肾交感神经去除术对心力衰竭犬心功能的影响  

Influence of renal sympathetic denervation on cardiac function of dogs with heart failure

作　　者：黄达民[1] 侯舒心[1] 罗晓菡[1] 张金春[1] 卢英民[1] 

机构地区：[1]上海交通大学医学院附属新华医院(崇明)心内科,上海市202150

出　　处：《心血管康复医学杂志》2016年第2期161-166,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：吴阶平医学基金会资助项目(320.6750.13150)~~

摘　　要：目的:研究肾交感神经去除术(RDN)对心力衰竭(HF)犬心功能的影响。方法:选择实验犬40只,随机均分为RDN组(接受双肾动脉射频消融)及模型组(仅予股动脉穿刺)。40只犬均安置心脏起搏器,用快速右室起搏的方法制造犬心衰动物模型。观察每只犬射频消融/假手术前,建模4周后的心、肾功能指标,BNP以及交感活性指标水平,并进行组间比较。结果:术后4周,与模型组比较,RDN组的肾上腺素(E)[(362.69±42.54)ng/ml比(290.36±42.32)ng/ml],肾素(R)[(305.46±39.68)ng/ml比(230.04±32.80)ng/ml],醛固酮(AD)[(408.00±38.56)ng/ml比(246.00±48.37)ng/ml],血管紧张素Ⅱ(ATⅡ)[(280.00±48.08)pg/ml比(172.00±25.04)pg/ml]和去甲肾上腺素(NE)[(425.65±50.54)ng/ml比(316.76±46.29)ng/ml]水平均显著降低(P均<0.05);与模型组比较,RDN组HR,呼吸频率(RR)和BNP显著降低(P均<0.05);SBP、LVEF、CO、CI、左心室压力最大上升速率(+dp/dtmax)、左心室压力最大下降速率(-dp/dtmax)和左室收缩末压(LVESP)显著升高,左室收缩末期内径(LVESd),左室舒张末期内径(LVEDd)和左室舒张末压(LVEDP)显著降低,P均<0.05;结论:RDN降低心衰犬的肾交感活性,改善心功能,抑制右室起搏所致心肌重构,疗效显著。Objective：To study influence of renal sympathetic denervation（RDN）on cardiac function of dogs with heart failure（HF）.Methods：A total of 40 dogs were randomly and equally divided into RDN group[received bilateral renal artery radiofrequency ablation（RFA）]and model group（only received femoral puncture）.Pacemaker was implanted in every dog,and dog HF model was established using rapid right ventricular pacing.Cardiac and renal function indexes,BNP and sympathetic activity index levels were observed and compared between two groups before RFA/sham operation,instant and four weeks after model establishment.Results：After operation four weeks,compared with model group,there were significant reductions in levels of epinephrine（E）[（362.69±42.54）ng/ml vs.（290.36±42.32）ng/ml],renin（R）[（305.46± 39.68）ng/ml vs.（230.04±32.80）ng/ml],aldosterone（AD）[（408.00±38.56）ng/ml vs.（246.00± 48.37）ng/ml],angiotensin Ⅱ（ATⅡ）[（280.00±48.08）pg/ml vs.（172.00±25.04）pg/ml]and norepinephrine（NE）[（425.65±50.54）ng/ml vs.（316.76±46.29）ng/ml]in RDN group（P〈0.05all）;there were significant reductions in HR,respiratory rate（RR）and BNP level in RDN group,P〈0.05all;there were significant rise in SBP,LVEF,CO,CI,left ventricular pressure maximal rising rate（＋dp/dtmax）,left ventricular pressure maximal dropping rate（-dp/dtmax）and left ventricular end-systolic pressure（LVESP）,and significant reductions in left ventricular end-systolic dimension（LVESd）,left ventricular end-diastolic dimension（LVEDd）and left ventricular end-diastolic pressure（LVEDP）in RDN group,P〈0.05 all.Conclusion：RDN can decrease renal sympathetic activity,improve heart function,inhibit myocardial remodeling,its therapeutic effect is significant

关 键 词：心力衰竭 交感神经切除术 心脏起搏器 人工 交感神经系统 

分 类 号：R541.6[医药卫生—心血管疾病]