中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2010年
3期
257-263
,共7页
魏捷%吕菁君%赵冬冬%林国生
魏捷%呂菁君%趙鼕鼕%林國生
위첩%려정군%조동동%림국생
心室颤动%动作电位%恢复性质%β-肾上腺素能受体%RyR2通道
心室顫動%動作電位%恢複性質%β-腎上腺素能受體%RyR2通道
심실전동%동작전위%회복성질%β-신상선소능수체%RyR2통도
Veutricular fibrillation%Action potentials%Restitution property%Cardiac ryanodine receptor%Beta-adrenergic receptor
目的 探讨在心室颤动心肺复苏模型中联合应用肾上腺素和艾司洛尔对心肌动作电位恢复性质的影响,了解β1-肾上腺素能受体拈抗剂艾司洛尔防治室颤的潜在机制.方法 稳定动态刺激健康雄性大Yorkshire猪发生心室颤动,心外膜接触标记,同步记录左心室5个标测部位单极电图,构建心肌组织激动-恢复间期(activation-recovery intervals,ARIs)恢复曲线,应用Western blot免疫印迹技术半定量测定并比较肾上腺素组和艾司洛尔组心肌磷酸化RyR2通道蛋白表达水平的差异.两组间均数比较采用成组t检验,计数资料用χ~2检验.局部ARI恢复曲线的坡度值比较采用Student t-test检验.结果 在心肺复苏过程中使用肾上腺素导致心室肌RyR2通道高度磷酸化,显著增加局部ARI恢复曲线斜率和心室ARI恢复曲线的空间异质性.在复苏早期联合使用艾司洛尔可显著下调心肌RyR2通道在Ser~(2815)和Ser~(2809)两个位点上的磷酸化蛋白表达,并部分拮抗肾上腺素对ARI恢复曲线的影响,提高室颤阈值,减少除颤次数,显著下降自主循环恢复后室颤再发生率.结论 在复苏早期使用艾司洛尔拮抗心室肌RyR2通道过度磷酸化,降低ARI恢复曲线斜率,缩小ARI恢复曲线空间异质性,是β1-肾上腺素受体阻滞剂减少室颤发作的重要机制之一.
目的 探討在心室顫動心肺複囌模型中聯閤應用腎上腺素和艾司洛爾對心肌動作電位恢複性質的影響,瞭解β1-腎上腺素能受體拈抗劑艾司洛爾防治室顫的潛在機製.方法 穩定動態刺激健康雄性大Yorkshire豬髮生心室顫動,心外膜接觸標記,同步記錄左心室5箇標測部位單極電圖,構建心肌組織激動-恢複間期(activation-recovery intervals,ARIs)恢複麯線,應用Western blot免疫印跡技術半定量測定併比較腎上腺素組和艾司洛爾組心肌燐痠化RyR2通道蛋白錶達水平的差異.兩組間均數比較採用成組t檢驗,計數資料用χ~2檢驗.跼部ARI恢複麯線的坡度值比較採用Student t-test檢驗.結果 在心肺複囌過程中使用腎上腺素導緻心室肌RyR2通道高度燐痠化,顯著增加跼部ARI恢複麯線斜率和心室ARI恢複麯線的空間異質性.在複囌早期聯閤使用艾司洛爾可顯著下調心肌RyR2通道在Ser~(2815)和Ser~(2809)兩箇位點上的燐痠化蛋白錶達,併部分拮抗腎上腺素對ARI恢複麯線的影響,提高室顫閾值,減少除顫次數,顯著下降自主循環恢複後室顫再髮生率.結論 在複囌早期使用艾司洛爾拮抗心室肌RyR2通道過度燐痠化,降低ARI恢複麯線斜率,縮小ARI恢複麯線空間異質性,是β1-腎上腺素受體阻滯劑減少室顫髮作的重要機製之一.
목적 탐토재심실전동심폐복소모형중연합응용신상선소화애사락이대심기동작전위회복성질적영향,료해β1-신상선소능수체념항제애사락이방치실전적잠재궤제.방법 은정동태자격건강웅성대Yorkshire저발생심실전동,심외막접촉표기,동보기록좌심실5개표측부위단겁전도,구건심기조직격동-회복간기(activation-recovery intervals,ARIs)회복곡선,응용Western blot면역인적기술반정량측정병비교신상선소조화애사락이조심기린산화RyR2통도단백표체수평적차이.량조간균수비교채용성조t검험,계수자료용χ~2검험.국부ARI회복곡선적파도치비교채용Student t-test검험.결과 재심폐복소과정중사용신상선소도치심실기RyR2통도고도린산화,현저증가국부ARI회복곡선사솔화심실ARI회복곡선적공간이질성.재복소조기연합사용애사락이가현저하조심기RyR2통도재Ser~(2815)화Ser~(2809)량개위점상적린산화단백표체,병부분길항신상선소대ARI회복곡선적영향,제고실전역치,감소제전차수,현저하강자주순배회복후실전재발생솔.결론 재복소조기사용애사락이길항심실기RyR2통도과도린산화,강저ARI회복곡선사솔,축소ARI회복곡선공간이질성,시β1-신상선소수체조체제감소실전발작적중요궤제지일.
Objective To investigate the effect on electrical restitution of β1-adrenergic receptor antagonist esmolol administered during cardiopulmonary resuscitation in the porcine ventricular fibrillation model. Method Ventricular fibrillation untreated for four minutes was induced by dynamic steady state pacing protocol in 40 healthy male pigs, in which local unipolar electrograms were recorded using one 10-electrode catheter that was sutured to the left ventrieular epicarditan. During CPR, animals were randomized into two groups to receive saline as placebo or esmolol after two standards doses of epinephrine. At postresuscitation 2-hour, six pigs were randomly selected from each group and the second VF induction was performed. Local activation-recovery intervals (ARI) restitutions and the VF inducibility between control group and esmolol group were compared. Western blotting was performed to determine cardiac ryanodine receptor (RyR2) protein expression, and their phosphorylation status. Results No sig-nificant differences were observed at the restoration of spontaneous circulation between two groups. Higher postre-suseitation 2-hour survival rate was observed in the esmolol group. Esmolol significantly flattened ARI restitution slope, lessened regional difference of ARI restitution, decreased the VF inducibility, and alleviated RyR2 hyper-phosphorylation. Conclusions Esmolol given during CPR significantly improved postresuscitation 2-hour survival rate. Its effects on modulating electrical restitution property and intracellular calcium handling make up the most important reasons why β1-blockade significantly reduced the onset and maintenance of VF.
