雷米普利对兔心肌梗死后室性心律失常的影响  

Effects of ramipril on ventricular arrhythmia after myocardial infarction in rabbits

作　　者：钟亚[1] 曹萍[1] 童传凤[1] 李夏[1] 

机构地区：[1]武汉大学中南医院综合科,武汉430071

出　　处：《中华急诊医学杂志》2012年第4期397-400,共4页Chinese Journal of Emergency Medicine

基　　金：湖北省自然科学基金（2007ABA288）

摘　　要：目的探讨血管紧张素转化酶抑制剂雷米普利对兔心肌梗死后室性心律失常发生的影响及其可能机制。方法24只新西兰大白兔随机（随机数字法）分为假手术对照组（SHAM）（n=8）、心肌梗死组（MI）（n=8）和雷米普利组（RAM）（n=8）。SHAM假手术对照组只开胸不结扎左冠状动脉前降支，MI组和RAM组分别结扎左冠状动脉前降支。观察心电图肢导联Ⅱ、Ⅲ导联出现ST段抬高大于0．2mV证实心肌梗死形成。RAM组术后第2天用雷米普利[1mg／（kg·d）]灌胃，3组共喂养12周。3组兔分别在心肌梗死前、心肌梗死12周后记录左心室内、中、外膜层心室肌细胞单相动作电位，并记录心肌梗死12周后诱发的恶性心律失常次数。采用t检验和方差分析处理结果。结果RAM组明显降低心肌梗死后VT／VF的发生次数[（2．6±0．8）VS．（12．4±2．9），P〈0．05]。心肌梗死12周后，MI组3层左心室肌APD。较心肌梗死前明显延长[（258．2±21．1）vs．（230．1±23．2），（278．0±23．8）vs．（245．8±25．4），（242．6±22．7）vs．（227．0±21．7），P〈0．05]；RAM组3层心室肌APD。。与心肌梗死前相比差异无统计学意义[（236．5±22．9）VS．（235．3±21．2），（259．4±26．6）VS．（246．0±23．6），（234．1±22．8）VS．（229．6±21．9），P〉0．05]。而且，MI组跨壁复极离散度较SHAM、RAM组明显延长[（36．2±10．2）VS．（18．7±6．2），（24．9±8．7），P〈0．05]；RAM组与SHAM组之间跨壁复极离散度比较差异无统计学意义[（18．7±6．2）VS．（24．9±8．7），P〉0．05]。结论雷米普利明显降低兔心肌梗死后恶性室性心律失常的发生次数，可能与改善兔心肌梗死后跨壁复极离散度有关。Objective To determine whether specific angiotensin-conventing enzyme inhibitor with ramipril would affect ventricular arrhythmia generation in rabbits after myocardial infarction and discuss the mechanism of its antiarrhymic efficacy. Methods Twenty-four New Zealand rabbits （Wuhan Laboratory Animal Research Center） were separated into 3 groups ： sham-operated （SHAM） group （ n = 8 ） , myocardial infraction （MI） group （ n = 8 ） and myocardial infraction with ramipril （RAM） group （ n = 8 ）. SHAM group received a median sternotomy without left ventricular coronary artery ligation. MI and RAM groups ＇ rabbits received a median sternotomy followed by left coronary artery ligation. The successful anterior MI was confirmed by elevation of the ST segment with more than 0. 2 mV in lead Ⅱ and Ⅲ, After MI, RAM group rabbits were fed with ramipril [ 1mg/ （kg · d）] by intragastric administration for 12 weeks. Before and after MI 12 weeks in three groups. Ventricular tachycardia or fibrillation episodes and the monophasic action potential duration in epicardium, mid-myocardium and endocardium cadiocytes were recorded. The statistical technique was t-test and ANOVA. Results Ventricular tachycardia or fibrillation episodes were markedly decreased in RAM group than that in MI group after 12 weeks [ （2.6 ＋0.8） vs. （12.4 ＋2.9）, P〈 0.05]. After MI 12 weeks, the action potential duration of repolarization 90% （APD90） of three-tier ventricular myocytes in MI group was prolonged than that before MI [ （258. 2 ＋21.1 ） vs. （230. 1 ＋23.2）, （ 278.0＋23.8 ） vs. （245.8＋25.4）, （242.6＋22.7） vs. （227.0＋21.7）, P〈0.05]; however, it was not significant difference between before and after MI 12w in RAM group （P 〉0. 05 ）. Moreover, the transmural dispersion of repolarization （TDR） was markedly increased after MI 12w in MI group than in SHAM and RAM group [ （36. 2＋ 10. 2 ） vs. （ 18.7 ＋ 6. 2） , （24. 9 ＋ 8.7） , P 〈 0. 05 ] ; but

关 键 词：心肌梗死 单相动作电位 室性心律失常 电生理 跨壁复极离散度 心肌细胞 雷米普利 兔 

分 类 号：R541.7[医药卫生—心血管疾病]