2018 年第 10 期 第 13 卷

射频消融犬迷走神经对Bezold-Jarisch反射相关血流动力学指标的影响

Effect of cardiac vagus nerve radiofrequency ablation on Bezold-Jarisch reflex related hemodynamic parameters in canine

作者：卢春山郭成军方冬平郝蓬何东方马克娟刘冰李果张英川

英文作者：

单位：100029首都医科大学附属北京安贞医院心内二十一病房

英文单位：

关键词：血管迷走性晕厥；Bezold-Jarisch反射；导管消融；室间沟脂肪

英文关键词：

• 摘要：

• 【摘要】目的    观察射频消融犬迷走神经对Bezold-Jarisch反射（BJR）相关血流动力学指标的影响。方法    健康成年杂种犬12只麻醉后经右侧开胸，完全随机分为心外膜组(n=6)及心内膜组(n=6)。心外膜组暴露左心室脂肪垫，行室间沟脂肪消融；心内膜组在左心室内沿高频刺激有效迷走反应1 cm周围区域消融。2组消融后均经左心室导管弹丸式推注藜芦定15 μg/kg诱发BJR。记录2组推注藜芦定前后窦性周长基础值、最低值、最大下降值，及动脉收缩压(SAP)、动脉舒张压(DAP)、平均动脉压(MAP)、左心室收缩压(LVSP)、左心室舒张末压(LVEDP)、左心室压上升最大速率(+dp/dtmax)、左心室压下降最大速率(-dp/dtmax)的基础值和最大下降值。结果    推注藜芦定前，2组各项指标基础值比较，差异均无统计学意义（均P＞0.05）。推注藜芦定后，心内膜组窦性周长最大下降值Δ窦性周长明显高于心外膜组［（198±32）ms比（190±28）ms］(P＜0.05)，2组其余各项指标的最大下降值ΔSAP、ΔDAP、ΔMAP、ΔLVSP、ΔLVEDP、Δ+dp/dtmax、Δ-dp/dtmax比较，差异均无统计学意义(均P＞0.05)。结论    犬室间沟脂肪消融削弱藜芦定诱发BJR时窦性周长下降的作用强于心内膜神经电位消融，但二者对动脉压、左心室压、左心室收缩及舒张功能的影响无明显差异。

• 【Abstract】Objective    To observe the effect of cardiac vagus nerve radiofrequency ablation on Bezold-Jarisch reflex(BJR) related hemodynamic parameters in canine. Methods    Twelve mongrel canines were randomly divided into epicardial group(n=6) and endocardial group(n=6). Both groups had thoracotomy under general anesthesia; the epicardial group had ablation at interventricular sulcus fat; the endocardial group had ablation at 1 cm around the BJR receptor. Veratridine was injected into left ventricle at bolus doses of 15 μg/kg through catheter to induce BJR after ablation. Sinus cycle length（SCL）, systolic arterial pressure(SAP), diastolic arterial pressure(DAP), mean arterial pressure(MAP), left ventricular systolic pressure(LVSP), left ventricular end-diastolic pressure(LVEDP), the maximum rate of left ventricular pressure rise(+dp/dtmax) and the maximum rate of left ventricular pressure drop(-dp/dtmax) were analyzed. Results    Basic values of the parameters were similar between groups(P＞0.05). After veratridine injection, the maximum decrease of SCL in the endocardial group was significantly higher than that in the epicardial group［（198±32）ms vs （190±28）ms］(P＜0.05); but the maximum descending values of SAP, DAP, MAP, LVSP, LVEDP, LVEDP, +dp/dtmax and -dp/dtmax showed no significant differences between groups(P＞0.05). Conclusion    In canine, interventricular sulcus fat ablation can more effectively reduce the decrease of SCL induced by BJR than endocardial nerve ablation; the two methods show similar effects on arterial pressure, left ventricular pressure, left ventricular systolic and diastolic function.