急性缺血后心室肌波长的整复性变化对心室纤颤发生的影响  

Wave length restitution changes in ventricular myocardium affecting the initiation of ventricular fibrillation during acute myocardial ischemia

作　　者：杨川[1] 张贺[1] 刘兴利[1] 孙英贤[1] 张薇[2] 

机构地区：[1]中国医科大学附属盛京医院心内科,110004 [2]中国医科大学附属盛京医院第二呼吸内科,110004

出　　处：《山西医药杂志（上半月）》2009年第5期387-389,共3页Shanxi Medical Journal

基　　金：国家自然科学基金(30270340)

摘　　要：目的了解急性缺血后心室肌波长的整复性变化对心室纤颤(室颤)发生的影响。方法选取健康成年杂种犬15只,采用心脏外科的方式开胸,切开并悬吊心包,暴露心脏。将64导心外膜标测电极置于左心室游离壁,将双极刺激电极(大头导管)置于64导心外膜标测电极旁,靠近室间隔侧。分别对正常的和急性缺血的心室肌以25mV为输出功率的程序化刺激(S1、S2),分别测量15条实验犬正常和急性缺血后心室肌的动作电位时程(APD)、传导速度(CV)及波长(WL)的整复性曲线的斜率及室颤阈值。分析正常和急性缺血后室颤阈值和3个斜率值的变化特点及差异。结果对正常和急性缺血心室肌诱发室颤的最长周期值(PI)进行比较,发现室颤阈值的差异具有统计学意义。同样对两组APD、CV及WL整复性曲线的斜率进行比较,WL整复性曲线表现差异有统计学意义。结论①急性缺血发生后,室性心动过速的发生更加容易诱发室颤;②WL的整复性对于预测室速转变为室颤的可能性优于APD和CV各自单独的整复性,可作为评估患者室颤发作可能性大小的有效指标。Objective To explore wave length restitution changes in ventricular myocardium affecting the initiation of ventricular fibrillation during acute myocardial ischemia. Methods By surgical method, opening fifteen adult canines chest to expose the heart. Then positing the 64-lead epicardial mapping plaque on the free wall of left ventricle, avoiding the coronary artery as far as possible. Deploy the bipolar stimulus catheter on the right side of the plaque. S1 ,S2 stimuli output in 25 mV is delivered to the normal and the acute ischemia ventricular myocardium. Measure the slope steepness of APD, CV and WL restitution curve in the normal and acute ischemia ventricular myocardium. The changes and differences between the normal and the ischemia can be found. Results Comparing the differences of slope steepness of APD, CV and WL between the normal and the acute ischemia, the slope steepness of WL restitution curve are significant. We also gain the significance in the threshold of VF in the same comparison. Conclusion①During acute myocardial ischemia period, once the ventricular tachycardia （VT） onsets, it can induce the VF more easily;②WL restitution is better to predict the possibility of the transformation from VT to VF than APD restitution or CV restitution separately.

关 键 词：动作电位 心室颤动 心肌缺血 整复性 

分 类 号：R541.75[医药卫生—心血管疾病]