新西蘭大白兔急性尿路梗阻繼發(fā)的肺部CT表現(xiàn)
發(fā)布時(shí)間：2019-05-21 22:36
【摘要】： 目的： 通過動(dòng)物實(shí)驗(yàn)建立急性尿路梗阻模型,了解急性尿路梗阻后實(shí)驗(yàn)動(dòng)物肺部所表現(xiàn)的影像學(xué)特點(diǎn)及病理改變,并結(jié)合相關(guān)化驗(yàn)檢查,分析發(fā)生原因,為臨床認(rèn)識(shí)急性尿路梗阻后肺改變提供資料,旨在為臨床醫(yī)生提供診斷依據(jù)。 方法： 選取常規(guī)肺部CT掃描無異常之新西蘭大白兔30只,隨機(jī)分為對(duì)照組,單側(cè)輸尿管梗阻組(單側(cè)組)及雙側(cè)輸尿管梗阻組(雙側(cè)組),術(shù)后第2天始行胸部高分辨CT掃描及血肌酐(Cr)、尿素氮(BUN)和心鈉素(ANP)檢查,至雙側(cè)組動(dòng)物完全死亡時(shí)結(jié)束。實(shí)驗(yàn)中及實(shí)驗(yàn)結(jié)束后取實(shí)驗(yàn)動(dòng)物肺組織進(jìn)行病理學(xué)檢查。 結(jié)果： 1、單側(cè)組動(dòng)物CT、病理及血BUN、Cr與ANP檢測(cè)值與對(duì)照組相比均無差異： (1)胸部CT示雙側(cè)肺野透亮度正常,肺紋理走行自然,未見異常密度灶；縱膈窗未見胸膜增厚、胸腔積液及心包積液； (2)病理切片于肺泡切面見兩種肺泡上皮細(xì)胞和肺泡間隔內(nèi)的毛細(xì)血管。肺組織結(jié)構(gòu)正常,肺泡間隔無水腫及炎細(xì)胞浸潤(rùn)等表現(xiàn)； (3)單側(cè)組血BUN、Cr與ANP檢測(cè)值分別于術(shù)后0d、2d、4d與對(duì)照組相比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 2、雙側(cè)組動(dòng)物CT、病理及血BUN、Cr及ANP檢測(cè)值與對(duì)照組相比具有顯著差異： (1)CT胸部高分辨表現(xiàn)呈多樣性,主要包括肺透亮度下降,間質(zhì)性肺水腫,肺泡性肺水腫,心包積液及胸腔積液等； (2)雙側(cè)組動(dòng)物肺部主要病理基礎(chǔ)包括僅肺泡間隔增寬；肺泡上皮細(xì)胞稀疏,肺泡間隔及肺泡腔中均勻粉染的水腫液；血管擴(kuò)張及充血,炎細(xì)胞浸潤(rùn)等； (3)分別于術(shù)后2d,4d對(duì)雙側(cè)組血中BUN、Cr及ANP與對(duì)照組進(jìn)行對(duì)比,結(jié)果顯示具有兩組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后0d對(duì)照組與雙側(cè)組相比差異無統(tǒng)計(jì)學(xué)差異(P0.05)； (4)雙側(cè)組肺部CT表現(xiàn)總體趨勢(shì)是由肺透亮度下降發(fā)展成為間質(zhì)性肺水腫再發(fā)展成為肺泡性肺水腫,胸腔積液及心包積液可與肺部表現(xiàn)相伴出現(xiàn),也可單獨(dú)出現(xiàn)于各種表現(xiàn)之后；各種表現(xiàn)與血BUN和Cr最高頻率值出現(xiàn)時(shí)相具有一定的一致性。 結(jié)論： 單側(cè)尿路梗阻不引起血Cr、BUN、ANP改變及肺高分辨CT和病理異常表現(xiàn)；雙側(cè)尿路梗阻后肺部CT表現(xiàn),病理表現(xiàn)及血Cr、BUN、ANP值出現(xiàn)明顯異常；發(fā)病機(jī)制主要與鈉水潴留,循環(huán)血量增加,大量毒素聚積有關(guān)。據(jù)此可知,若雙側(cè)尿路梗阻時(shí)合并肺部改變應(yīng)首先考慮肺水腫；而單側(cè)尿路梗阻時(shí)若同時(shí)合并肺部改變則不以肺水腫為首要病因。
[Abstract]:Objective: to establish the model of acute urinary tract obstruction through animal experiment, to understand the imaging features and pathological changes of lungs in experimental animals after acute urinary tract obstruction, and to analyze the causes of acute urinary tract obstruction combined with related laboratory examination. To provide data for clinical understanding of lung changes after acute urinary tract obstruction in order to provide diagnostic basis for clinicians. Methods: 30 New Zealand white rabbits without abnormal pulmonary CT scan were randomly divided into control group, unilateral ureter obstruction group (unilateral group) and bilateral ureter obstruction group (bilateral group). Chest high resolution CT scan, serum creatinine (Cr), urea nitrogen (BUN) and atrial natriuretic peptide (ANP) were performed on the 2nd day after operation, and ended when the animals in the bilateral group died completely. The lung tissue of the experimental animals was taken for pathological examination during and after the experiment. Results: 1. There was no difference in CT, pathology and blood BUN,Cr and ANP between the unilateral group and the control group: (1) chest CT showed that the transmittance of bilateral lung field was normal, the lung texture was natural, and no abnormal density foci were found. No pleura thickening, pleural effusion and pericardial fluid were found in the mediastinal window. (2) two kinds of alveolar epithelial cells and capillaries in the alveolar septum were found in the alveolar section. The structure of lung tissue was normal, there was no edema in alveolar septum and inflammatory cell infiltration. (3) the detection values of BUN,Cr and ANP in unilateral group were 0 d, 2 d and 4 d after operation, respectively, and there was no significant difference between the two groups (P 0.05). 2. The pathological changes of CT, and the values of BUN,Cr and ANP in blood of the bilateral group were significantly different from those of the control group: (1) the chest high resolution of CT was diverse, including the decrease of lung transmittance and interstitial pulmonary edema. Alveolar pulmonary edema, pericardial effusions and pleural effusions, etc. (2) the main pathological basis of the lungs in the bilateral group included only the widening of alveolar septum, sparse alveolar epithelial cells, evenly powdered edematous fluid in alveolar septum and alveolar cavity, vasodilation and hyperemia, inflammatory cell infiltration, etc. (3) on the 2nd and 4th day after operation, the blood BUN,Cr and ANP in the bilateral group were compared with those in the control group, and the results showed that there was significant difference between the two groups (P 0.05). There was no significant difference between the control group and the bilateral group 0 days after operation (P 0.05). (4) in the bilateral group, the overall trend of pulmonary CT findings was from the decrease of pulmonary transmittance to the development of interstitial pulmonary edema and then to alveolar pulmonary edema, and pleural effusion and pericardial effusion could be accompanied by pulmonary manifestations. It can also appear alone after all kinds of performance; All kinds of manifestations were consistent with the highest frequency values of blood BUN