心室肌无水酒精灌注消融的组织学损伤形态及量效关系
发布时间：2018-12-27 08:46
【摘要】：目的对于起源于心室肌深部的室性心律失常,经特殊针式灌注导管行无水酒精化学消融是一种潜在选择。然而,目前有关无水酒精化学消融所致的心肌损伤特点尚不清楚,本研究旨在观察经心外膜途径行无水酒精灌注消融的心肌损伤形态和注射酒精剂量与心肌损伤范围之间的量效关系。方法选取6只健康成年家猪(体重35-39Kg,年龄9-12个月)的新鲜离体心脏,以左心室的游离壁和心尖为研究区域。实验组选取10个注射点,分别注射不同剂量的无水酒精,对照组选取2个注射点注射不同剂量的生理盐水。完成注射后,4个心脏标本行TTC染色,肉眼观察并测量心肌损伤范围,计算损伤心肌体积,对无水酒精注射剂量与心肌损伤范围的关系行相关性分析。其余2个心脏标本行HE染色和TUNEL染色。对HE染色组织切片于光镜下观察两组心肌损伤区形态改变。对TUNEL染色组织切片扫描和分析,求出两组心肌细胞凋亡率。结果肉眼下实验组所有注射点均可观察到不同范围的心肌坏死,对照组未见心肌损伤。损伤形态在每一层面呈沿心肌纤维走向的类椭圆形,空间上为类椭球体。HE染色光镜下,实验组均可见心肌纤维呈凝固性坏死改变,大部分心肌细胞核固缩,核周可见明显空晕,部分细胞核碎裂、核消失,可见空泡征。对照组心肌细胞排列整齐,肌质均匀,细胞核形态规则。根据心肌组织切片TUNEL染色扫描结果,实验组和对照组心肌细胞凋亡率有统计学差异(84.99±2.87%VS4.56±3.36%,P0.001)。无水酒精注射剂量(ml)和心肌损伤体积(mm3)之间呈显著正相关,y=864.14x-165.17(R2=0.93124,P0.001)。注入心室肌的无水酒精剂量X(ml)与心肌损伤的深度(mm)、最大直径(mm)、最小直径(mm)的线性关系分别是8x+3.4,6.2x+2.1,8.3x+5.6。结论无水酒精化学消融致心肌坏死切实可行,其心肌损伤形态呈类椭球体,且心肌损伤体积与无水酒精的注射剂量呈显著相关。
[Abstract]:Objective to study the potential choice of anhydrous alcohol ablation via a special needle catheter for ventricular arrhythmias originating in the deep ventricular muscle. However, the characteristics of myocardial injury caused by chemical ablation of anhydrous alcohol are unclear. The purpose of this study was to observe the morphologic changes of myocardial injury and the dose-effect relationship between the dose of alcohol injection and the extent of myocardial injury after anhydrous alcohol perfusion ablation via epicardial pathway. Methods fresh isolated hearts of 6 healthy adult domestic pigs (body weight 35-39 kg, age 9-12 months) were selected and the free wall and apex of left ventricle were used as the study area. In the experimental group, 10 injection sites were selected and different doses of anhydrous alcohol were injected respectively. In the control group, 2 injection sites were used to inject different doses of normal saline. After the injection, 4 hearts were stained with TTC. The extent of myocardial injury was observed and measured with the naked eye, and the volume of injured myocardium was calculated. The relationship between the injection dose of anhydrous alcohol and the extent of myocardial injury was analyzed. The other two hearts were stained with HE and TUNEL. The morphologic changes of myocardial injury area in two groups were observed under light microscope with HE staining tissue sections. The apoptotic rate of cardiomyocytes in the two groups was obtained by scanning and analyzing the TUNEL staining tissue sections. Results Myocardial necrosis was observed at all injection points in the experimental group under the naked eye, but no myocardial injury was observed in the control group. The injured morphology was ellipsoid along the direction of myocardial fiber on each plane, and was ellipsoid in space. Under the HE staining light microscope, the myocardial fibers showed coagulative necrosis in the experimental group, and most of the myocardial nuclei were pyknosis. Around the nucleus, there were obvious empty halos, some nuclei were broken apart, the nucleus disappeared, and vacuole sign could be seen. In the control group, the cardiomyocytes were arranged neatly, the muscle cytoplasm was uniform, and the nuclear morphology was regular. According to the results of TUNEL staining in myocardial tissue sections, there was a statistical difference between the experimental group and the control group (84.99 卤3.36 卤3.36). There was a significant positive correlation between the injection dose of absolute alcohol (ml) and myocardial injury volume (mm3), y=864.14x-165.17 (R2C0.93124P0.001). The linear relationship between the absolute alcohol dose (X (ml) injected into ventricular muscle and the maximum diameter of myocardial injury (mm), the maximum diameter (mm),) and the minimum diameter (mm) of (mm), were 8x3.4 卤6.2x 2.1 卤8.3x 5.6respectively. Conclusion the myocardial necrosis induced by chemical ablation of anhydrous alcohol is feasible. The myocardial injury is ellipsoid, and the volume of myocardial injury is significantly correlated with the injection dose of anhydrous alcohol.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7
