摘要
目的 :研究急性下壁心肌缺血时影响房室传导的基础和临床相关因素。方法 :动物实验通过模板匹配方法从房室束电图检测 A,H,V波并测量两心房间期 (AA) ,心房波与房室束波间期 (AH) ,房室束波与心室波间期 (HV)和心房波与心室波间期 (AV) ;临床试验对急性下壁心梗患者在急性期或缓解期行冠脉造影。结果 :1自主神经对AV传导的调节呈现一种动态过程。迷走神经对 AV的作用呈现第一延迟系统特征 ,排除心率影响 ,其作用由4.6 %增加至 13.2 % ;而交感神经对 AV的作用呈现第 2延迟系统特征 ,排除心率影响 ,其作用由 32 %增加至46 %。 2急性右冠状动脉阻塞后可直接或间接地引起 AV传导的延长。在快速起搏后 ,这种延长明显增加。再灌注发生后 ,可使延长的 AV恢复 ;急性右冠状动脉阻塞后迷走神经对 AV传导的调节功能增强 ,而交感神经对 AV传导的调节减弱。 3急性下壁心肌梗死引起的房传导阻滞 (AVB)主要与优势型冠状动脉的狭窄程度有关 ,其狭窄程度越重 ,AVB越易发生。结论 :急性下壁心肌梗死伴 AVB的出现、消失与冠脉阻塞、再开放有关。在急性 AVB出现时 ,可见冠脉阻塞 ,而恢复期 AVB消失时 ,提示冠脉血管再通 ;溶栓疗法对 AVB发生、发展期无明显影响 ,而能缩短
AIM:To investigate factors effecting to atrioventricular conduction function in acute inferior myocardial ischemia. METHODS:Animal experiments were performed in denervated cats. With a template matching algorithm from His bundle electrogram, A,H and V waves were picked up, AA interval, AH interval and HV interval,AV interval were measured respectively. In clinical experiments,patients complicated with acute inferior myocardial infarction underwent coronary angiography in acute or sub acute phase. RESUTLS:①The transfer function from vagal stimulation to AV interval characterized as a first order delay system,the gain of transfer function increased by constant pacing from 4.6% to 13.2% relative to AA interval change. The transfer function from sympathetic stimulation to AV interval characterized as a second order delay system,the gain increased by constant pacing from 32% to 46%. ② Atrioventricular conduction prolonged directly or indirectly after right coronary artery occulded,and prolonged directly or indirectly after right coronary artery occluded,and prolonged more significantly after rapid atrial pacing. The prolonged AV was recovered after reperfusion. The regulation of vagal nerve on AV was increased but that of sympathetic nerve on AV conduction was decreased after right coronary artery occulded. ③The occurrence of AV block was related to the severity of lesion of the dominant coronary artery,the more severe the dominant coronary artery lesion was,the higher rate of AV block occurred. CONCLUSIONS:The occurrence and disappearance of AV block in acute inferior myocardial infarction was related to the occlusion of and reperfusion of the infarct related artery,whereas the disappearance of AV block indicated the reopening of occluded coronary artery. The occurrence of AV block didn′t change but the durance of AV block was shortened after thrombolytic therapy.
出处
《心脏杂志》
CAS
2000年第5期349-352,共4页
Chinese Heart Journal
基金
全军医药卫生科研基金部分资助课题!(No.98M15 8)
关键词
心肌梗死
急性
心脏传导阻滞
动物实验
myocardial infarction,acute,inferior
heart block
animal experiment
clinical investigation
