摘要
为探讨溶栓疗法对急性肺栓塞内皮素分泌水平的影响及相应的肺小动脉组织病理变化，使用自体血栓注入法建立犬急性肺栓塞实验模型。观察尿激酶溶栓组与对照组犬注栓前、溶栓前即刻、溶栓后１．５ｈ及３．０ｈ的血液动力学改变，并采动脉血测血浆内皮素含量，术毕肺组织行病理及电镜观察。结果：溶栓组犬静注尿激酶３０ｍｉｎ后，肺动脉压力和肺血管阻力显著下降，动脉血浆内皮素水平逐渐升高，溶栓后３．０ｈ为（９９．２５±１２．９０）ｐｇ／Ｌ，与注栓前（５１．６３±１０．０９）ｐｇ／Ｌ比较Ｐ＜０．０５，与对照组同期值（５５．９３±２．１０）ｐｇ／Ｌ比较Ｐ＜０．０１。对照组随时间肺动脉压力、肺血管阻力和动脉内皮素水平无显著性变化。组织病理及超微结构研究显示，对照组犬肺组织明显出血、肺泡壁增厚，肺小动脉内皮细胞及平滑肌细胞痉挛、线粒体变性，溶栓组犬肺组织病变较轻。结果提示：溶栓不仅逆转了肺栓塞引起的血液动力学损害，也可减轻肺组织和肺小动脉病损；溶栓组动脉血浆内皮素水平的增加可能是血管再通的一个指标。
To investigate the effects of thrombolysis on endothelin release in acute pulmonary embolism and related histopathologic changes in pulmonary arteriols, a canine model of acute pulmonary embolism was designed by injecting autologous blood clot. Fourteen model dogs were randomized to either urokinasetreated(UK) or control (CTL) group. Haemodynamic monitoring was performed by introducing catheters through right femoral artery and vein. Arterial endothelin was determined before embolization, before UK infusion, 1.5 and 3.0 h after UK administration(corresponding time point in CTL ). At the end, the dogs were sacrificed and lung removed for histopathologic and transmission electron microscopic investigations. Plasma endothelin of UK treated dogs increased progressively with the decrease of pulmonary artery pressure and pulmonary vascular resistance[from baseline (51.63±10.09) pg/L to (99.25±12.90) pg/L 3.0 h after UK initiation , P<0.05 and P<0.01 within and between groups respectively]. There were no significant changes in pulmonary artery pressure and pulmonary vascular resistance and plasma endothelin remained unchanged in CTL dogs with time. Histopathologic analysis showed notable patchy hemorrhages with thickened alveolar walls in CTL dogs.In marked contrast with UK dogs with relative normal pulmonary structures, vasoconstrictive sign with degenevated mitochondria in it was demonstrated in the endothelial cells and smooth muscle cells in this group. In conclusion, thrombolytic therapy in acute pulmonary embolism can not only revert the haemodynamic changes, but also relieve the lung tissue and pulmonary arterial injuries; the elevation of arterial plasma endothelin levels in UK dogs may not be the result of pulmonary lesions, but rather an index of pulmonary reperfusion.
出处
《首都医科大学学报》
CAS
1997年第4期340-343,共4页
Journal of Capital Medical University
关键词
肺栓塞
内皮素
超微结构
溶栓疗法
pulmonary embolism
endothelin
ultramicroscopic structure
