射频消融犬迷走神经对Bezold-Jarisch反射相关血流动力学指标的影响  

Effect of cardiac vagus nerve radiofrequency ablation on Bezold-Jarisch reflex related hemodynamic parameters in canine

作　　者：卢春山[1] 郭成军[1] 方冬平[1] 郝蓬[1] 何东方[1] 马克娟[1] 刘冰[1] 李果[1] 张英川[1] Lu Chunshan;Guo Chengjun;Fang Dongping;Hao Peng;He Dongfang;Ma Kejuan;Liu Bing;Li Guo;Zhang Yingchuan(The 21th Ward of Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内二十一病房,100029

出　　处：《中国医药》2018年第10期1461-1464,共4页China Medicine

基　　金：北京市优秀人才培养资助项目(20081D0300600077)~~

摘　　要：目的观察射频消融犬迷走神经对Bezold-Jarisch反射(BJR)相关血流动力学指标的影响。方法健康成年杂种犬12只麻醉后经右侧开胸,完全随机分为心外膜组(n=6)及心内膜组(n=6)。心外膜组暴露左心室脂肪垫,行室间沟脂肪消融;心内膜组在左心室内沿高频刺激有效迷走反应1 cm周围区域消融。2组消融后均经左心室导管弹丸式推注藜芦定15μg/kg诱发BJR。记录2组推注藜芦定前后窦性周长基础值、最低值、最大下降值,及动脉收缩压(SAP)、动脉舒张压(DAP)、平均动脉压(MAP)、左心室收缩压(LVSP)、左心室舒张末压(LVEDP)、左心室压上升最大速率(+dp/dt_(max))、左心室压下降最大速率(-dp/dt_(max))的基础值和最大下降值。结果推注藜芦定前,2组各项指标基础值比较,差异均无统计学意义(均P>0.05)。推注藜芦定后,心内膜组窦性周长最大下降值△窦性周长明显高于心外膜组[(198±32)ms比(190±28)ms](P <0. 05),2组其余各项指标的最大下降值ASAP、ADAP、AMAP、ALVSP、△LVEDP、△+dp/dt_(max)、△-dp/dt_(max)比较,差异均无统计学意义(均P>0.05)。结论犬室间沟脂肪消融削弱藜芦定诱发BJR时窦性周长下降的作用强于心内膜神经电位消融,但二者对动脉压、左心室压、左心室收缩及舒张功能的影响无明显差异。Objective To observe the effect of cardiac vagus nerve radiofrequency ablation on Bezold-Jarisch reflex（BJR） related hemodynamic parameters in canine. Methods Twelve mongrel canines were randomly divided into epicardial group（n=6） and endocardial group（n=6）. Both groups had thoracotomy under general anesthesia; the epicardial group had ablation at interventricular sulcus fat; the endocardial group had ablation at 1 cm around the BJR receptor. Veratridine was injected into left ventricle at bolus doses of 15 μg/kg through catheter to induce BJR after ablation. Sinus cycle length（SCL）, systolic arterial pressure（SAP）, diastolic arterial pressure（DAP）, mean arterial pressure（MAP）, left ventricular systolic pressure（LVSP）, left ventricular end-diastolic pressure（LVEDP）, the maximum rate of left ventricular pressure rise（＋dp/dtmax） and the maximum rate of left ventricular pressure drop（-dp/dtmax） were analyzed. Results Basic values of the parameters were similar between groups（P〉0.05）. After veratridine injection, the maximum decrease of SCL in the endocardial group was significantly higher than that in the epicardial group[（198±32）ms vs （190±28）ms]（P〈0.05）; but the maximum descending values of SAP, DAP, MAP, LVSP, LVEDP, LVEDP, ＋dp/dtmax and -dp/dtmax showed no significant differences between groups（P〉0.05）. Conclusion In canine, interventricular sulcus fat ablation can more effectively reduce the decrease of SCL induced by BJR than endocardial nerve ablation; the two methods show similar effects on arterial pressure, left ventricular pressure, left ventricular systolic and diastolic function.

关 键 词：血管迷走性晕厥 Bezold—Jarisch反射 导管消融 室间沟脂肪 

分 类 号：R741[医药卫生—神经病学与精神病学]