迷走神经张力对QT滞后现象的影响  

The effects of parasympathetic activation on QT hysteresis

作　　者：包明威[1] 张逸杰[1] 钟慧[1] 李彦[1] 谭团团[1] 戴明彦 

机构地区：[1]武汉大学人民医院心内科,湖北武汉430060

出　　处：《中国心脏起搏与心电生理杂志》2015年第4期331-334,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金项目资助(项目编号:30600241);湖北省自然科学基金项目资助(项目编号:2012FFB04332)

摘　　要：目的 探讨迷走神经张力改变对QT滞后现象的影响。方法 刺激右侧颈部迷走神经升高迷走神经张力,静脉注射阿托品抑制迷走神经张力,以右房（RA）起搏或静脉注射异丙基肾上腺素（ISO）为基本方法,造成心率的大范围动态变化,共设计6套方案造成犬心率的动态变化。A：RA增减频起搏;B：静脉注射ISO;C：迷走神经刺激＋RA增减频起搏;D：迷走神经刺激＋静脉注射ISO;E：阿托品＋RA增减频起搏;F：阿托品＋静脉注射ISO;同时记录犬的体表心电图,测量RR间期和QT间期。绘制QT鄄RR曲线,并计算QT滞后指数（用中位数表示）。比较不同实验方案的QT滞后指数,观察迷走神经张力改变对QT滞后现象的影响。结果 方案A的QTe滞后指数和QTp滞后指数显著低于方案B[QTe：0.260（-2.615-3.748）msvs 14.320（11.805-23.915）ms,P〈0.05;QTp：1.090（-2.213-3.698）ms vs 9.460（0.125-19.090）ms,P〈0.05]。方案B的QTe滞后指数显著高于方案D[QTe：14.320（11.805-23.915）ms vs 5.155（-7.633-7.670）ms,P〈0.05];但QTp滞后指数差异无统计学意义。方案D的QTe滞后指数和QTp滞后指数显著低于方案F[QTe：5.155（-7.633-7.670）ms vs 10.760（7.018-19.198）ms,P〈0.05;QTp：3.810（-3.785-11.293）ms vs 20.450（0.230-26.720）ms,P〈0.05]。方案E的QTe滞后指数和QTp滞后指数显著低于方案F[QTe：2.140（0.155-6.595）ms vs 10.760（7.018-19.198）ms,P〈0.05;QTp：2.390（0.550-3.955）ms vs 20.450（0.230-26.720）ms,P〈0.05]。结论 兴奋迷走神经可抑制QT滞后现象,可对抗交感神经兴奋所引起的QT滞后现象,但静脉注射足量阿托品抑制迷走神经张力对犬QT滞后程度无明显影响。Objective To investigate the effects of parsympathetic activation on QT hysteresis. Methods Parsympa- thetic activation was increased by stimulating right cerical vagus nerve, and was inhibited by administrating atropine intrave- nously. Based on right atrium pacing or isopropylarterenol （ISO） intravenous injection, six protocols were employed to pro- duce dynamic heart rate fluctuation. These protocols included A： right atrium increase-decrease frequency pacing, B： ISO intravenous injection, C： parasympathetic stimulation ＋ protocol A, D： parasympathetic stimulation ＋ protocol B, E： atro- pine ＋ protocol A, F： atropine ＋ protocol B. The surface electrocardiogram was recorded, RR and QT interval were deter- mined. The QT and RR interval were plotted and the QT hysteresis index were calculated. The QT hysteresis index were compared between different protocols, and the effects of parsympathetic activation on QT hysteresis index were evaluated. Results The QTe and QTp hysteresis index of protocol A were significantly lower than protocol B[ QTe： 0. 260（ -2.615- 3. 748） ms vs 14. 320 （ 11. 805-23. 915 ） ms, P〈0.05 ; QTp ： 1. 090 （ -2. 213-3. 698 ） ms vs 9. 460 （0. 125-19. 090） ms, P〈0. 05 ]. The QTe hysteresis index of protocol B was significantly higher than protocol D [ QTe ： 14. 320 （ 11. 805-23. 915 ） ms vs 5. 155 （ -7. 633-7. 670） ms, P〈0.05 ], but there QTp hysteresis indexes did not show significant difference. The QTe and QTp hysteresis index of protocol D were significantly lower than protocol F[ QTe ： 5. 155 （ -7. 633-7. 670） msvs 10.760（7.018-19. 198） ms, P〈0. 05; QTp： 3. 810 （ -3. 785-11. 293 ） ms vs 20. 450 （ 0. 230-26. 720） ms, P〈0.05 ]. The QTe and QTp hysteresis index of protocol E were significantly lower than protocol F [ QTe： 2. 140 （0. 155-6.595） ms vs 10.760（7.018-19. 198） ms, P〈0. 05 ; QTp： 2. 390（0.550-3. 955） ms vs 20.450（0. 230-26. 720） ms, P〈0.05 ]. Conclusion Increased parasympathetic

关 键 词：心血管病学 迷走神经 复极 QT滞后 

分 类 号：R540.41[医药卫生—心血管疾病]