灌注显像诊断PE具有很高的敏感性和特异性 ,与肉眼病理所见完全吻合。可作为肺动脉造影前的筛选 ,及临床疗效观察的重要手段

Comparison of pulmonary angiogrphy and pulmonary perfusion scan in animal model of pulmonary embolism

Objective:The study is to evaluate the use of perfusion scan in the diagnosis and therapy in animal model of pulmonary embolism.Method:8 male computer-randomised Chinese experimental pigs,with average weight 16.1±1.4 kg. 2～5 ml blood was to made emboli,and was sent to pulmonary artery by catheter to create pulmonary embolism animal model.Both chosen pulmonary angiography and nuclear perfusion scan were performed before and after creating animal model as well as thrombolytic therapy,and then two methods were compared.Result:CPA were all normal,and one didn't show well-distribution in left lung,and specificity of pulmonary perfusion scan was 87.5%(1/8).CPA showed that 5 pigs were formed into PE in 7 living pigs,and the other 2 were not clear.Compared with CPA,the sensitivity and accuracy of pulmonary perfusion scan were 100% and 90% respectively,consent with pathological autopsy.One was normal in pulmonary angiography and perfusion scan was sub-segmental embolism,and after thrombolytic therapy,pulmonary perfusion returned to normal.If the standard was that thrombolytic therapy and pulmonary angiogram was effective,the accuracy was raised to 100%,perfusion scan completely accorded with pulmonary angiogram.One CPA showed completely open,and perfusion scan partly amlieration,autopsy showed necrosis.Conclusion:The sensitivity and specificity of perfusion scan was high in diagnosing pulmonary embolism,and completely consent with pathological autopsy.Perfusion scan could be the screen before pulmonary angiogram,and the important tool to observe therapy effect.