不同除颤能量对于除颤后血流动力学及心室复极离散度的影响  

Influence of shock energy on post-shock hemodynamics and ventricular repolarization dispersion

作　　者：庞旸[1] 金奇[1] 张凝[1] 任淑静[1] 林长坚[1] 周建[1] 凌天佑[1] 吴立群[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心脏科,200025

出　　处：《国际心血管病杂志》2011年第4期238-241,共4页International Journal of Cardiovascular Disease

基　　金：上海市科委课题(08140900600;10140903100);上海市教委"高校创新团队"二期

摘　　要：目的:探讨腔内除颤能量对于短时间心室颤动(VF)除颤后血流动力学及局部心室复极离散度的影响。方法:7只比格犬麻醉后开胸,暴露心脏,将单极电极片缝在犬的左室侧壁心外膜,以诱发VF并记录心室激动信号。通过股动脉穿刺监测动脉血压,完成短时间VF(20s)除颤阈值(DFT)测定后,将除颤能量分别调至125%DFT(小能量组)及250%DFT(大能量组),评价不同能量除颤各血流动力学参数及局部心室复极离散度的变化。结果:两组的收缩压、平均动脉压及动脉血压曲线正向最大斜率(dP/dt峰值)在除颤后即刻、1min、5min均无显著差别。大能量组动脉血压曲线负向最大斜率(-dP/dt峰值)在除颤后即刻要低于小能量组,但在1min及5min时无统计学差异。大能量组除颤后即刻的平均心率要低于小能量组,窦性节律恢复时间长于小能量组。大能量组除颤后的局部心室复极离散度显著高于小能量组。结论:除颤能量对于除颤后的血流动力学改变无明显影响,但大能量除颤会引起除颤后局部心室复极离散度的增加,可能具有潜在的致心律失常作用。Objective：To evaluate the influence of shock energy on post-shock hemodynamics and dispersion of regional ventricular repolarization. Methods：Seven open-chest dogs were anesthetized and instrumented for continuous recording of ECG and blood pressures. Ventricular fibrillation （VF） was electrically induced and recorded from a 6 × 6 unipolar electrode plaque （4 mm spacing） sutured on the left ventricular epicardium. Defibrillation threshold （DFT） was determined after VF continued for 20 seconds. The dispersion of regional ventricular repolarization （DRVR） was measured and calculated before VF and 30 seconds after successful defibrillation, respectively. Post shock hemodynamics and DRVR were respectively evaluated after the various shock energies of 125% DFT （low energy group, LEG） and 250% DFT （high energy group, HEG）. Results： Systolic blood pressure （SBP）, mean arterial pressure （MAP） and dP/dt （first derivative of pressure measured over time, a measure of left ventricular contractility） after defibrillation between the two groups were not significantly different. Negative dP/dt and Heart rate （HR） immediately after defibrillation were lower in HEG. Sinus recovery time （SRT） in HEG was longer than that in LEG. DRVR of 30s after successful defibrillation was significantly higher in HEG compared to that in LEG. Conclusion： Shock energy has little influence on post-shock hemodynamic. However, high shock energy increased DRVR after defibrillation, which may play an important in the initiation of cardiac arrhythmia.

关 键 词：心室颤动 血流动力学 除颤 

分 类 号：R541.7[医药卫生—心血管疾病]