心脏自主神经节消融治疗睡眠呼吸暂停并发心房颤动的实验研究  

Effects of cardiac autonomic ganglia ablation on atrial fibrillation associated with sleep apnea

作　　者：余小梅[1] 鲁志兵[1] 何文博[1] 何勃[1] 黄兵[1] 赵劲波[1] 江洪[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6期455-459,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金（81100128、81070143、81270250）;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）;武汉市青年科技晨光计划（201271031429）

摘　　要：目的研究心脏自主神经节（GP）消融对睡眠呼吸暂停（sA）并发心房颤动（房颤）的影响。方法成年杂种犬13只，采用随机数字法分为2组。第1组先制作SA模型再行GP消融（n=7），分别在基础状态、SA1h和GP消融后记录心电图、采集动脉血及测量心房、肺静脉和上腔静脉的不应期（ERP）和心房易颤窗口（WOV）；第2组先行GP消融再制作SA模型（n=6），分别在基础状态、GP消融后和SA1h后收集或测量以上参数。比较心率、血压、动脉血气、心率变异性（HRV）和各部位ERP、WOV在两组之间和消融前后的变化。结果第1组在SA过程中，心率、血压先上升后下降，SA1h末HRV低频／高频比值（LF／HF）减小[（0．6±0．2）对（0．8±0．2），P〈0．05]，各部位ERP显著缩短，2WOV显著增加（P〈0．05）。GP消融后LF／HF增大[（1．1±0．3）对（0．8±0．2），P〈0．05]，各部位ERP显著延长，EWOV显著减小（P〈0．05）。第2组在GP消融后，SA过程中心率、血压同样先上升后下降，各部位ERP不同程度缩短，但LF／HF和EWOV变化则不明显。无论先SA或者先消融GP，两组犬在SA1h末均出现低氧血症、高碳酸血症和酸中毒。结论自主神经活性的变化在SA并发的房颤中起着重要作用，消融心脏GP可以逆转或阻止SA导致的房颤。Objective To investigate the effects of cardiac autonomic ganglionated plexus （GP）abla- tion on atrial fibrillation （AF）associated with sleep apnea （SA）. Methods Thirteen dogs were randomly divid- ed into two groups.GP ablation was performed after SA in the first group（ n = 7）and before SA in the second group （ n = 6）. Surface electrocardiograms and blood were collected. Effective refractory period （ERP） and window of vulnerability（WOV） of the atrium, pulmonary veins and superior vena cava were measured in the baseline state,at the end of SA which was lasted for 1 hour and after GP ablation, respectively. Changes of heart rate, blood pressure, arterial blood gas analysis, heart rate viability （HRV）, ERP and WOV were compared between the two groups before and after GP ablation. Results In the first group, during the process of SA, the heart rate and blood pressure increased and then decreased.At the end of 1 h SA,the HRV analysis revealed that the ratio of low frequency/high frequency（LF/HF） reduced compare to the level of baseline state [ （0. 6±0. 2）vs. （0. 8± 0. 2） ,P〈0. 05] ; ERP was significantly shortened,and EWOV was significantly increased（P〈0. 05）.After GP ablation, LF/HF was significantly increased （ （ 1.1 ±0. 3 ） vs （0. 8±0. 2）, P〈0. 05 ）, ERP was significantly pro- longed ,and EWOV was decreased（ P〈0.05 ）.In the second group ,during SA process following GP ablation ,the heart rate and blood pressure were increased and then decreased.ERP was shortened at several sites.However, there were no significant changes of LF/HF and EWOV.In both groups,hypoxemia,hypercapnia and acidosis were observed after lh SA. Conclusion The autonomic nervous system plays an important role in the occur- rence of AF associated with SA.GP ablation may reverse and prevent AF caused by SA.

关 键 词：自主神经系统 消融 睡眠呼吸暂停 心房颤动 

分 类 号：R766[医药卫生—耳鼻咽喉科] R541.75[医药卫生—临床医学]