刺激左右颈部迷走交感干对兔心房与心室电生理特性的影响

发布时间：2018-01-03 05:32

  本文关键词：刺激左右颈部迷走交感干对兔心房与心室电生理特性的影响　出处：《山东大学》2008年硕士论文　论文类型：学位论文

  更多相关文章： 颈迷走交感干 有效不应期 心房纤颤 心房易损窗口 Q-T间期离散度 室颤阈值

【摘要】： 研究目的:本研究旨在通过给予兔左右颈部迷走交感干不同强度的电刺激,测量反映心房肌和心室肌电生理特性变化的相关指标,从而探讨心脏外在自主神经对心脏电生理特性的影响及其在心律失常发生中的可能作用。 研究方法:新西兰大白兔10只,静脉麻醉后,连接并记录体表心电图,分离右侧颈静脉,将6F四极电极导管经上腔静脉先后插入右心房、右心室,给予设定的电程序刺激,记录心房有效不应期(AERP)、P波离散度(PD)、发生心房纤颤(AF)的动物比例数、心房易损窗口(WOV)、心室有效不应期(VERP)、Q-T间期离散度(Q-Td)、Tpeak-Tend(Tp-e)离散度、室颤阈值(VFT),再分离并暴露双侧颈部迷走交感干,植入刺激电极,并与高频电刺激仪连接,分别给予左右单侧及双侧迷走交感干电刺激,使心率较基础状态分别减慢10%、30%、50%,重复上述电刺激,并测量上述电生理指标。 结果:①随着刺激左侧颈迷走交感干强度的增加,与基础状态相比较,AERP逐渐缩短,至刺激强度使心率减慢50%时,AERP缩短有统计学意义(71.5±12.39vs 99.0±21.55,P＜0.01);PD随刺激强度的增加呈逐渐增大趋势,至刺激强度使心率减慢50%时,PD与基础状态相比明显增大(48.8±17.05 Vs 30.6±9.34,P＜0.05);发生AF的动物比例数及WOV虽分别有增多和增宽趋势,但均无统计学意义。 ②随着刺激右侧颈迷走交感干强度的增加,与基础状态时比较,AERP逐渐缩短,直至刺激强度使心率减慢30%时,AERP缩短有统计学意义(81.6±12.20 vs99.0±21.55,P＜0.05),且继续增加刺激强度使心率减慢50%时,AERP较基础状态缩短更显著(69.2±14.05 vs 99.0±21.55,P＜0.01);PD随刺激强度的增加呈逐渐增大趋势,至刺激强度使心率减慢30%时,PD与基础状态相比明显增大(42.3±10.85 vs 30.6±9.34,P＜0.05),且刺激强度增加至使心率减慢50%时,PD较基础状态增大更显著(55.5±13.99 vs 30.6±9.34,P＜0.01);发生AF的动物比例数及WOV虽分别有增多和增宽趋势,但亦无统计学意义。 ③给予双侧颈迷走交感干刺激,当刺激强度使心率减慢10%时,与基础状态比较,AERP即有缩短(82.0±15.35 vs 99.0±21.55,P＜0.05),当刺激强度分别增至使心率减慢30%、50%时,AERP缩短更显著(P＜0.01);与基础状态比较,PD则随刺激强度的增加呈逐渐增大趋势,至刺激强度使心率减慢30%时,PD明显增大(55.0±14.79 vs 30.6±9.34,P＜0.05),且继续增加刺激强度使心率减慢50%时,PD较基础增大更明显(64.4±18.45 vs 30.6±9.34,P＜0.01);发生AF的动物比例数虽有增多趋势,但仍无统计学意义;而WOV随着刺激强度的增加与基础状态比较呈增宽趋势,至刺激强度使心率减慢50%时,WOV增宽有统计学意义(7.6±3.51 vs 3.4±1.52,P＜0.05)。 ④随着刺激左侧颈迷走交感干强度的增加,与基础状态相比较,VERP逐渐延长,至刺激强度使心率减慢50%时,VERP延长有统计学意义(209.8±40.09 vs173.7±43.00,P＜0.05);Q-Td随刺激强度的增加呈逐渐增大趋势,至刺激强度使心率减慢30%时,Q-Td与基础状态相比明显增大(47.1±10.91 vs 35.6±5.36,P＜0.05),且继续增加刺激强度使心率减慢50%时,Q-Td增大更显著(54.59±14.38 vs 35.6±5.36,P＜0.01);Tp-e离散度随刺激强度的增加呈逐渐增大趋势,至刺激强度使心率减慢30%时,Tp-e离散度增大有统计学意义(29.9±10.62 vs 21.8±5.17,P＜0.05);然而随刺激强度的增加,与基础状态比较室颤阈值无明显变化。 ⑤随着刺激右侧颈迷走交感干强度的增加,与基础状态相比较,VERP逐渐延长,至刺激强度使心率减慢50%时,VERP延长有统计学意义(214.3±40.92 Vs173.7±43.00,P＜0.05);Q-Td随刺激强度的增加呈逐渐增大趋势,至刺激强度使心率减慢30%时,Q-Td与基础状态相比明显增大(48.6±7.00 vs 35.6±5.36,P＜0.05),且刺激强度继续增加至使心率减慢50%时,Q-Td增大更显著(56.2±14.34 vs 35.6±5.36,P＜0.01);随刺激强度的增加Tp-e离散度逐渐增大,至刺激强度使心率减慢30%时,Tp-e离散度增大有统计学意义(32.8±9.91 vs21.8±5.17,P＜0.01);然而随刺激强度的增加,与基础状态比较室颤阈值无明显变化。 ⑥随着刺激双侧颈迷走交感干强度的增加,与基础状态相比较,VERP逐渐延长,至刺激强度使心率减慢30%时,VERP延长有统计学意义(210.6±40.35 vs173.7±43.00,P＜0.05);当刺激强度使心率减慢10%时,Q-Td与基础状态相比明显增大(44.2±6.10 vs 35.6±5.36,P＜0.05),随刺激强度的增加Q-Td进一步增大,至心率减慢50%时,Q-Td增大更显著(62.8±16.36 vs 35.6±5.36,P＜0.01);Tp-e离散度随刺激强度的增加逐渐增大,至刺激强度使心率减慢30%时,Tp-e离散度增大有统计学意义(32.5±9.19 vs 21.8±5.17,P＜0.01);然而随刺激强度的增加,与基础状态比较,室颤阈值虽有逐渐减小的趋势,但无统计学意义。 结论:①右心房电生理特性受双侧颈迷走交感干的影响,且以右侧为优势,其中左右颈迷走交感干对右心房电生理特性的影响存在叠加作用;右心室电生理特性受双侧颈迷走交感干的影响,左右侧无差异,但左右颈迷走交感干对右心室电生理特性的影响存在叠加作用。②心脏外在自主神经在心房电生理特性变化中起重要作用,并可能参与房性心律失常的发生;心脏外在自主神经在心室电生理特性变化中亦起重要作用,可能是室性心律失常发生的潜在因素。
