暨南大学学报（自然科学与医学版）
暨南大學學報（自然科學與醫學版）
기남대학학보（자연과학여의학판）
JOURNAL OF JINAN UNIVERSITY（NATURAL SCIENCE & MEDICINE EDITION）
2014年
2期
152-156
,共5页
张煜%徐涛%廖德宁%王昊%张冉
張煜%徐濤%廖德寧%王昊%張冉
장욱%서도%료덕저%왕호%장염
心血管病学%胺碘酮%伊布利特%跨壁复极离散度%室性心动过速%心房扑动%心房颤动
心血管病學%胺碘酮%伊佈利特%跨壁複極離散度%室性心動過速%心房撲動%心房顫動
심혈관병학%알전동%이포리특%과벽복겁리산도%실성심동과속%심방복동%심방전동
cardiology%amiodarone%ibutilide%transmural dispersion of repolarization%ven-tricular tachycardia%atrial flutter%atrial fibrillation
目的：研究胺碘酮与伊布利特联合应用对心肌室性心律失常的影响及机制．方法：新西兰大白兔35只，随机分配，分为A组：正常对照组、B组：含伊布利特质量浓度2 mg/L正常台式液灌流、C组：含伊布利特质量浓度2 mg/L低钾低镁台式液灌流、D组：含伊布利特质量浓度2 mg/L正常台式液灌流、E组：含伊布利特质量浓度2 mg/L低钾低镁台式液灌流，每组7只．C组及D组实验前每日称量大白兔体质量，并根据体质量用电子天平称取质量分数50 mg/kg药粉，经灌胃针给予灌胃，每日1次，连续4周．实验时，每组大白兔均在麻醉后制作左室楔形心肌块，经左冠脉开口处灌流，记录内膜及外膜动作电位时程，计算出灌流前后跨壁复极离散（TDR）的改变，后给予程序刺激，观察室性心律失常发生情况．结果：单独使用伊布利特心肌TDR升高为（50.42±4.2）ms，较对照组的（41.7±15.3）ms明显升高（P＜0.05）．单独使用胺碘酮心肌TDR则降低为（16.8±3.3）ms，与对照组比较亦有显著差异．胺碘酮应用后再使用伊布利特心肌TDR改变为（27.22±5.1）ms，同样明显低于对照组TDR．而在低钾低镁环境下，单独使用伊布利特心肌TDR的升高则更为显著，达到（67.21±12.62）ms，而胺碘酮的降低心肌TDR的作用则与正常环境相同，为（16.8±3.3）ms．低钾低镁环境下胺碘酮应用后再使用伊布利特的心肌TDR为（32.21±5.2）ms，仍然明显低于对照组的心肌TDR水平．在观察室性心动过速的实验过程中，口服胺碘酮后再应用伊布利特，无论是在正常台式液环境还是低钾低镁台式液环境下，均无室速的发生，与在低钾低镁情况下单独使用伊布利特组中5只发生室速有明显差异（P＜0.05）．结论：口服胺碘酮后再使用伊布利特，可以减少依布利特单独使用时诱发的室性心律失常．
目的：研究胺碘酮與伊佈利特聯閤應用對心肌室性心律失常的影響及機製．方法：新西蘭大白兔35隻，隨機分配，分為A組：正常對照組、B組：含伊佈利特質量濃度2 mg/L正常檯式液灌流、C組：含伊佈利特質量濃度2 mg/L低鉀低鎂檯式液灌流、D組：含伊佈利特質量濃度2 mg/L正常檯式液灌流、E組：含伊佈利特質量濃度2 mg/L低鉀低鎂檯式液灌流，每組7隻．C組及D組實驗前每日稱量大白兔體質量，併根據體質量用電子天平稱取質量分數50 mg/kg藥粉，經灌胃針給予灌胃，每日1次，連續4週．實驗時，每組大白兔均在痳醉後製作左室楔形心肌塊，經左冠脈開口處灌流，記錄內膜及外膜動作電位時程，計算齣灌流前後跨壁複極離散（TDR）的改變，後給予程序刺激，觀察室性心律失常髮生情況．結果：單獨使用伊佈利特心肌TDR升高為（50.42±4.2）ms，較對照組的（41.7±15.3）ms明顯升高（P＜0.05）．單獨使用胺碘酮心肌TDR則降低為（16.8±3.3）ms，與對照組比較亦有顯著差異．胺碘酮應用後再使用伊佈利特心肌TDR改變為（27.22±5.1）ms，同樣明顯低于對照組TDR．而在低鉀低鎂環境下，單獨使用伊佈利特心肌TDR的升高則更為顯著，達到（67.21±12.62）ms，而胺碘酮的降低心肌TDR的作用則與正常環境相同，為（16.8±3.3）ms．低鉀低鎂環境下胺碘酮應用後再使用伊佈利特的心肌TDR為（32.21±5.2）ms，仍然明顯低于對照組的心肌TDR水平．在觀察室性心動過速的實驗過程中，口服胺碘酮後再應用伊佈利特，無論是在正常檯式液環境還是低鉀低鎂檯式液環境下，均無室速的髮生，與在低鉀低鎂情況下單獨使用伊佈利特組中5隻髮生室速有明顯差異（P＜0.05）．結論：口服胺碘酮後再使用伊佈利特，可以減少依佈利特單獨使用時誘髮的室性心律失常．
