生物起搏与电子起搏“串联”起搏心脏的研究  

Biological and electronic pacemaker implanted together： the experimental research of pacing heart

作　　者：张浩[1] 宋智钢[1] 姚颖龙[1] 段炼[1] 邹毅清[2] 李白翎[1] 黄盛东[1] 徐志云[1] 

机构地区：[1]第二军医大学长海医院解放军胸心外科研究所胸心外科,上海200433 [2]第二军医大学长海医院解放军胸心外科研究所麻醉科,上海200433

出　　处：《中华实验外科杂志》2008年第9期1100-1102,共3页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金资助项目（30672075、30700157）

摘　　要：目的观察自体窦房结细胞移植与电子起搏器“串联”起搏心脏的作用。方法健康成年犬12条，随机分为实验组和对照组（n=6）。所有犬安置电子心脏起搏器以保证存活，然后切取窦房结。将实验组犬窦房结组织消化成细胞悬液后，注射到自体右室前壁心肌内，对照组相同部位注射等量培养液。2周后射频消融希氏束，建立完全性房室传导阻滞犬模型，观察并记录犬心律。对实验组犬经股静脉应用异丙肾上腺素，研究心律变化。免疫荧光染色观察移植的细胞存活状况及其与心室肌细胞形成的缝隙连接结构。结果建立完全性房室传导阻滞犬模型1h后，实验组心率高于对照组（P〈0．01）。注射异丙肾上腺素后，实验组心率变化明显（P〈0．01）。实验组心律在14d内保持稳定。免疫荧光染色法证实，移植的细胞在移植部位存活，且细胞间有缝隙连接结构形成。结论自体窦房结细胞移植是一种对儿茶酚胺类物质的调节作用反应敏感的生物起搏技术，并且在与电子起搏技术串联后，其起搏作用在14d内保持稳定。移植的窦房结细胞可与周围细胞形成电一机械耦联的结构基础。Objective To explore the effect of autograft of sino-atrial nodal cells for pacing heart working with electronic pacemaker. Methods Twelve healthy adult dogs were randomly assigned to experimental group or control group. The sino-atrial node （ SAN ） was harvested after the electronic pacemaker was implanted into the dogs. The SAN from dogs in experimental group was digested into cell suspension, then injected into autogenie right ventrieular anterior wall. Commensurable culture medium was injected into the same position in control group. Two week later, all dogs underwent eleetrophysiologie study and transeatheter ablation of His bundle to create three-degree AV block models. Isoproterenol （ISO） was administrated to the dogs in experimental group to investigate the change of the rhythm. Immunofluoreseent staining was done to investigate the survival of grafted cells and gap junction formed between cells. Results One h after the establishment of three-degree AV block models, heart rates in the dogs from experimental group were quicker than those in control group （ P 〈 0.01 ）. This escape rhythm was altered remarkably when ISO was administrated （ P 〈 0.01 ）. And this rhythm maintained for 14 days. Immunofluorescent staining suggested that the grafted SAN cells survived in ventricular myocardium and gap junctions expressed between cells. Conclusion Autograft of SAN cells from adult dogs is a kind of biopacing techniques sensitive to ISO. This effect is stable during 14 days. Grafted SAN cells can form gap junctions with adjacent myocytes.

关 键 词：生物起搏 电子起搏 窦房结/细胞学 自体移植 心脏 

分 类 号：R541.7[医药卫生—心血管疾病]