CAJ | 학술논문

目的将窦房结组织带蒂移植入自体心室中，通过观察带蒂移植的窦房结组织能否存活并与心室肌建立细胞连接；射频消融希氏束建立完全性房室传导阻滞动物模型，观察其能否起搏心室；为完全性房室传导阻滞探索新的治疗思路和方法。方法健康家犬10只，随机分为移植组和对照组，每组各5只。安置临时心外膜起搏导线后，将犬窦房结组织带蒂移植于实验组自体右心室心外膜下，对照组仅切除窦房结组织，于第1、2、3、4周观测体表心电图变化。4周后射频消融希氏束，建立完全性房室传导阻滞动物模型。建立模型后对两组动物经股静脉微泵注射异丙肾上腺素（ISO），观察心率变化。并观测带蒂移植后的窦房结组织学及超微结构变化。结果体表心电图无明显变化。射频消融希氏束后，移植组和对照组均表现为完全性房室传导阻滞心电图，两组室性心率无明显差别（P>0.05）。注射ISO后，两组室性心率改变不明显（P>0.05）。带蒂移植的窦房结组织可以存活，并与心室肌细胞建立桥粒连接，但细胞连接数目不多，不能起搏心室。结论带蒂移植入自体心室的窦房结组织细胞可以和心肌细胞建立细胞连接。
목적장두방결조직대체이식입자체심실중，통과관찰대체이식적두방결조직능부존활병여심실기건립세포련접；사빈소융희씨속건립완전성방실전도조체동물모형，관찰기능부기박심실；위완전성방실전도조체탐색신적치료사로화방법。방법건강가견10지，수궤분위이식조화대조조，매조각5지。안치림시심외막기박도선후，장견두방결조직대체이식우실험조자체우심실심외막하，대조조부절제두방결조직，우제1、2、3、4주관측체표심전도변화。4주후사빈소융희씨속，건립완전성방실전도조체동물모형。건립모형후대량조동물경고정맥미빙주사이병신상선소（ISO），관찰심솔변화。병관측대체이식후적두방결조직학급초미결구변화。결과체표심전도무명현변화。사빈소융희씨속후，이식조화대조조균표현위완전성방실전도조체심전도，량조실성심솔무명현차별（P>0.05）。주사ISO후，량조실성심솔개변불명현（P>0.05）。대체이식적두방결조직가이존활，병여심실기세포건립교립련접，단세포련접수목불다，불능기박심실。결론대체이식입자체심실적두방결조직세포가이화심기세포건립세포련접。
Objective To observe the changes of surface ECG and cell couplings between sinoatrial node cells and myocardial cells following transplantion of pedicled autologous sinoatrial node tissue graft into the right ventricle of a canine model of complete atrioventricular block. Methods Ten healthy dogs were randomized into transplantation group and control group. Pedicled autologous sinoatrial node tissue grafts were transplanted into the right ventricle in the transplantation group, while the sinoatrial nodes were only excised in the control group after placement of temporary myocardial pacing wires. The changes of surface ECG were observed at 1, 2, 3 and 4 weeks postoperatively. At 4 weeks, complete atrioventricular block was induced in the dogs by radiofrequency ablation of the His bundle. The heart rate of the dogs in both groups were recorded after the injection of isoproternol (ISO) from the femoral vein, and the transplanted tissue graft was observed under optical and transmission electron microscopes. Results No significant changes occurred in the surface ECG. All the dogs showed ECG waveforms specific of complete heart block after the ablation, and the ventricular heart rates were similar between the two groups (P>0.05). The ventricular heart rate did not undergo obvious changes after ISO injection (P>0.05). The transplanted pedicled autologous sinoatrial node survived in the dogs and the sinoatrial node cells established desmosome junctions with the myocardial cells, but the number of junctions was not sufficient to support heart pacing. Conclusions Desmosome junction can occur between ventricular myocardial cells and sinoatrial node cells at the edge of transplanted pedicled autologous sinoatrial node tissue.