经胸射频肺动脉去神经术对兔肺动脉高压模型的保护作用  

Effect of transthoracic pulmonary artery denervation on monocrotaline-induced pulmonary arterial hypertension in rabbits

作　　者：周静[1] 董文鹏 吴水碧 桂龙 于旭 周志 葛圣林[1] 林敏[1] Zhou Jing;Dong Wenpeng;Wu Shuibi;Gui Long;Yu Xu;Zhou Zhi;Ge Shenglin;Lin Min(Department of Cardiovascular Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Cardiothoracic Surgery,Lu’an Hospital of Anhui Medical University,Lu’an 237006,China)

机构地区：[1]安徽医科大学第一附属医院心脏大血管外科,合肥230022 [2]安徽医科大学附属六安医院心胸外科,237006

出　　处：《中华实验外科杂志》2022年第5期839-843,共5页Chinese Journal of Experimental Surgery

基　　金：安徽省高等学校自然科学研究项目(KJ2018A0180);安徽医科大学第一附属医院临床研究启动计划(LCYJ2021YB016)。

摘　　要：目的探讨在野百合碱诱导的肺动脉高压新西兰兔模型中,实施经胸射频肺动脉去神经术(TPADN)是否能改善肺动脉高压,延缓肺动脉高压的进展。方法将16只健康雄性新西兰兔采用随机数法分为对照组(n=5)、假手术组(n=5)及TPADN组(n=6),假手术组和TPADN组予以腹腔注射野百合碱溶液(50 mg/kg)。造模4周后,经右心室测压,以平均右心室压≥20 mmHg为造模成功;TPADN组行TPADN,假手术组开胸后仅钳夹肺动脉但并不进行射频消融。术后第3周再次行右心室测压,测量各组兔右心室收缩压、右心室舒张压和平均右心室压;并观察各组兔心肺组织显微形态学变化,以评估各组兔的肺血管重构及右心肥厚程度,两组间比较采用两独立样本t检验,组内前后比较采用配对t检验。结果TPADN术后,TPADN组兔的平均右心室压明显低于假手术组[(16.0±1.7)mmHg比(22.4±2.1)mmHg,t=5.677,P<0.05],且TPADN组肺小动脉相对管壁厚度[(24.39±4.54)%比(37.32±7.42)%,t=10.748,P<0.05],TPADN组右心室纤维化程度低于假手术组[(5.94±2.02)%比(9.09±2.08)%,t=4.205,P<0.05],排列整齐,心肌纤维直径[(9.12±1.45)μm比(12.31±2.17)μm,t=12.174,P<0.05],右心室心肌细胞横截面积显著小于假手术组[(338.10±44.94)μm2比(419.65±21.91)μm2,t=3.686,P<0.05]。结论TPADN可以降低野百合碱诱导的肺动脉高压兔模型的肺动脉压力,并改善其肺动脉血管重构及右心室肥厚程度。Objective To explore whether transthoracic pulmonary artery denervation(TPADN)by radiofrequency ablation can reduce pulmonary hypertension and delay the progression of pulmonary hypertension in rabbits with pulmonary arterial hypertension induced by monocrotaline(MCT).Methods A total of 16 healthy male rabbits were randomly divided into control group(n=5),sham operation group(n=5)and operation group(n=6)by random number method.Rabbits in sham operation group and operation group received single intraperitoneal injection of MCT(50 mg/kg).After 4 weeks,the model with mean right ventricular pressure≥20 mmHg evaluated by right cardiac catheterization was established successfully.The transthoracic pulmonary artery radiofrequency ADN was performed on the operation group,while only thoracotomy and clamping of pulmonary artery were performed on the sham operation group.After 3 weeks of operation,hemodynamic parameters such as mean right ventricular pressure were measured by the right heart catheter.Meanwhile,the micromorphological changes of heart and lung tissue of rabbits in each group were observed to evaluate the degree of pulmonary vascular remodeling and right ventricular hypertrophy in each group.Two independent sample t-test was used for comparison between the two groups,and paired t-test was used for intra-group comparison.Results After TPADN,the average right ventricular pressure in the operation group was significantly lower than that in the sham operation group[(16.0±1.7)vs.(22.4±2.1)mmHg,t=5.677,P<0.05].Meanwhile,the percentage of wall thickness to outer diameter of the small pulmonary arterioles[(24.39±4.54)%vs.(37.32±7.42)%,t=10.748,P<0.05],the degree of fibrosis[(5.94±2.02)%vs.(9.09±2.08)%,t=4.205,P<0.05],the diameter of right ventricular cardiomyocyte[(9.12±1.45)μm vs.(12.31±2.17)μm,t=12.174,P<0.05]and the right ventricular cardiomyocyte cross-sectional area[(338.10±44.94)μm2 vs.(419.65±21.91)μm2,t=3.686,P<0.05]were also decreased in the operation group compared to the sham operation group

关 键 词：肺动脉高压 射频消融术 交感神经去除术 

分 类 号：R544.1[医药卫生—心血管疾病] R-332[医药卫生—内科学]