本文编号：2392802
[Abstract]:Objective to study the potential choice of anhydrous alcohol ablation via a special needle catheter for ventricular arrhythmias originating in the deep ventricular muscle. However, the characteristics of myocardial injury caused by chemical ablation of anhydrous alcohol are unclear. The purpose of this study was to observe the morphologic changes of myocardial injury and the dose-effect relationship between the dose of alcohol injection and the extent of myocardial injury after anhydrous alcohol perfusion ablation via epicardial pathway. Methods fresh isolated hearts of 6 healthy adult domestic pigs (body weight 35-39 kg, age 9-12 months) were selected and the free wall and apex of left ventricle were used as the study area. In the experimental group, 10 injection sites were selected and different doses of anhydrous alcohol were injected respectively. In the control group, 2 injection sites were used to inject different doses of normal saline. After the injection, 4 hearts were stained with TTC. The extent of myocardial injury was observed and measured with the naked eye, and the volume of injured myocardium was calculated. The relationship between the injection dose of anhydrous alcohol and the extent of myocardial injury was analyzed. The other two hearts were stained with HE and TUNEL. The morphologic changes of myocardial injury area in two groups were observed under light microscope with HE staining tissue sections. The apoptotic rate of cardiomyocytes in the two groups was obtained by scanning and analyzing the TUNEL staining tissue sections. Results Myocardial necrosis was observed at all injection points in the experimental group under the naked eye, but no myocardial injury was observed in the control group. The injured morphology was ellipsoid along the direction of myocardial fiber on each plane, and was ellipsoid in space. Under the HE staining light microscope, the myocardial fibers showed coagulative necrosis in the experimental group, and most of the myocardial nuclei were pyknosis. Around the nucleus, there were obvious empty halos, some nuclei were broken apart, the nucleus disappeared, and vacuole sign could be seen. In the control group, the cardiomyocytes were arranged neatly, the muscle cytoplasm was uniform, and the nuclear morphology was regular. According to the results of TUNEL staining in myocardial tissue sections, there was a statistical difference between the experimental group and the control group (84.99 卤3.36 卤3.36). There was a significant positive correlation between the injection dose of absolute alcohol (ml) and myocardial injury volume (mm3), y=864.14x-165.17 (R2C0.93124P0.001). The linear relationship between the absolute alcohol dose (X (ml) injected into ventricular muscle and the maximum diameter of myocardial injury (mm), the maximum diameter (mm),) and the minimum diameter (mm) of (mm), were 8x3.4 卤6.2x 2.1 卤8.3x 5.6respectively. Conclusion the myocardial necrosis induced by chemical ablation of anhydrous alcohol is feasible. The myocardial injury is ellipsoid, and the volume of myocardial injury is significantly correlated with the injection dose of anhydrous alcohol.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7
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