自主神经刺激对快速心房起搏犬内皮功能的影响

发布时间：2018-06-16 16:02

本文选题：颈迷走交感神经干 + 快速心房起搏　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：研究颈迷走交感神经干刺激对快速心房起搏犬血管内皮功能相关指标如一氧化氮（Nitric Oxide，NO）、前列环素（Prostacyclin，PGI2）、降钙素基因相关肽（Calcitonin gene-related Peptide，CGRP）、血浆内皮素（Endothelin，ET）、以及血栓素A2（ThromboxaneA2，TXA2）水平的影响。方法：随机将24只健康成年杂种犬分成4组：快速心房起搏（rapidatrial pacing，RAP）组、颈部自主神经干刺激（vagosympathetic nervestimulation，VNS）组、自主神经干刺激+快速心房起搏组（VNS+RAP）和自主神经阻断+快速心房起搏组（autonomic blockade+RAP，AB+RAP）。每组均以3%戊巴比妥钠溶液腹腔内注射麻醉。麻醉后行双侧颈部及四肢备皮，固定于操作台，连接肢体导联心电记录仪，气管插管，呼吸机辅助呼吸。实验中根据动物体重按照6-12mL/Kg空气辅助通气，实验过程中监测血氧饱和度维持90%以上。维持体温在37.5±1.5℃。无菌操作下行颈部正中切口，钝性分离双侧自主神经干，为了避免刺激逆向传入神经中枢，进而抑制呼吸运动及其他神经反射，结扎双侧自主神经干头端。将两根自制金属丝电极分别插入双侧神经干近心端，连接神经刺激仪。连接6F双极标测起搏电极导管至多导心电生理记录仪，通过穿刺右股静脉置入双极电极于右心房，当心内电图出现大A小V波形则提示起搏电极进入右心房。给予600次/分的起搏刺激后，出现RR间期不等的窄QRS心动过速，进一步证实起搏电极进入右心房。在VNS组，电刺激迷走神经干，使心率降低50%表示刺激有效；在RAP组，给予右心房600次/分钟起搏刺激。在VNS+RAP组，同时行颈迷走交感神经干刺激和右心房600次/分起搏刺激。在AB+RAP组，静脉持续应用美托洛尔和阿托品阻断自主神经，同时予以快速右心房起搏刺激。每组实验犬均在刺激前即刻（0h）及刺激后第1h、2h、3h、4h、5h和6h抽取静脉血，血样经由第三方上海源叶生物科技公司采用酶联免疫吸附试验（ELISA）方法测定血清中NO、PGI2、CGRP、ET及TXA2水平。结果：单纯颈迷走交感神经干刺激后血清中舒血管物质NO、PGI2、CGRP有下降趋势，而缩血管物质ET、TXA2有上升趋势，但差异无统计学意义（P＞0.05）。快速心房起搏后舒血管物质NO、PGI2及CGRP均下降（P＜0.05），而ET、TXA2均上升（P＜0.05），提示快速心房起搏对血管内皮功能有影响。VNS+RAP组刺激后舒血管物质NO、PGI2及CGRP均下降（P＜0.05），而缩血管物质ET、TXA2均上升（P＜0.05）；与RAP组相比，在同一时间点NO、PGI2及CGRP水平略下降，而ET、TXA2水平略上升，但两组间差异无统计学意义（P0.05）。AB+RAP组舒张血管物质NO、PGI2及CGRP在自主神经阻断后均明显下降（P＜0.05），而ET、TXA2收缩血管物质均明显上升（P＜0.05）；与RAP组相比，NO、PGI2及CGRP均明显下降，而ET、TXA2收缩血管物质均明显上升，且两组间差异有统计学意义（P＜0.05）。结论：短期的快速心房起搏能够引起血管内皮功能损伤。自主神经刺激本身对血管内皮功能影响较小。快速心房起搏和自主神经刺激同时作用与单纯快速心房起搏相比，，二者对血管内皮功能的影响基本一致。阻断自主神经后，快速心房起搏所导致的血管内皮损伤加重。提示房颤时自身的自主神经调节可能对血管内皮具有保护作用。
[Abstract]:Objective : To study the effects of cervical vagotomy sympathetic trunk stimulation on endothelial function related indexes such as nitric oxide ( NO ) , prostacytidine ( PGI2 ) , calcitonin gene - related peptide ( CGRP ) , plasma endothelin ( ET ) , and thromboxaneA2 ( TXA2 ) .

Methods : 24 healthy adult hybrid dogs were randomly divided into four groups : rapid atrial pacing ( RAP ) group , cervical autonomic nerve trunk stimulation ( VNS ) group , autonomic nerve trunk stimulation + rapid atrial pacing group ( VNS + RAP ) and autonomic nerve block + rapid atrial pacing group ( VNS + RAP , AB + RAP ) . In the experiment , two self - made metal wire electrodes were inserted into the right atrium , and the pacing electrode was connected to the right atrium .
In the group of RAP , 600 / min pacing stimulation was given to the right atrium . At the same time , the sympathetic trunk stimulation and the right atrium 600 / minute pacing stimulation were performed in the VNS + RAP group . In the AB + RAP group , the venous blood was isolated from the group AB + RAP , 1h , 2h , 3h , 4h , 5h and 6h after stimulation . The serum levels of NO , PGI2 , CGRP , ET and TXA2 were measured by enzyme linked immunosorbent assay ( ELISA ) method .

Results : The contents of NO , PGI2 and CGRP decreased in the serum of the patients with simple cervical vagotomy , but there was no significant difference between ET and TXA2 ( P > 0.05 ) . The contents of NO , PGI2 and CGRP decreased after rapid atrial pacing ( P < 0.05 ) , and the contents of NO , PGI2 and CGRP decreased ( P < 0 . 05 ) in the VNS + RAP group .
Compared with RAP group , the levels of NO , PGI2 and CGRP decreased slightly at the same time , but the level of ET and TXA2 increased slightly , but there was no significant difference between the two groups ( P0.05 ) .
Compared with RAP group , NO , PGI2 and CGRP decreased significantly , while ET and TXA2 decreased significantly , and the difference between the two groups was statistically significant ( P < 0.05 ) .

Conclusion : Short - term rapid atrial pacing can cause vascular endothelial function injury . The effect of self - autonomic nerve stimulation on vascular endothelial function is relatively small . Both rapid atrial pacing and autonomic nerve stimulation are consistent with the effects of rapid atrial pacing .
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.7

【共引文献】