and Cr. Conclusion: unilateral urinary tract obstruction does not cause blood Cr,BUN,ANP changes, lung high resolution CT and pathological abnormalities, but there are obvious abnormalities in pulmonary CT findings, pathological findings and blood Cr,BUN, ANP values after bilateral urinary tract obstruction. The pathogenesis is mainly related to sodium and water retention, the increase of circulating blood volume and the accumulation of a large number of toxins. According to this, pulmonary edema should be considered first if bilateral urinary tract obstruction is complicated with pulmonary change, while pulmonary edema should not be the primary cause if unilateral urinary tract obstruction is complicated with pulmonary change at the same time.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R-332
本文編號(hào)：2482459
[Abstract]:Objective: to establish the model of acute urinary tract obstruction through animal experiment, to understand the imaging features and pathological changes of lungs in experimental animals after acute urinary tract obstruction, and to analyze the causes of acute urinary tract obstruction combined with related laboratory examination. To provide data for clinical understanding of lung changes after acute urinary tract obstruction in order to provide diagnostic basis for clinicians. Methods: 30 New Zealand white rabbits without abnormal pulmonary CT scan were randomly divided into control group, unilateral ureter obstruction group (unilateral group) and bilateral ureter obstruction group (bilateral group). Chest high resolution CT scan, serum creatinine (Cr), urea nitrogen (BUN) and atrial natriuretic peptide (ANP) were performed on the 2nd day after operation, and ended when the animals in the bilateral group died completely. The lung tissue of the experimental animals was taken for pathological examination during and after the experiment. Results: 1. There was no difference in CT, pathology and blood BUN,Cr and ANP between the unilateral group and the control group: (1) chest CT showed that the transmittance of bilateral lung field was normal, the lung texture was natural, and no abnormal density foci were found. No pleura thickening, pleural effusion and pericardial fluid were found in the mediastinal window. (2) two kinds of alveolar epithelial cells and capillaries in the alveolar septum were found in the alveolar section. The structure of lung tissue was normal, there was no edema in alveolar septum and inflammatory cell infiltration. (3) the detection values of BUN,Cr and ANP in unilateral group were 0 d, 2 d and 4 d after operation, respectively, and there was no significant difference between the two groups (P 0.05). 2. The pathological changes of CT, and the values of BUN,Cr and ANP in blood of the bilateral group were significantly different from those of the control group: (1) the chest high resolution of CT was diverse, including the decrease of lung transmittance and interstitial pulmonary edema. Alveolar pulmonary edema, pericardial effusions and pleural effusions, etc. (2) the main pathological basis of the lungs in the bilateral group included only the widening of alveolar septum, sparse alveolar epithelial cells, evenly powdered edematous fluid in alveolar septum and alveolar cavity, vasodilation and hyperemia, inflammatory cell infiltration, etc. (3) on the 2nd and 4th day after operation, the blood BUN,Cr and ANP in the bilateral group were compared with those in the control group, and the results showed that there was significant difference between the two groups (P 0.05). There was no significant difference between the control group and the bilateral group 0 days after operation (P 0.05). (4) in the bilateral group, the overall trend of pulmonary CT findings was from the decrease of pulmonary transmittance to the development of interstitial pulmonary edema and then to alveolar pulmonary edema, and pleural effusion and pericardial effusion could be accompanied by pulmonary manifestations. It can also appear alone after all kinds of performance; All kinds of manifestations were consistent with the highest frequency values of blood BUN and Cr. Conclusion: unilateral urinary tract obstruction does not cause blood Cr,BUN,ANP changes, lung high resolution CT and pathological abnormalities, but there are obvious abnormalities in pulmonary CT findings, pathological findings and blood Cr,BUN, ANP values after bilateral urinary tract obstruction. The pathogenesis is mainly related to sodium and water retention, the increase of circulating blood volume and the accumulation of a large number of toxins. According to this, pulmonary edema should be considered first if bilateral urinary tract obstruction is complicated with pulmonary change, while pulmonary edema should not be the primary cause if unilateral urinary tract obstruction is complicated with pulmonary change at the same time.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R-332
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