实验性急性肺栓塞溶栓疗法与动脉血浆内皮素水平变化  

Changes of arterial plasma endothelin levels induced by acute pulmonary embolism and thrombolytic therapy

作　　者：许俊堂[1] 袁训芝[1] 黄永麟[2] 田野[2] 孟繁超[2] 杨志洁[3] 徐云松 胡大一[1] 翁心植[1] 

机构地区：[1]首都医科大学附属北京红十字朝阳医院心脏中心,100020 [2]哈尔滨医科大学附属第一医院心内科 [3]哈尔滨医科大学附属第一医院同位素室

出　　处：《岭南心血管病杂志》1997年第2期38-40,61-62,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的：自体血栓注入法建立急性肺栓塞动物模型，探讨内皮素在急性血栓栓塞性肺动脉高压中的作用和溶栓疗法对肺动脉释放内皮素的影响。方法：14只杂种犬，自体血栓注入法建立急性肺栓塞模型。模型犬随机分入溶栓组和对照组，溶栓组7只犬给予尿激酶20000U/kg，100ml液体稀释后30分钟静脉滴入，对照组同期输入等量的生理盐水。分别于注栓前、溶栓前（对照组同期）、溶栓后（对照组同期）血液动力学测定，采动脉血放免法测定血浆内皮素水平。结果：溶栓组犬静注尿激酶30分钟后，伴随肺动脉压力和肺血管阻力的显著性下降，动脉血浆内皮素水平显著升高，溶栓后30小时为99.25±12.90pg/L，与注栓前51．63±10．09pg/L比较P＜005，与对照组同期值55．93±2.10pg/L比较P＜001，对照组犬栓塞后4小时内肺动脉压力和肺血管阻力无显著变化，内皮素水平亦无显著性改变。结论：内皮素可能与急性血栓栓塞性肺动脉高压的形成有关，动脉血浆内皮素水平的增加可能是血管再通的一个标志。Objective: To investigate the role played by endothelin in acute thromboembolic pulmonary hypertension and the effects of thrombolytic therapy on endothelin release from pulmonary arterioles, we employed an animal model of acute pulmonary embolism by intravenous infusion of autologous blood clot. Methods: A canine model of acute pulmonary embolism was established by injecting thrombin-induced autologous clot in the guidance of pulmonary artery pressure.Fourteen dogs were randomized ot either urokinase -treated (UK, n=7) or control(CTL, n=7) group.Haemodynamic monitoring and arterial plasma endothelin determinations(radio immunoassay) were conducted periodically. Urokinase, 20 000 U/kg over 30 min, was given to seven UK dogs intravenously, whteras the CTL dogs received only 100 ml intravenous saline solution.Results: Plasma endothelin of UK treated dogs increased progressively with the decrease of pulmonary artery pressure and pulmonary vascu lar resistance (from baseline 51.36 ±10.09 pg/L to 99.25 ±12.90 pg/L 3 .Oh after UK initiation, P<0.05; P<0.01 compared with control value). There were no significant changes in pulmonary artery pressure and pulmonary vascular resistare and plasma endothelin remained unchanged in UK dogs with time. Conclusion: It is shown that endothelin may play a very important role in the formation of acute thromboembolic pulmonary hypertension, and the increased endothelin levels of arterial plasma may be a marker of pulmonary revascularization.

关 键 词：急性肺栓塞 溶栓疗法 内皮素 

分 类 号：R563[医药卫生—呼吸系统]