胸外非同步直流电除颤电流对家兔心肌的影响  

Effects of transthoracic defibrillating dircet current on myocardium of rabbits

作　　者：柴湘平[1] 吴祖林[1] 常瑞明[1] 贺志飚[1] 

机构地区：[1]中南大学湘雅二医院急诊科,长沙市410011

出　　处：《实用医学杂志》2006年第18期2096-2098,共3页The Journal of Practical Medicine

摘　　要：目的:探讨胸外非同步直流电除颤电流对正常家兔心肌的影响。方法:将30只家兔随机分成3组,对照组、观察组1和观察组2。每组10只。对照组不予以电击,观察组1在3min内用除颤电流电击3次,观察组2在3min内用除颤电流电击6次,每次电击的能量均为4J/kg。电击后6h抽耳沿静脉血检测肌钙蛋白-I。并取心肌分别送病理和透射电镜检查,观察其光镜下和透射电镜下的改变。结果:(1)肌钙蛋白-I,对照组为(0.44±0.57)μg/L,观察组1为(1.46±0.87)μg/L,观察组2为(2.41±0.76)μg/L。3组之间差异有显著性。(2)光镜下的变化,对照组心肌纤维正常,无充血水肿。观察组1和观察组2均可见急性心肌损伤,表现为肌纤维肿胀,胞浆空泡变性,肌浆颗粒增粗,细胞核增大,间质水肿,血管扩张。观察组2的程度更严重。电镜下的变化,对照组心肌结构基本正常,观察组1和观察组2均可见肌纤维、线粒体、细胞核的损伤性改变。观察组2表现更严重。结论:(1)胸外非同步直流电除颤电流可导致心肌损害。(2)这种损害在显微结构表现为心肌细胞和血管的改变。超微结构的变化主要表现在细胞膜、线粒体和细胞核的改变。(3)该损害的严重程度与累积的能量有关。Objectives To investigate the effects of transthoracic defibrillating direct current on myocardium of rabbits. Methods Thirty rabbits were randomly divided into three groups： control group （ n = 10）, group 1 （ n = 10） and group 2 （ n = 10）. The times of defibrillation for each group were 0, 3 and 6 within 3 minutes respectively. The energy for defibrillation was 4 J/kg each time. Blood samples were drawn to detect cardiac tropenin Ⅰ at 6 hours after defibriLlation. At the same time, myocardium of each rabbit was tested for change under microscopy and electron microscopy. Results The levels of plasma cardiac troponin Ⅰ were （0. 44 ± 0. 57）μg/L in control group, （1.46±0. 87 ）μg/L in group 1 and （2.41±0. 76）μg/L in group 2. The myocardium was normal in control group, and showed acute myocardial injury in group 1 and group 2, such as myofiber swelling, cytochylema vacuolar metamorphosis, granule thickening in myoplasm, cytoblast enlargement, interstitial edema and blood vessel dilation. Severe myocardial metamorphosis was observed by the electron microscopy, which includes swelling of mitochondria, disruption of mitochondria crests and loss of integrity of the mitochondria inner and outer membranes. The myocardial injury in group 2 was more severe than that in group 1. Conclusion It is suggested that transthoracic direct current defibrillation could lead to acute myocardial injury, of which the injured severity may be related to the accumulated energy of defibrillation.

关 键 词：电抗休克 心肌 电击伤 肌钙蛋白Ⅰ 病理过程 

分 类 号：R541.7[医药卫生—心血管疾病]