急性肺栓塞性肺高压局部溶栓和全身溶栓的比较

目的研究经导管肺动脉局部溶栓与外周静脉全身溶栓在急性肺栓塞性肺动脉高压治疗中的作用。方法20只小猪自体血栓注入建立急性肺栓塞性肺动脉高压模型。随机分成两组:经导管肺动脉局部溶栓(A组10只),外周静脉全身溶栓(B组10只)。溶栓前、溶栓后2h测肺动脉压,肺动脉收缩压(PASP),心率(HR),心输出量(CI),血气分析(PaO2、PaCO2、pH),纤溶酶_抗纤溶酶复合物(PAP),DD二聚体(DD),一氧化氮(NO)。结果两组肺动脉压、CI、PaO2、PaCO2、PAP、DD、NO均较治疗前有显著变化(P<0.05),A组的肺动脉压、PaO2、PaCO2、PAP的变化较全身溶栓组B组的变化更显著(P<0.05)。结论肺栓塞治疗中局部溶栓的疗效优于全身溶栓。

The comparison of local throbolysis and systemic thrombolysis in treatment of acute thromboembolic pulmonary hypertension

Objective To compare local thrombolysis by catheter and systemic thrombolysis by venous in treatment of acute thromboembolic pulmonary hypertension.Methods An animal models of acute pulmonary embolism was established by intravenous infusion of autologous blood clot.Twenty model pigs were randomly assigned to receive local thrombolytic therapy(group A,n=10)or systemic thrombolytic therapy(group B,n=10).Pulmonary arterial systolic pressure(PASP),cardiac index(CI),heart rate(HR),blood gas analysis,nitric oxide(NO),D-dimer(DD),plasmin-antiplasmin(PAP)were measured respectively before treatment and 2 hours after treatment.Results PASP,CI,PaO_2,PaCO_2,PAP,DD,and NO changed significantly after thrombolysis in the two groups(P<0.05).Compared with group B,SPAP,PaO_2,PaCO_2,PAP changed more significantly in group A(P<0.05).Conclusion Local thrombolysis by catheter is more effective than systemic thrombolysis by venous in the treatment of acute thromboembolic pulmonary hypertension.