睡眠呼吸暂停低通气综合征并发心房颤动的实验模型  

A new model of atrial fibrillation associated with sleep apnea known as hypopnea syndrome

作　　者：聂莉[1] 鲁志兵[2] 何勃[2] 黄兵[2] 余锂镭[2] 胡笑容[2] 吴薇[3] 江洪[2] 

机构地区：[1]武汉大学人民医院老年病科,湖北武汉430060 [2]武汉大学人民医院心内科,湖北武汉430060 [3]武汉大学人民医院检验科,湖北武汉430060

出　　处：《中国心脏起搏与心电生理杂志》2013年第1期40-43,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金资助项目(项目编号:81100128;81070143;81270250);武汉大学2008年博士研究生自主科研项目(项目编号:20083020101000062);中央高校基本科研业务费专项资金;武汉大学自主科研项目(项目编号:4101024);教育部博士点专项基金新教师基金(项目编号:20100141120072);武汉市青年科技晨光计划(项目编号:201271031429)

摘　　要：目的构建睡眠呼吸暂停低通气综合征(SAHS)并发心房颤动(简称房颤)的实验模型并研究其特点。方法健康成年杂种犬10只,麻醉后开胸,将多极电生理导管分别缝于左右心房、肺静脉及上腔静脉表面。调整呼吸机模拟SAHS和持续气道内正压通气(CPAP)各1h,间断测量血压、心率、各部位有效不应期(ERP)和心房易颤窗口(WOV),进行血气和心率变异性(HRV)分析。结果随着SAHS时间的延长,PH值、动脉血氧分压和血氧饱和度逐渐降低,动脉二氧化碳分压逐渐增加。SAHS开始的前30 min,血压和心率逐渐增加,反映交感活性(LF)和迷走活性(HF)的指标均逐渐上升,LF/HF不变,ERP和WOV无明显变化。后30 min血压和心率开始下降至基础水平以下,反映迷走神经活性的指标逐渐占主导(LF/HF值降低),ERP显著缩短,WOV显著增加。ERP和WOV的变化在上腔静脉表现最为明显。持续气道正压呼吸后,以上各项指标均恢复至基础水平左右。结论本实验成功构建了一种新的SAHS动物模型。该模型显示了与临床SAHS患者相似的病理生理和电生理特点。恢复气道通气后,该模型所造成的病理生理变化和电生理变化均能逆转。Objective To construct a new model of atrial fibrillation（AF） associated with sleep apnea hypopnea syndrome （SAHS）. Methods In 10 anesthetized dogs, via a right or left thoracotomy, multiple-electrode catheters were sutured to the surface of both atria,pulmonary veins and superior vena cava. The settings of ventilator were adjusted to simulate the SAILS and continuous positve airway pressure（CPAP）. The heart rate,blood pressure ,effective refractory period （ERP）and window of vulnerability（WOV） were measured, and the blood gas and heart rate variability were analyzed. Results As the SAHS prolonged, the PH, PaO2 and SaO2 were progressively decreased ,while the PaCOz were progressively increased. At the first 30 minutes of SAHS,the blood pressure and sinus rate were progressively increased. The indexes associated with sympathetic activity（ LF）and parasympathetic activity（HF） both increased. The ratio between LF/HF was unchanged. The ERP and WOV did not change. At the second 30 minutes of SAHS ,the blood pressure and sinus rate were significantly decreased. The HF further increased and the ratio of LF/HF decreased. In this stage ,the ERP shortened and WOV increased, especially at the superior vena eava. All the above changes caused by SAHS were reversed by CPAP. Conclusion This new animal model of SAHS is reminiscent of important pathophysiological and electrophysiological changes in SAHS patients and underlined the important role of the inrbalance of autonomic activity in AF. The changes induced by SAHS can be reversed by CPAF.

关 键 词：心血管病学 睡眠呼吸暂停低通气综合征 心房颤动 持续气道内正压通气 心率变异 动物模型 

分 类 号：R541.75[医药卫生—心血管疾病]