文章摘要
低温缺血-再灌注对心房肌电稳定性的影响
Effects of hypothermia ischemia-reperfusion on the electrical stability of atrial myocardium
  
DOI：10.12089/jca.2019.11.017
中文关键词: 缺血-再灌注  心房肌  电稳定性  房性心律失常
英文关键词: Ischemia-reperfusion  Atrial myocardium  Electrical stability  Atrial arrhythmia
基金项目:
作者单位E-mail
何幼芹 550004,贵阳市,贵州医科大学麻醉学院  
高鸿 贵州医科大学第三附属医院 2169617@qq.com 
刘艳秋 贵州医科大学附属医院麻醉科  
苏殿三 上海交通大学医学院附属仁济医院麻醉科  
王贵龙 550004,贵阳市,贵州医科大学麻醉学院  
王子君 550004,贵阳市,贵州医科大学麻醉学院  
冯玉蓉 550004,贵阳市,贵州医科大学麻醉学院  
唐剑 550004,贵阳市,贵州医科大学麻醉学院  
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中文摘要:
      
目的 观察低温缺血-再灌注对离体大鼠心房肌电稳定性的影响,以此探讨电稳定性在低温缺血-再灌注促进房性心律失常中的作用。
方法 将制备成功的Langendorff离体大鼠心脏灌注模型,随机分为对照组(C组)和缺血-再灌注组(IR组),每组8例。C组K-H液(37 ℃)平衡灌注120 min。IR组K-H液(37 ℃)平衡灌注30 min后停止,注射Thomas液(4 ℃,20 ml/kg)使心脏停搏60 min,心脏周围用低温(4 ℃)Thomas液保护,停搏30 min时半量复灌Thomas液(4 ℃,10 ml/kg),停搏60 min时再次灌注K-H液(37 ℃)30 min。记录平衡灌注30 min(T0)、C组平衡灌注105 min/IR组再灌注15 min(T1)和C组平衡灌注120 min/IR组再灌注30 min(T2)时右心房单相动作电位复极90％时程(MAPD90)。记录T2时右心房有效不应期(ERP)、ERP与MAPD90比值(ERP/MAPD90)、诱发房颤的最大起搏周长(AF-PCL max)和房颤诱发率。记录C组平衡灌注90 min/IR组再灌注即刻后房性早搏、房性心动过速、心房颤动等房性心律失常发生情况。
结果 与T0时比较,T1—T2时IR组MAPD90明显延长(P<0.05)。T1—T2时IR组MAPD90明显长于C组(P<0.05)。T2时IR组ERP、AF-PCLmax明显长于C组(P<0.05),ERP/MAPD90明显小于C组(P<0.05),房颤诱发率明显高于C组(P< 0.05)。在C组平衡灌注90 min/IR组再灌注即刻后,IR组房性心律失常发生率明显高于C组(P< 0.05)。
结论 低温缺血-再灌注通过增加心房肌单相动作电位复极90％时程、有效不应期和诱发房颤的最大起搏周长,降低有效不应期与单相动作电位复极90％时程的比值,使心房肌电稳定性降低,从而增加房性心律失常的发生风险。
英文摘要:
      
Ojective To observe the effects of hypothermia ischemia-reperfusion on atrial electrical stability in isolated rat hearts, so as to explore the role of electrical stability in atrial arrhythmia induced by hypothermia ischemia-reperfusion.
Methods Sixteen Langendorff isolated rat heart perfusion models were successfully established and randomly divided into control group (group C) and ischemia-reperfusion group (group IR), 8 in each group. In group C, the heart was balanced perfusion with K-H solution at 37 ℃ for 120 min. In group IR, the heart was balanced perfusion with K-H solution at 37 ℃ for 30 min and then stopped, and cardiac arrest was induced for 60 min with the injection of Thomas solution (20 ml/kg) at 4 ℃ while the heart was protected in a low temperature Thomas solution at 4 ℃ around it. Perfusion of Thomas solution at 4 ℃ (10 ml/kg) was performed again at 30 min of cardiac arrest and the heart was resuscitated by the reperfusion of K-H solution at 37 ℃ for 30 min at 60 min of cardiac arrest. The 90％ repolarization duration of monophasic action potential(MAPD90) was recorded at balanced perfusion for 30 min (T0), balanced perfusion for 105 min in group C/reperfusion for 15 min in group IR (T1) and balanced perfusion for 120 min in group C/reperfusion for 30 min in group IR (T2). The right atrial effective refractory period (ERP), the ratio of ERP to MAPD90 (ERP/MAPD90), the maximum pacing cycle length that can induce atrial fibrillation (AF-PCLmax) and the induction rate of atrial fibrillation were recorded at T2. The occurrence of atrial arrhythmias such as atrial premature beats, atrial tachycardia and atrial fibrillation were recorded after balanced perfusion for 90 min in group C/immediate reperfusion in group IR.
Results Compared with T0, MAPD90 was significantly prolonged in group IR at T1 and T2 (P < 0.05). MAPD90 in group IR was significantly longer than that in group C at T1and T2 (P < 0.05). At T2, the ERP and AF-PCLmax in group IR were significantly higher than those in group C(P < 0.05), the ERP/MAPD90 was significantly smaller than that in group C(P < 0.05), and the induction rate of atrial fibrillation was significantly higher than that in group C (P < 0.05).After balanced perfusion for 90 min in group C/immediate reperfusion in group IR, the incidence of atrial arrhythmia in group IR was significantly higher than that in group C (P < 0.05).
Conclusion Hypothermic ischemia-reperfusion decreases the electrical stability of atrial myocardium by increasing the atrial 90% repolarization duration of monophasic action potential, effective refractory period and maximum pacing cycle length that can induce atrial fibrillation, and reducing the ratio of effective refractory period to 90% repolarization duration of monophasic action potential, thus increasing the risk of atrial arrhythmia.
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