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目的建立犬肺血栓栓塞症(PTE)模型;观察栓塞后不同时间犬动脉血气、血液动力学、影像学及血栓病理的变化情况。方法健康成年杂种犬16只,其中栓塞左下肺动脉的15只按随机数字表法随机分为3组,每组5只:假手术组;1周组:5段血栓柱栓塞,观察1周;2周组:5段血栓柱栓塞,观察2周。另外1只将血栓柱栓塞至右下肺动脉以证实选择性栓塞的可行性,观察2周。观察指标为动脉血气、血液动力学参数及局部肺动脉造影影像学变化。实验犬经血栓栓塞制模后肌注氨甲环酸,1、2周后解剖观察栓塞情况;应用磷钨酸苏木精染色(PTAH)观察血栓的病理变化。结果犬肺血栓栓塞前,氧合指数(PaO_2/FiO_2)为(508±58)mm Hg(1 mm Hg=0.133 kPa),栓塞1 h 后为(395±100)mm Hg;栓塞前平均肺动脉压(MPAP)为(15±3)mm Hg,栓塞1 h后为(21±4)mm Hg;肺血管阻力(PVR)栓塞前为(178±114)mm Hg·s/L,栓塞1 h后为(404±260)mm Hg·s/L,差异均有统计学意义(均 P<0.05)。实验犬肺动脉栓塞后局部肺动脉造影可见截断征;1周时见栓塞近端肺动脉明显增粗,管壁僵硬样改变等。栓塞1、2周时解剖发现实验犬肺动脉内血栓表面不平滑;PTAH 染色见血栓表面机化,2周组见血栓内多处再通,肺动脉壁增生组织包绕、分割血栓。结论将血栓柱栓塞犬肺叶动脉,并用氨甲环酸抑制纤溶,可建立模拟慢性 PTE 部分病理改变的动物模型;栓塞不同时间,肺动脉造影表现不同;时间越长,血栓机化越明显。
Objective To establish a model of canine pulmonary thromboembolism (PTE) and observe the changes of blood gas, hemodynamics, imaging and thrombosis of canine arteries at different time after embolization. Methods Twenty-six healthy adult dogs were randomly divided into three groups randomly divided into three groups: sham-operation group, 1-week group, 5-segment thrombosis embolism, observation for 1 week, 2 Week group: 5 thrombus embolism, observed for 2 weeks. In addition, only one embolization of thrombus to the right lower pulmonary artery to confirm the feasibility of selective embolization observed for 2 weeks. Observations were arterial blood gas, hemodynamic parameters and local pulmonary angiography changes. The experimental dogs were treated with tranexamic acid intramuscularly after thromboembolism, and the embolism was observed 1,2 weeks later. The pathological changes of thrombus were observed by using phosphotungstic acid hematoxylin-eosin staining (PTAH). Results PaO2 / FiO2 was (508 ± 58) mm Hg (1 mm Hg = 0.133 kPa) in canine pulmonary thromboembolism and (395 ± 100) mm Hg 1 h after embolization. Mean pulmonary embolism The MPAP was (15 ± 3) mm Hg, (21 ± 4) mm Hg after 1 h of embolization, and (178 ± 114) mm Hg · s / L before embolization of pulmonary vascular resistance (PVR) (404 ± 260) mm Hg · s / L, the difference was statistically significant (P <0.05). Experimental pulmonary embolism after local pulmonary arteriography showed truncated signs; 1 week to see embolism proximal pulmonary artery was significantly thicker, rigid wall-like changes. At 1 and 2 weeks after embolization, the pulmonary artery thrombus surface was not smooth in the experimental dogs. PTAH staining showed that the surface of the thrombus was mechanized. In the second week group, multiple thrombus was recanalized, pulmonary artery wall hyperplasia tissue was wrapped and the thrombus was separated. Conclusion Thrombus embolization of the canine pulmonary arteries and the inhibition of fibrinolysis with tranexamic acid may establish an animal model that simulates the pathological changes of chronic PTE. The embolization at different times showed different manifestations of pulmonary arteriography. The longer the time, the more obvious the thrombotic mechanism.