不同部位绝对不应期电刺激对慢性心力衰竭兔心功能的影响  

Effects of cardiac contractility modulation applied to different locations of heart on cardiac functions in rabbits with heart failure

作　　者：张飞飞[1] 齐晓勇[2] 李英肖[2] 刘惠良[2] 党懿[2] 宁彬[1] 秦晨[1] 

机构地区：[1]河北医科大学研究生学院 [2]河北省人民医院心脏中心,河北石家庄050051

出　　处：《中国病理生理杂志》2013年第6期998-1002,共5页Chinese Journal of Pathophysiology

基　　金：河北省自然科学基金资助项目(No.C2010001631)

摘　　要：目的:观察心脏不同部位绝对不应期电刺激对慢性心力衰竭兔心脏功能及心脏收缩同步性的影响,探讨绝对不应期电刺激治疗慢性心力衰竭的最佳模式。方法:40只新西兰大白兔通过升主动脉根部套扎法建立兔慢性心力衰竭模型,将其分为心衰组、左室前壁(LVAW)刺激组、左室后侧壁(LVPLW)刺激组和右室心尖(RVA)刺激组。刺激组发放心脏收缩力调节信号(CCM),每天刺激6 h,连续刺激7 d。观察心脏功能及心脏收缩同步性的变化。结果:与心衰组相比,LVAW刺激组、LVPLW刺激组及RVA刺激组的左室收缩末内径、左室舒张末内径和血浆脑钠肽(BNP)水平下降(P<0.05),左室射血分数和左室短轴缩短率升高(P<0.05),其中以LVAW刺激组变化最为明显,其次为LVPLW刺激组与RVA刺激组。室间隔厚度和左室后壁厚度各组之间刺激前后未见明显变化(P>0.05)。采用脉冲多普勒频谱测量主、肺动脉射血前间期之差评价心脏收缩同步性,各组之间刺激前后未见明显变化。结论:心脏不同部位绝对不应期电刺激改善心功能的程度不同,左室前壁刺激组最为明显,其次为左室后侧壁与右室心尖刺激组。绝对不应期电刺激并不影响左右心室之间的收缩同步性。AIM： To investigate the effect~ of cardiac contractility modulation （CCM） applied to different loca- tions of the heart on cardiac functions and cardiac dys-synchrony in the rabbits with chronic heart failure, and to explore the best pattern of CCM. METHODS： Forty rabbits were divided into 4 groups according to the location of receiving CCM： heart failure （HF） group, left ventrieular anterior wall （LVAW-CCM） group, left ventricular posterior lateral wall （LV- PLW-CCM） group and right ventricular apex （RVA-CCM） group. The model of chronic heart failure was made by ligating ascending aortic root of the rabbits. After 12 weeks, the electrical stimulations during the absolute refractory period were delivered in different locations of the heart, lasting 6 h everyday for 7 days. The changes of cardiac functions and cardiac dys-synchreny were observed by cardiac ultrasonic cardiogram before and after CCM stimulation. The plasma level of brain natriuretic peptide （BNP） was detected by ABC-ELISA method. Pulsed-wave Doppler was used to acquire aortic pre-ejec- tion interval （APEI） and pulmonary pre-ejection internal （PPEI）, and inter-ventricular mechanical delay （IVMD） was cal- culated to evaluate the cardiac dys-synchrony. RFSUILTS： Compared with HF group, left ventricular end-systolic dimension （LVESD） and left ventricular end-diastolic dimension （LVEDD） in LVAW-CCM group, LVPLW-CCM group and RVA- CCM group were significantly decreased （P 〈 0.05 ）, while left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） were significantly increased （P 〈 0.05 ）, especially in LVAW-CCM group. Interventricular septal thickness （IVS） and left ventricular posterior wall thickness （LVPW） were similar among groups. No significant difference of plasma BNP level before CCM delivery among the 4 groups was observed. However, the plasma BNP level in control group was the highest, followed by LVPLW-CCM group and RVA-CCM group, and

关 键 词：心力衰竭 绝对不应期 电刺激 心功能 

分 类 号：R363[医药卫生—病理学]