临床和实验医学杂志
臨床和實驗醫學雜誌
림상화실험의학잡지
JOURNAL OF CLINICAL AND EXPERIMENTAL MEDICINE
2015年
16期
1332-1335
,共4页
犬%人工血管移植%心力衰竭
犬%人工血管移植%心力衰竭
견%인공혈관이식%심력쇠갈
Dog%Artificial blood vessel%Heart failure
目的：探讨带钛镍记忆合金支架的人工血管将犬升主动脉、主动脉弓及降主动脉合为一体进行移植的可行性及移植后血浆 N 氨基末端脑钠肽前体（NT - proBNP）、血清中门冬氨酸氨基转移酶（AST）和肌酸激酶（CK）的变化对心力衰竭的预判价值。方法选取23只15 kg 以上的成年杂种犬，在全麻深低温停循环及上腔静脉逆行灌注的条件下进行全胸主动脉带钛镍记忆合金支架人工血管移植，记录犬术中生理参数、手术时间、生存期、分析死亡原因。观察术后不同时间血浆 NT - proBNP、血清 AST、CK 浓度与心力衰竭的关系。结果全组23条成年杂种犬30 d 总生存率为65.2%（15/23）；手术时间约（174.6±27.0）min；生存期在30 d 之内的犬，自开胸后至人工血管吻合完成所需时间明显长于生存期超过30 d 的犬；人工血管移植术后24~48 h，NT - proBNP、AST、CK 的浓度平均达到高峰，随着生存期的延长，浓度逐渐降低，但在犬死亡前1~3 d 各指标的浓度达到最高值。结论带钛镍记忆合金支架的人工血管进行全胸主动脉移植的方法可行；人工血管吻合时间越短，对生理参数及心、肝肾功能影响越小；检测 NT - proBNP、AST、CK 的浓度变化可预判犬人工血管移植术后心力衰竭的程度。
目的：探討帶鈦鎳記憶閤金支架的人工血管將犬升主動脈、主動脈弓及降主動脈閤為一體進行移植的可行性及移植後血漿 N 氨基末耑腦鈉肽前體（NT - proBNP）、血清中門鼕氨痠氨基轉移酶（AST）和肌痠激酶（CK）的變化對心力衰竭的預判價值。方法選取23隻15 kg 以上的成年雜種犬，在全痳深低溫停循環及上腔靜脈逆行灌註的條件下進行全胸主動脈帶鈦鎳記憶閤金支架人工血管移植，記錄犬術中生理參數、手術時間、生存期、分析死亡原因。觀察術後不同時間血漿 NT - proBNP、血清 AST、CK 濃度與心力衰竭的關繫。結果全組23條成年雜種犬30 d 總生存率為65.2%（15/23）；手術時間約（174.6±27.0）min；生存期在30 d 之內的犬，自開胸後至人工血管吻閤完成所需時間明顯長于生存期超過30 d 的犬；人工血管移植術後24~48 h，NT - proBNP、AST、CK 的濃度平均達到高峰，隨著生存期的延長，濃度逐漸降低，但在犬死亡前1~3 d 各指標的濃度達到最高值。結論帶鈦鎳記憶閤金支架的人工血管進行全胸主動脈移植的方法可行；人工血管吻閤時間越短，對生理參數及心、肝腎功能影響越小；檢測 NT - proBNP、AST、CK 的濃度變化可預判犬人工血管移植術後心力衰竭的程度。
목적：탐토대태얼기억합금지가적인공혈관장견승주동맥、주동맥궁급강주동맥합위일체진행이식적가행성급이식후혈장 N 안기말단뇌납태전체（NT - proBNP）、혈청중문동안산안기전이매（AST）화기산격매（CK）적변화대심력쇠갈적예판개치。방법선취23지15 kg 이상적성년잡충견，재전마심저온정순배급상강정맥역행관주적조건하진행전흉주동맥대태얼기억합금지가인공혈관이식，기록견술중생리삼수、수술시간、생존기、분석사망원인。관찰술후불동시간혈장 NT - proBNP、혈청 AST、CK 농도여심력쇠갈적관계。결과전조23조성년잡충견30 d 총생존솔위65.2%（15/23）；수술시간약（174.6±27.0）min；생존기재30 d 지내적견，자개흉후지인공혈관문합완성소수시간명현장우생존기초과30 d 적견；인공혈관이식술후24~48 h，NT - proBNP、AST、CK 적농도평균체도고봉，수착생존기적연장，농도축점강저，단재견사망전1~3 d 각지표적농도체도최고치。결론대태얼기억합금지가적인공혈관진행전흉주동맥이식적방법가행；인공혈관문합시간월단，대생리삼수급심、간신공능영향월소；검측 NT - proBNP、AST、CK 적농도변화가예판견인공혈관이식술후심력쇠갈적정도。
Objective To investigate the feasibility of artificial blood vessel with titanium nickel memory alloy stent graft in the dogˊs as-cending aorta,aortic arch and descending aorta,assessment on the anticipating value of the plasma N - terminal pro brain natriuretic peptide(NT proBNP)precursors,serum aspartate aminotransferase(AST)and creatine kinase(CK)on heart failure. Methods From March 2015 to May 2014,Selecting 23 15kg or more adult hybrid dogs. Under the condition of deep hypothermia circulatory arrest and retrograde perfusion of the su-perior vena cava,all thoracic aortic vascular grafts were performed. The physiological parameters,operation time,survival time and death cause were recorded. To investigate the relationship between plasma NT - proBNP,AST,CK concentration and heart failure at different time after opera-tion. Results The overall survival rate was 65. 2%(15 / 23)of 23 adult hybrid dogs in the whole group. Operation time was about(174. 6 ± 27. 0)min. The survival period of the dog in the 30 d,which the time of the artificial blood vessel anastomosis was significantly longer than that of over 30 d. 24 ~ 48 h after artificial blood vessel transplantation,NT - proBNP,AST and CK concentrations reached the highest level. With the extension of survival time,the concentration of above three index gradually decreased,but the concentration of the index of the dog reached the highest value 1 ~ 3 d before death. Conclusion Method of artificial blood vessel with titanium nickel memory alloy stent for the whole thoracic aortic transplantation is feasible. The shorter time of artificial blood vessel anastomosis,the smaller the impact on the physiological parameters,the function of heart,liver and kidney. The concentration of NT - proBNP,AST and CK can be estimated to the extent of heart failure after artificial blood vessel transplantation.
