双心室起搏-不应期电刺激的急性血液动力学变化和离子机制_临床医学论文.docVIP

双心室起搏-不应期电刺激的急性血液动力学变化和离子机制_临床医学论文 双心室起搏-不应期电刺激的急性血液动力学变化和离子机制_临床医学论文 作者：王东琦，舒娟，崔长琮，薛小临，马奕，苏显明，赵小静，朱参战，张海柱 【摘要】 目的 观察双心室起搏(BivP)对病态窦房结综合征(SSS)患者的急性血液动力学变化和心脏绝对不应期电刺激(ARPES )对豚鼠衰竭心室肌细胞钙离子流的影响。方法 对10例SSS患者经冠状静脉左室后外侧支和右心室心尖部进行BivP，观察起搏前后5 min的心脏每分输出量(CO)、心脏排血指数(CI)、肺毛细血管嵌压(PCWP)和心电图QRS离散度(QRSd)、QT离散度(QTd)、跨室壁复数离散度(TDR)的变化。应用单细胞收缩动缘检测仪和膜片钳技术，观察ARPES前后单个豚鼠衰竭心室肌细胞收缩幅度、ICa-L、Ca-T的变化。结果 BivP时CO、CI分别增加16.2%、16.8%，PCWP下降，TDR变小，表明BivP可增加心肌收缩功能，减小跨室壁复极离散度。ARPES使单个衰竭心室肌细胞收缩幅值和Ca-T分别增高15.5%和16.8%。结论 ARPES可触发ICa-L开放，增加Ca-T，增强豚鼠衰竭心室肌细胞的收缩功能。BivP时一个电信号必然进入另一个电信号的绝对不应期，因此BivP-ARPES时ICa-L开放，Ca-T增加等，可能也是其改善心脏收缩功能的机制之一。 【关键词】 双心室起搏；绝对不应期电刺激；心脏再同步治疗；慢性心力衰竭；L型钙电流-钙瞬变 　　ABSTRACT: Objective To evaluate the acute homodynamic effects of biventricular pacing (BivP) in sick sinus syndrome (SSS) patients and investigate the Ca2+ changes during absolute refractory period electrical stimulation (ARPES) in failing guinea-pig ventricular myocyte. Methods The CO, CI, PCWP and ECG parameters were measured in ten patients with SSS before and after 5 min BivP connecting RVA+LVB. The extent of contraction and Ca2+ transient (Ca-T) changes of failure guinea-pig ventricular myocyte were recorded with the motion edge detection system. Results CO and CI increased by 16.2% and 16.8%, respectively; PCWP and TDR decreased during BivP, which suggested that BivP could improve systolic function and TDR. The contraction extent and Ca-T(F360/F380) of failure guinea-pig ventricular myocyte increased by 15.5% and 16.8%, respectively, during ARPES. It suggested that increased contractility of failure myocyte might be due to ICa-L and Ca2+ released from SR after appropriate ARPES. Conclusion Appropriate ARPES might strengthen contractility through increasing ICa-L and Ca-T of failing guinea-pig ventricular myocyte. One signal has conducted into another’s ARP in BivP, so the changed ICa-L and Ca-T during BivP-ARPES may be one of the mechanisms of improving systolic function. 　　KEY WORDS: biventricular pacing; absolute r