Mechanical thrombectomy in experimental acute pulmonary embolism
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF RADIOLOGY
- Issue:
- 9
- DOI:
- 10.3760/j.issn:1005-1201.2005.09.004
- Key Word:
- 肺栓塞;动物实验替代试验;血栓溶解疗法;机械祛栓
Abstract： 目的实验性比较经导管机械祛栓、经导管肺动脉内局部溶栓和经导管机械祛栓联合局部溶栓治疗急性肺动脉栓塞疗效和安全性. 方法 28只杂种犬经数字法随机分为4组,机械祛栓治疗组、局部溶栓治疗组、机械祛栓联合局部溶栓治疗组和对照组(CTL组)各7只.用犬的自体血栓建立急性肺动脉栓塞模型,分别采用经导管予机械祛栓(helix thrombectomy device, HTD) 、尿激酶(UK)局部溶栓、机械祛栓联合尿激酶及生理盐水治疗.监测肺动脉平均压(PAMP)、主动脉收缩压(SBP)、血气及肺动脉造影情况.术后取动物肺组织行病理检查.结果在各组中,治疗后PAMP在30 min时,CTL组为(33.5±3.38) mm Hg(1mm Hg=0.133 kPa),UK组为(29.00±3.96)mm Hg,HTD组为(29.39±3.17)mm Hg,HTD+UK组为(25.24±3.04)mm Hg(q=6.88,P=0.002);60 min时, CTL组为(33.19±3.54)mm Hg,UK组为(28.79±3.96)mm Hg,HTD组为(24.44±3.70)mm Hg,HTD+UK组为(23.57±4.57)mm Hg(q=8.73,P=0.000);120 min时, CTL组为(31.50±3.75)mm Hg,UK组为(26.43±4.04)mm Hg,HTD组为(22.00±3.62)mm Hg,HTD+UK组为(17.86±3.26)mm Hg(q=17.78,P=0.000).治疗后30、60和120 min与对照组同时相的PAMP相比均明显降低,差异有统计学意义(P<0.05).HTD组于治疗后120 min与UK组同时相PAMP相比差异有统计学意义(P<0.05).HTD+UK组治疗后30 min和120 min较UK组和HTD组同时相的PAMP降低更为明显(P<0.05);治疗60 min与UK组差异有统计学意义(P<0.05).治疗后的肺动脉造影表现为阻塞的肺动脉血流完全或不完全再通;充盈缺损减小;相应肺组织血流完全或不完全恢复.病理检查:(1)对照组:所见栓塞部位与肺动脉造影结果一致.光学显微镜下,肺动脉血管内可见血栓,肺组织大片出血灶,部分肺泡腔内大量红细胞.(2)治疗组:肺出血轻, 肺泡腔内少量红细胞.HTD操作的相应肺动脉内膜轻微损伤.结论 HTD消融器祛栓联合局部溶栓的疗效明显优于单独经导管肺动脉内局部溶栓或HTD消融器祛栓治疗,具较高的安全性.
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