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目的观察急性肺栓塞(APE)后冠状动脉血流量及心脏肌钙蛋白T(cTnT)与肌红蛋白(Mb)含量变化,探讨心肌血流灌注在急性肺栓塞继发心肌损伤机制中的作用。方法通过介入方法经导管注入自体血栓选择性栓塞肺动脉,建立不同栓塞面积的急性肺栓塞动物模型。监测栓前、栓后5、30 min,1、2 h冠状动脉血流量变化及栓后4 h血清cTnT与Mb含量。结果急性肺栓塞后血清cTnT与Mb含量升高。急性肺栓塞导致冠状动脉血流量显著下降,肺血管栓塞后15～ 30 min降至最低值,30 min后趋于平稳。右冠血流量下降程度与肺检塞面积有显著相关性。结论冠状动脉血流量减少及血清心肌结构蛋白含量升高为急性肺栓塞继发心肌缺血改变提供了直接证据。急性心肌缺血严重影响急性肺栓塞的预后。
Objective To observe the change of coronary blood flow, cardiac troponin T (cTnT) and myoglobin (Mb) after acute pulmonary embolism (APE), and to explore the role of myocardial perfusion in the mechanism of myocardial injury secondary to acute pulmonary embolism. Methods The pulmonary embolism was selectively embolized by autologous thrombus through the catheterization method and the animal model of acute pulmonary embolism with different embolization area was established. The change of coronary blood flow at 5, 30, 1, 2 h after embolization and the level of cTnT and Mb at 4 h after embolization were measured. Results Serum levels of cTnT and Mb increased after acute pulmonary embolism. Acute pulmonary embolism led to a significant decline in coronary blood flow, pulmonary embolism 15 to 30 min after the minimum value, 30 min stabilized. There was a significant correlation between the extent of right coronary blood flow decay and lung plugs area. Conclusions The decrease of coronary blood flow and the increase of serum myocardial protein content provide direct evidence of myocardial ischemia secondary to acute pulmonary embolism. Acute myocardial ischemia severely affects the prognosis of acute pulmonary embolism.