[Abstract]:Objective: This study aims to give the rabbit left and right cervical Vagosympathetic trunk electrical stimulation of different intensity measurements, changes of physiological characteristics of atrial and ventricular myocardium of heart, so as to explore the external effect of autonomic nerve on cardiac electrophysiology and arrhythmia in May.
Methods: 10 New Zealand rabbits were anesthetized, connected and recorded electrocardiogram, right jugular vein, 6F quadrupole electrode catheter via superior vena cava were inserted into the right atrium, right ventricle, set the programmed electrical stimulation, recording the atrial effective refractory period (AERP), P wave dispersion (PD), atrial fibrillation (AF) in the proportion of the number of animal vulnerable window (WOV), atrial, ventricular effective refractory period (VERP), Q-T dispersion (Q-Td), Tpeak-Tend (Tp-e) dispersion and ventricular fibrillation threshold (VFT), then separated and exposed double lateral cervical Vagosympathetic trunk. Implantation of stimulating electrodes, and high frequency electrical stimulation instrument connection, were given about unilateral and bilateral Vagosympathetic trunk stimulation, the heart rate compared to the basic state respectively decreased 10%, 30%, 50%, repeat the above electrical stimulation, and measuring the electrophysiological index.
Results: with the stimulation of the left cervical vagal intensity increased the sympathetic trunk, compared with the basic state, AERP gradually reduced to the stimulus intensity decreased heart rate 50%, AERP shortening was statistically significant (71.5 + 99 12.39vs + 21.55, P < 0.01 PD); with the increase of stimulus intensity increase gradually, to the stimulus intensity decreased heart rate of 50%, compared with the basic state of PD increased significantly (48.8 + 17.05 Vs 30.6 + 9.34, P < 0.05); AF and WOV respectively, although the proportion of animal has increased and widened trend, but no statistical significance.
The right cervical vagal stimulation with increasing intensity of the sympathetic trunk, compared with the baseline, AERP decreased gradually, until 30% when the stimulus intensity decreased heart rate, shortening of AERP was statistically significant (81.6 + 12.20 vs99.0 + 21.55, P < 0.05), and continue to increase the intensity of stimulation make the heart rate of 50%, compared with the basic AERP shorten the state more significant (69.2 + 14.05 vs 99 + 21.55, P < 0.01 PD); with the increase of stimulus intensity increase gradually, to stimulate strength make the heart rate of 30%, compared with the basic state of PD increased significantly (42.3 + 10.85 vs 30.6 + 9.34, P < 0.05), and the stimulus intensity increased to the heart rate of 50%, PD was more significantly increased state (55.5 + 13.99 vs 30.6 + 9.34, P < 0.01); AF and WOV respectively, although the proportion of animal has increased and widened trend, but it has no statistical significance.
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