超声导管心室肌消融的实验研究  

Ultrasound Catheter Ablation of Ventricular Myocardium in an in Vitro Thermodynamic Model:Assessment of Tissue Injury and Factors Influencing Lesion Size.

作　　者：董军[1] 罗开良[1] 黄晶[1] 李伦旭[2] 邓建川[3] 殷跃辉[1] 李增高[1] 

机构地区：[1]重庆医科大学附属第二医院心内科,重庆400010 [2]重庆医科大学附属第一医院麻醉科 [3]重庆医科大学附属第二医院血液科

出　　处：《中国心脏起搏与心电生理杂志》2000年第3期195-198,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金资助课题 !(批准号 39870 740 )

摘　　要：评估超声消融损伤灶的组织学改变 ,探讨各种物理因素对超声损伤范围的影响。使用自行研制的超声导管消融系统 ,在冠状动脉灌注及表面灌流的犬离体右室或左室游离壁热动力学模型上 ,以不同的电功率及辐照时间进行心室肌消融。结果 :持续 45s的超声消融能造成均一的、边界清楚的心肌坏死灶。电功率与损伤灶深度呈线性相关 (Y =2 .81+ 0 .4X ,r2 =0 .745 ) ,电功率 2 3.81W、超声辐照 6 0s产生的损伤灶最深 ,达 12 .2 7± 1.75mm。损伤面积与辐照时间呈正相关关系 (Y =17.94+ 0 .2 8X ,r2 =0 .5 8)。结论 :超声能量可能成为心内消融的能源。与射频消融相比 ,超声消融可造成更深的心肌损伤灶 ,提示超声消融有可能消除位于较深层心肌中的致心律失常病灶 。This study was designed to assess tissue injury and investigate the influence of various physical factors on the size of the resultant lesion during ultrasound catheter ablation.Methods:An ultrasound catheter ablation system was constructed and a thermodynamic model in isolated perfused and superfused canine right or left free wall was established.Ultrasound energy was delivered through a small transducer mounted on the tip of a modified 7F radiofrequency catheter.Different levels of electrical power and acoustic time were adopted and the size of the resulting lesions was measured to observe the dose response relationship.Results:Homogenous and well circumscribed myocardium tissue necrosis could be produced by the application of ultrasound energy for 45 s or longer.There was a linear relationship between increasing electrical power and depth of lesion ( Y =2.81±0.4 X , r 2 =0.745).Myocardial lesions of 12.27±1.75 mm in depth were produced with electrical power of 23.81 watts applied for 60 s.There were also positive relationships between lesion area and sonication time ( Y =17.94±0.28 X , r 2 =0.58).Conclusion:Ultrasound energy could become a new energy source for intracardiac ablation.In comparison with radiofrequency,ultrasound should be able to creat deeper leions that should be beneficial for the treatment of ventricular tachycardia after myocardial infarction.[Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(3):195～198]

关 键 词：超声导管消融 室性心动过速 实验研究 

分 类 号：R541.710.5[医药卫生—心血管疾病] R454.3[医药卫生—内科学]