异丙酚复合瑞芬太尼对离体家兔心脏传导系统和心肌β_1受体表达的影响  

The Effects of Propofol-remifentanil on Cardiac Condution System and Expression of Cardiac β_1-adrenoreceptors in Isolated Rabbit Heart

作　　者：方开云[1] 何祥[1] 史静[1] 

机构地区：[1]贵阳医学院附属医院麻醉科,贵阳550004

出　　处：《中国医科大学学报》2011年第1期50-52,共3页Journal of China Medical University

摘　　要：目的观察异丙酚复合瑞芬太尼对离体家兔心脏传导系统和心肌β1肾上腺素受体蛋白表达的影响,初步探讨其引起心率减慢的原因。方法健康家兔32只,随机分为A、B、C、D4组,每组8只。开胸后迅速取出心脏,将心脏连接于Langendorff离体灌注装置,用K-H液(95%O2+5%CO2)进行恒温恒压逆行灌注,平衡15min。A组(对照组):灌流正常K-H液;B组:灌注含异丙酚4μg/ml的K-H液;C组:灌流含瑞芬太尼4ng/ml的K-H液;D组:灌注含异丙酚4μg/ml+瑞芬太尼4ng/ml的K-H液。持续25min后,测定HR、窦房传导时间(SACT)、窦房结功能恢复时间(SNRT)、校正SNRT(CSNRT)、房室传导文氏现象的最低心房起搏频率(WBR)和出现2∶1房室传导的最低心房起搏频率(2∶1BR)。测定完毕留取右心房心肌组织,采用Westernblot方法检测心肌β1肾上腺素受体蛋白的表达。结果 D组与A、B、C组比较,心率明显减慢,SACT、SNRT和CSNRT显著延长(P<0.05),WBR和2∶1BR频率显著缩短(P<0.05);A、B、C组3组间各电生理指标差异无统计学意义。C组和D组与A组比较,β1肾上腺素能受体蛋白表达显著减少(P<0.05),但C、D两组间差异无统计学意义。结论瑞芬太尼复合异丙酚可以抑制心脏传导系统功能,从而导致心率减慢。Objective To investigate the effects of propofol- remifentanil on cardiac condution system and the expression of cardiac β1- adrenoreceptors in isolated rabbit heart,and to clarify the mechanism of propofol- remifentanil-induced bradyarrhythmias.Methods Thirty-two rabbits weighing 22.5 kg were randomly divided into four groups （n =8）.Chest was opened and heart removed.After completion of dissection and instrumentation according to the Langendorff technique,the hearts were allowed to equilibrate for 15 min.Then the isolated hearts were perfused with oxygenated Kreb-Hensleit （K-H） buffer solution （95% O2＋5%CO2） in group A （control group）,Kreb-Hensleit buffer with propofol 4 μg/ml,remifentanil 4 ng/ml,and propofol 4 μg/ml＋ remifentanil 4 ng/ml in group B,C and D respectively for 25 minutes.The HR,sinoatrial conduction time（SACT）,sinus node recovery time （SNRT）,corrected sinus node recovery time （CSNRT）,Wenckebach block rate and 2∶1 block rate were measured.Then the right atrial myocardium was taken to determine the expression of β1-adrenoreceptor protein by western blot.Results A combination of propofol-remifentanil caused a significant decrease in HR,wenckebach block rate and 2∶1 block rate and a significant prolongation of SNRT,corrected SNRT and SACT in comparison with group A,B and C （P 〈 0.05）.No statistical difference was observed between group A,B and C.The expression levels of β1-adrenoreceptor protein were lower in group C and D than that in group A and B （P 〈 0.05）.Conclusion Propofol-remifentanil depresses sinus node function and atrioventricular conducting function,which gives an explanation for clinical observations of propofol-remifentanil-caused severe bradyarrhythmias.

关 键 词：异丙酚 哌啶类 受体 肾上腺素能Β1 心脏传导系统 心肌 

分 类 号：R614.2[医药卫生—麻醉学]