慢性心力衰竭对兔心室肌电重构的影响  

Effects of Chronic Heart Failure on Electrical Remodeling of Failing Ventricles in Rabbits

作　　者：瞿龙 李风云 黄德嘉[2] 

机构地区：[1]绵阳市第六医院心内科,四川绵阳621900 [2]华西医科大学附属第一医院心内科

出　　处：《中国心脏起搏与心电生理杂志》2000年第2期75-78,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：探讨慢性心力衰竭 (简称慢性心衰 )对兔心室肌电重构的影响及其与室性快速性心律失常的关系。 30只家兔随机分成两组 :实验组 2 0只 ,由阿霉素静脉注射 ( 8周 )引起慢性心衰 ;对照组 10只。所有家兔在麻醉开胸后进行电生理检查 :右室心尖部心外膜 2 5 0ppm快速起搏 ,每次持续 10min ,然后停止 1min ,如此重复 6次。其间若诱发出室性快速性心律失常 ,电生理实验便提前终止。分别在起搏前及每次 10min快速起搏后测定心室有效不应期(V ERP)、心室单相动作电位 (MAP)复极 90 %时间 (V MAPD90 )及右室心尖部和左室心底部MAP去极化 10 %处的时差 (CTARV BLV)。结果 :6次右室快速起搏后 ,实验组与对照组V ERP和V MAPD90 均延长 ,但与对照组相比 ,实验组V ERP显著延长的时间提前 (第 3次 10min快速起搏时vs第 5次 10min快速起搏时 ) ,延长的幅度增大 (平均每次 10min快速起搏延长V ERP :9.70msvs 2 .87ms ,P <0 .0 0 1) ;V MAPD90 明显延长的时间提前 (第 3次 10min快速起搏时vs第 4次 10min快速起搏时 ) ;CTARV BLV 延长的幅度增大 ( 1.5 0msvs 0 .6 0ms ,P <0 .0 1) ;诱发出心室颤动 (简称室颤 )的时间提前 (第 3次 10min快速起搏完成时 :35 .3 %vs 0 ,P =0 .0 4) ;室颤总诱发率增高 ( 70 .6 %vs 2 0 .0 % 。This study sought to determine whether advanced heart failure has effects on electrical remodeling of failing ventricles in rabbits and whether the electrical remodeling was associated with high induction of ventricular tachyarrhythmias in failing rabbits.Thirty rabbits were divided into two groups at random.Induction of chronic congestive heart failure was attemped in 20 rabbits by adriamycin.The others were controlled.In all open chest anesthetized rabbits,electrophysiological study was performed.Each phase of rapid pacing at apical right ventricle at cycle length of 250 msec lasted 10 minutes,then stopped for 1 minute,and after 6 times the electrophysiological study was ended.The 90% monophasic action potential durations of ventricle (VMAPD 90 ) and conduction time between apical right ventricle and basal left ventricle (CT ARVBLV ) were measured when cycle lengh was 250 msec at rest and just before the end of each rapid pacing period.In the meantime,verntricular effective refractory period (VERP) was measured with S 1S 2 stimulation.The electrophysiologic study was finished in advance when any ventricular tachyarrhythmias induced.Results:As rapid pacing was continuing,VERP was prologned earlier (the end of the third rapid pacing vs the end of the fifth rapid pacing) and larger (9.70 ms/10 min vs 2.87 ms/10 min,P<0.001),VMAPD 90 was extended earlier (the end of the third rapid pacing vs the end of the fourth rapid pcing),and CT ARVBLV was lengthened greater (1.50 ms vs 0.60 ms,P<0.01) in failing rabbits than in normal ones.Ventricular fibrillations were induced earlier in failing rabbits than in normal ones (at the end of the third rapid pacing,35.3% vs 0,P=0.04).Furthermore,failing rabbits were higher incidence of ventricular fibrillation during rapid pacing period than normal ones (70.6% vs 20.0%,P=0.03).Conclusion:The ventricular electrical remodeling in failing rabbits results in obvious changes of VERP,VMAPD 90 and CT ARVBLV ,which are in parallel with early induction and high

关 键 词：心力衰竭 室性心律失常 心室肌电重构 

分 类 号：R541.6[医药卫生—心血管疾病] R541.7[医药卫生—内科学]