急性肺栓塞面积对血流动力学变化的影响

目的制备不同梗阻面积的急性肺栓塞动物模型,研究血流动力学变化与肺栓塞面积的相关性。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;比较栓前、栓后15min,30min,1h,2h血流动力学指标变化,同时观察心脏超声影像学变化。结果自体血栓均按要求阻塞相应肺动脉,肺栓塞形成后心输出量下降,肺动脉压力显著增高,并在1h,2h达到峰值,各血流动力学指标随肺栓塞面积增大而变化更显著。结论此急性肺栓塞动物模型制作方法确切可行,具有可重复性。肺栓塞导致血流动力学及左右心室功能紊乱,栓塞面积与其损害程度呈正相关,并严重影响预后。

Correlation between obstructive area of acute pulmonary embolism and hemodynamic changes

Objective To study the correlation of hemodynamic instability and the area of pulmonary vascular obstruction by establishing animal models of acute pulmonary embolism (APE) of different obstructive areas. Methods With cardiac catheterization,autologous thrombus was injected respectively into right total pulmonary artery and right lower pulmonary artery to establish different embolism-area animal models. Before and at 15 min,30 min,1 h,2 h after embolization,the hemodynamic transformations were compared. The continuous transesophageal echocardiographic imaging was also observed. Results Anatomy showed thrombus obstructed corresponding pulmonary artery. After thrombus injected,cardiac output dropped rapidly,pulmonary artery pressure rose significantly,and all parameters attained to extremum in 1 h,2 h. Compared between the animals of different embolism-area,wider anatomic region obstructed,more serious hemodynamics changed. Conclusions The establishment of APE model was feasible and repeatable. APE can produce significant hemodynamic instability and biventricular cardiac dysfunction. It seems reasonable to propose that hemodynamic injury and the prognosis in APE is directly related to the area of pulmonary vascular obstruction.