急性肾损伤早期对心室心电稳定性的影响

发布时间：2019-01-11 08:12

【摘要】：目的:探讨急性肾损伤早期对室性心律失常发生及心功能影响。方法:21只新西兰大白兔随机分配为假手术组(sham组,n=6),缺血再灌注组(I/R组,n=15),I/R组通过结扎双侧肾动静脉1h,再灌注4h,建立急性肾损伤模型,sham组行不进行双侧肾动静脉结扎的假手术。结果:(1)双侧肾动静脉结扎1h再灌注4h可以成功建立肾脏缺血再灌注引起的急性肾损伤模型。(2)I/R组与sham组缺血1h及再灌注4h比较,心率减慢、dERP明显增加(p0.05),缺血与再灌注前后的QT间期、QTc、ERP相比较无明显差异(P0.05)。(3)I/R组与sham组再灌注4h心脏超声比较,左室舒张末大小、收缩末大小、射血分数各时间点比较差异无统计学意义(P0.05)。(4)I/R组与sham组缺血前BNP、cTn-T浓度差异无统计学意义(p0.05),肾脏缺血1h及再灌注4h,I/R组BNP、cTn-T浓度明显高于sham组(p0.001)。(5)sham组整个实验过程中未出现室性性心律失常,I/R组在肾脏缺血1h时2只兔子出现偶发室性早搏,再灌注4h时5只兔子出现频发室性早搏。两组在整个实验过程中未能诱发室性心动过速、心室颤动等恶性心律失常。(6)I/R组肾脏缺血1h及再灌注4h,TNF-、IL-6、CRP浓度与sham组比较均明显升高(p0.05)。结论:急性肾损伤早期增加室性心律失常发生率,其机制可能与急性肾损伤所致的炎症反应引起心肌细胞凋亡,增加心肌复极不同步性增加,进一步影响心室不应期离散度有关。但是早期急性肾损伤不会增加室速、室颤等恶性心律失常发生率。
[Abstract]:Objective: to investigate the effects of early acute renal injury on ventricular arrhythmia and cardiac function. Methods: Twenty-one New Zealand white rabbits were randomly assigned to sham operation group (sham group, n = 6), ischemia reperfusion group (I / R group, n = 15), and I / R group to establish acute renal injury model by ligating bilateral renal arteriovenous vessels for 1 h and reperfusion for 4 h. Sham group received sham operation without bilateral renal arteriovenous ligation. Results: (1) the acute renal injury induced by renal ischemia and reperfusion could be successfully established by bilateral renal arteriovenous ligation for 1 h and reperfusion for 4 h. (2) the heart rate of I / R group was slower than that of sham group for 1 h and 4 h after reperfusion. DERP increased significantly (p0.05). There was no significant difference in QT interval before and after ischemia and reperfusion between I / R group and sham group (P0.05). (3). The left ventricular end diastolic size and end systolic size were compared between I / R group and sham group for 4 h reperfusion. There was no significant difference in ejection fraction at different time points (P0.05). (4). There was no significant difference in BNP,cTn-T concentration between I / R group and sham group before ischemia (p0. 05), but there was no significant difference in BNP, concentration in renal ischemia 1 h and reperfusion 4 h in I / R group (p0. 05). The concentration of cTn-T was significantly higher than that in the sham group (p0.001). (5) sham group. There was no ventricular arrhythmia in the whole experiment. In the I / R group, two rabbits had occasional ventricular premature beats after 1 hour of renal ischemia. Ventricular premature beats occurred frequently in 5 rabbits after 4 h reperfusion. In both groups, ventricular tachycardia, ventricular fibrillation and other malignant arrhythmias could not be induced during the whole experiment. (6) the concentration of TNF-IL-6 CRP in the I / R group was significantly higher than that in the sham group at 1 h after ischemia and 4 h after reperfusion (p0.05). Conclusion: the incidence of ventricular arrhythmia is increased in the early stage of acute renal injury, and its mechanism may be related to the inflammatory reaction induced by acute renal injury, which may lead to myocardial cell apoptosis and increase myocardial repolarization. Further influence on the dispersion of ventricular refractory period. But early acute renal injury does not increase the incidence of malignant arrhythmias such as ventricular tachycardia and ventricular fibrillation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R541.7

【参考文献】