建立肺血减少型先心病幼猪动物模型评估肺血管发育  

A porcine model of congenital heart defect with decreased pulmonary blood flow established and the evaluate of immature pulmonary vascular of morphological chang

作　　者：刘学刚[1] 刘戈[1] 王康武[1] 张俊祥[2] 宋伟[3] 于东红[4] 张雷[1] 段贵新[1] 

机构地区：[1]蚌埠医学院第一附属医院胸心外科,233004 [2]蚌埠医学院第一附属医院CT室,233004 [3]蚌埠医学院第一附属医院超声科,233004 [4]蚌埠医学院第一附属医院病理科,233004

出　　处：《中华胸心血管外科杂志》2011年第5期300-303,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：本课题受安徽省高等学校省级重点自然科学研究项目资助（KJ2009A74）

摘　　要：目的采用球囊扩张人工房间隔造口加肺动脉环缩术建立肺血减少型先心病幼猪动物模型，探讨肺血减少对其未成熟肺血管发育病理形态学变化的影响。方法选用1～2月龄幼猪共20头，随机分为3组：正常对照组（c组，6头），右胸小切口造成一过性肺血减少；轻中度肺动脉狭窄组（T1组，7头），经右心房表面送入球囊扩张器行人工房间隔造口加肺动脉Banding环缩术，术中收缩期肺动脉环缩处压差（Trans—PABP）20～30mmHg（1mmHg=0．133kPa）；重度肺动脉狭窄组（L组，7头），术中Trans—PABP／〉30～50mmHg。术后超声评估、1个月时行64排CT扫描评估、2个月时行二次剖胸手术验证评估，测量各组血管近端直径及Trans—PABP，处死动物切取心、肺组织测量房间隔缺损、肺动脉和Banding环直径。手术结束、术后2个月取右肺中叶外侧段1．0cm×0．8cm×0．8cm肺组织，Weihgt弹性纤维＋VanGieson染色，光镜下观察其病理形态学变化。结果T1和T2组存活动物房间隔造口加肺动脉环缩术均获得成功。C组动物因麻醉意外术后10h死于呼吸衰竭1头；T1组术后21天死于肠梗阻、肠坏死1头；T2组死亡2头，分别因急性和慢性右心功能衰竭，于术后24h和39天死亡。64排CT扫描示，肺动脉环缩处直径（BD）显著低于其主动脉直径（AOD）（P〈0．01），近端狭窄后扩张、远端肺血管纹理稀少。肺组织病理学示术后2个月肺细小动脉内径T1、T2组明显高于C组（P〈0．05、P〈0．01），单位面积小动脉数量（NAPSC）实验组均显著低于对照组（P〈0．01）。结论构建的幼猪动物模型更接近于临床病理生理状态，64排螺旋CT联合肺组织病理学观察用于肺血管发育不良的评估是一种可靠方法。肺血减少时幼猪肺小动脉中层发育不良伴数量减少，随环缩加重肺动脉发育不良和肺血流的减少的程度逐渐加重。Objective Artificial atrial septum defect combining pulmonary artery banding to create a model of congenital heart defect with decreased pulmonary blood flow to explore the morphological changes of immature pulmonary vascular. Methods Choose twenty piglets with about one to two-month-old, which are exclusively for experiment used. The piglets were randomly divided into three groups ： normal control group （ group C, n = 6 ）, Small incisions on the right chest, produced a transient reduction in pulmonary blood; low-medium pulmonary artery stenosis groups （ group T1, n = 7 ） ： Did artificial room septostomy creation by self-dilators which were delivered into the surface of the right atrium and controlled Systolic traMs pulmonary artery banding pressure（Trans-PABP） at pressure of 20 - 30 mmHg ; severe pulmonary artery stenosis groups （ group T2, n = 7 ） ： T2 were the same surgical procedures with group T1, and controlled Trans-PABP ≥ 30 -50 mmHg. Monitored ultrasound after operation, carried out 64-slice computed tomography scanning after one month, to measure the proximal vessel diameter and TransPABP, after two month surgical exploration on the left chest. When the animals were sacrificed, the heart and lung tissue was cut to measure atrial septal defect, pulmonary artery and the banding diameter. By weihgt elastic fiber and van Gieson staining to observe the morphological pathological changes, three groups took lung tissue with right middle lobe lateral segment about 1.0 cm ×0.8 cm × 0.8cm at the end of surgery and 2-months after operation respectively. Results The models were all successfully in the survival animal of the two test groups. One pig died from tracheal intubation accident in the C group, there was one case died due to bowel obstruction in the T1 group, And there were two cases died result from acute right heart failure and chronic heart failure respectively in T2 group. 64-slice CT angiography showed that BD was significantly lower than the AOD in the two test groups, the pr

关 键 词：先天性心脏病 动物替代试验 肺动脉 病理学 肺血流减少 

分 类 号：R-332[医药卫生]