| ObjectivePulmonary embolism ( PE) is a common disease process, and gradually become one of the focuses in clinical employment. Patients are at highest risk of death within the first hours of onset due to right ventricular failure, two of every three deaths occur in the first hour. Pulmonary embolism is difficult to diagnose, The necropsy from overseas shown that more than 30% patients were misdiag-nose . So correct diagnose and rapid therapeutic action are essential to save the life of the patient. Interventional therapy become a additional option for patients with acute Pulmonary embolism for its advantages of little trauma, high efficiency and low mortality rate . At present, the evaluation of interventional therapeutic efficacy is limited to clinical retrospective investigation. And there is no comparison analysis of the maximus exponent yet. Moreover there is no one ideal mechanism could rapidly get rid of the Pulmonary Artery thrombus.The purpose of this study is to investigate the influence on hemodynamic and imageology of acute Pulmonary embolism by Helix Thrombectomy Device ( HTD) , urokinase( UK) ,and HTD with UK( HTD + UK). Based on the experiments results , clinical efficacy was observed the by compared the arterial PO2 and PAMP beforetreament and posttreament . in this study , the demonstration a-bout whether HTD is a ideal option for the therapy of acute Pulmonary embolism will be gotten , and the basis of clinical therapy standard for acute Pulmonary embolism was eager to provided.Material and methodsThis study is consisted of 3 parts.Animal model of acute Pulmonary embolism. Experiment animals are mongrel dogs . 50 - 80ml vain blood was collected and add in the plat with thrombin 500 U, finally was made to clots which size is 10 10 8 mm3. Through femoral vein , 8 - F sheath was put in the Pulmonary Artery, and then inject the clot through sheath.. The situation of pulmonary embolism was observed by arteriography , and the Pulmonary Artery pressure was sustained at the level 50 - 60mmHg. A-mong whole 31 mongrel dogs, 28 dogs were successfully formed acute Pulmonary embolism model .2. The experiment investigation of the mechanical thrombectomy for acute pulmonary embolism. 28 dogs were divided randomly into 4 groups;Helix Thrombectomy Device ( HTD ) , urokinase ( UK ) , HTD with UK ( HTD + UK ) and control (CTL) group. PAMP, SBP, gasometric parameters and pulmonary angiography was observed before and immediately, 30 min, 1 hour, 2 hour after embolism. At last the specimens of lung were made for gross evaluation and histology of HE.3. The clinical appilication of helix thrombectomy device in acute pulmonary embolism. HTD was performed in 12 cases with acute pulmonary embolism. To evaluate the clinical efficacy of the helix thrombectomy device by the clinical improvement, complications and the change of PAMP and pulmonary angiography and pulmonary artery mean pressure.Results1. Among whole 31 mongrel dogs, 28 dogs were successfully formed acute Pulmonary embolism model .2. In every therapy group, PAMP30min,CTL group was 33. 5 ±3. 38,Uk group was 29.00 ±3.96,HTD group was 29. 39 ±3.17,HTD + UK25. 24 ±3. 04,q =6.88,p =0.002;60min, CTL group was 33.19 ±3.54,UK group 28.79±3.96,HTD group 24.44 ±3.70,HTD + UK group 23. 57 ±4.57,q =8. 73,p = 0.000;120min, CTL group % 31. 50 ± 3.75,UK group 26.43 ±4. 04, HTD group 22.00 ±3. 62,HTD+UK group 17. 86 ±3. 26,q = 17.78,p =0. 000o a significant decrease in pulmonary artery mean pressure after treatment at the time of 30 min, 1 hour, 2 hour after embolism compared with those in control group. The difference in PAMP between HTD and UK groups at 120 min after therapy was significant ( P < 0. 05 ). The overall PAMP of HTD + UK group posttreatment at 30min and 120 min compared with UK and HTD groups had a significant decrease(P <0.05) , was significant difference at 60 min compared with UK group. The SBP of every group was no difference. The pulmonary arter-y angiography of posttreatment in every therapy group showed that the occlusive artery was restored and the pulmonary artery circulation was improved. Pathologic study: (1) control group;The embolism locus was as same as Pulmonary ar-teriography. Under the light microscope, the thrombosis can be seen in the Pulmonary Artery, there were large piece of blood in lung constitution. (2) therapy group : The degree of the blood in lung is light, and there were few red cells in alveolar. The autologous embolus can be seen in pulmonary arteries in pathology. Focal intimal injury in the pulmonary artery was made by HTD.3. Technical success was achieved in 12 cases. The difference in mean PAMP before and after treatment was significant , t index was 0. 016, p < 0. 001;The PaO2 of posttreament was improvement significantly, t index was -0. 023, p <0.001 o With regard to complications, there were no cases of major bleeding. No renal failure was observed in any patient.Conclusion1. The dog animal model of this study is easily performed, and can provide a reliable animal model for clinical investigation of pathophysiology and imageol-ogy of acute Pulmonary embolism.2. HTD has abilities of thrombectomy and the restore of the pulmonary artery circulation with light injure to intima of vessel. And it is a optional device in the clinical therapy of acute Pulmonary embolism as well, especially one withthe abstinence of thrombolytic treatment.3. The results of this study shown that intrapulmonary thrombolysis throm-bectomy can decrease the Pulmonary Artery pressure and improve the hemody-namicology with the advantages of low agent , rapid and little possibility of blood complication.4. HTD combined with thrombolytic treatment is safe , with better results than HTD or pharmacologic fibrinolysis alone.5. These clinical applications of HTD suggested that it was an rather ideal devise . And combined with thrombolysis it could restore the Pulmonary Artery circulation in most short timeand relieve the right ventricular load, save the patient' s life.
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