低强度神经节丛刺激对正常心室电生理性质和急性心肌缺血室性心律失常发生的影响  

Effects of low-intensity ganglionated plexi stimulation on ventricular electrophysiological properties in normal heart and acute myocardial ischemia in canine

作　　者：江洪[1] 何勃[1] 何文博[1] 鲁志兵[1] 黄兵[1] 吴柳[1] 胡笑容[1] 崔博[1] 

机构地区：[1]武汉大学人民医院心内科,430060

出　　处：《中华心律失常学杂志》2013年第3期214-218,223,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金（81100128、81070143）：武汉大学2008年博士研究生自主科研项目（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（4101024）;教育部博士点专项基金新教师基金（20100141120072）

摘　　要：目的研究低强度神经节丛（GP）刺激对正常心室电生理性质和急性心肌缺血室性心律失常发生的影响。方法体重18～25kg的正常成年杂种犬39只随机分为正常心脏组（n=12）和急性心肌缺血组（n=27，其中对照组12只，低强度GP刺激组15只），以2根多极电生理导管记录左、右心室局部电图，以自制Ag．AgCl电极记录左、右心室单相动作电位。在正常犬，分别在6h低强度GP刺激前和刺激后测量心室各部位有效不应期（ERP）、动作电位时限（APD），APD回复性质和APD交替以及血清乙酰胆碱和去甲肾上腺素浓度；在急性心肌缺血犬，比较室性心律失常的发生情况。结果在正常犬，6h低强度GP刺激显著延长心室各部位ERP及APD（P〈0．05），但未改变其空间离散度；6h低强度GP刺激促进APD交替发生但不改变APD回复曲线斜率及其空间离散度；6h低强度GP刺激后血清去甲肾上腺素和乙酰胆碱水平均显著增加（P〈0．05）。在急性心肌缺血犬，低强度GP刺激组室性心律失常的发生率显著低于对照组（P〈0．05）。结论低强度GP刺激不增加正常心脏室性心律失常的风险日有助于抑制急性心肌缺血心脏窜性心律失常的发生。Objective To investigate the effect of low-intensity ganglionated plexi stimulation （GPS）on ventricular electrophysiological property in normal heart and acute myocardial ischemia （AMI）in canine. Meth- otis Thirty-nine adult mongrel dogs were assigned into the normal heart group （n = 12）and the AMI group （n = 27, 12 in control and 15 in low-intensity GPS）.Two multi-electrode catheters were sutured to record electrograms at 8 epicardial sites from the apex to base in left and right ventricular free walls.A custom-made Ag-AgC1 elec- trode was used to record monophasic action potentials from the epicardial surface of the left and right ventricular free walls at 6 sites. In normal heart, ventricular effective refractory period （ ERP ）, action potential duration （APD）, electrical alternans, dynamic APD restitution and serum levels of norepinephrine and acetylcholine were measured at baseline and after 6-hour low-intensity GPS （ the strength for low-intensity GPS was set at the voltage level causing a 10% decrease of sinus rate）.In AMI heart, low-intensity GPS was performed 1 hour be- fore coronary artery ligation and the electrocardiograms were continuously monitored for 1 hour during ligation to record the incidence and duration of ventricular arrhythmias. Results In the normal heart, 6-hour low-intensity GPS significantly prolonged ventrieular ERP and APD （all P〈0.05）but did not change their spatial dispersions.Six-hour low-intensity GPS facilitated APD alternans but did not change the slope of APD restitution curves and its spatial dispersion.Both norepinephrine and acetylcholine levels were significantly increased after 6-hour low-intensity GPS （P〈0. 05）.In the AMI heart, the incidence of ventricular arrhythmias in low-intensity GPS group was significantly lower than that in control group （P〈0. 05）. Conclusion Low-intensity GPS did not in- crease the risk of ventricular arrhythmias in the normal heart as well as significantly reduced the incidence of ventricular arrhyt

关 键 词：神经节丛 室性心律失常 急性心肌缺血 

分 类 号：R541.7[医药卫生—心血管疾病]