목적：연구알전동여이포리특연합응용대심기실성심률실상적영향급궤제．방법：신서란대백토35지，수궤분배，분위A조：정상대조조、B조：함이포리특질량농도2 mg/L정상태식액관류、C조：함이포리특질량농도2 mg/L저갑저미태식액관류、D조：함이포리특질량농도2 mg/L정상태식액관류、E조：함이포리특질량농도2 mg/L저갑저미태식액관류，매조7지．C조급D조실험전매일칭량대백토체질량，병근거체질량용전자천평칭취질량분수50 mg/kg약분，경관위침급여관위，매일1차，련속4주．실험시，매조대백토균재마취후제작좌실설형심기괴，경좌관맥개구처관류，기록내막급외막동작전위시정，계산출관류전후과벽복겁리산（TDR）적개변，후급여정서자격，관찰실성심률실상발생정황．결과：단독사용이포리특심기TDR승고위（50.42±4.2）ms，교대조조적（41.7±15.3）ms명현승고（P＜0.05）．단독사용알전동심기TDR칙강저위（16.8±3.3）ms，여대조조비교역유현저차이．알전동응용후재사용이포리특심기TDR개변위（27.22±5.1）ms，동양명현저우대조조TDR．이재저갑저미배경하，단독사용이포리특심기TDR적승고칙경위현저，체도（67.21±12.62）ms，이알전동적강저심기TDR적작용칙여정상배경상동，위（16.8±3.3）ms．저갑저미배경하알전동응용후재사용이포리특적심기TDR위（32.21±5.2）ms，잉연명현저우대조조적심기TDR수평．재관찰실성심동과속적실험과정중，구복알전동후재응용이포리특，무론시재정상태식액배경환시저갑저미태식액배경하，균무실속적발생，여재저갑저미정황하단독사용이포리특조중5지발생실속유명현차이（P＜0.05）．결론：구복알전동후재사용이포리특，가이감소의포리특단독사용시유발적실성심률실상．
Aim:To study how the combined use of amiodarone with Ibutilide effects on myocardial transmural dispersion of repolarization (TDR),and whether the combined use of Ibutilide with amioda-rone is able to reduce the side effects compared with the use of Ibutilide alone.Methods:35 New Zeal-and rabbits were randomly divided into control group,Ibutilide group A(perfused with normal tyrode's so-lution containing 2 mg/L Ibutilide ),Ibutilide group B (perfused with hypopotassemia and hypomag-nesemia tyrode's solution containing 2 mg/L Ibutilide),amiodarone (50 mg/kg amiodarone orally given every day for 4 weeks)combined with Ibutilide group A (perfused with normal tyrode's solution contai-ning 2 mg/L Ibutilide),amiodarone (50mg/kg amiodarone orally given every day for 4 weeks )com-bined with Ibutilide group B(perfused with hypopotassemia and hypomagnesemia tyrode's solution contai-ning 2 mg/L Ibutilide),with 7 rabbits in each group.The left ventricular wedge preparations were made for each group.Transmural ECG and action potentials from both endocardium and epicardium were simul-taneously recorded.The changes of TDR and Tdp were analyzed.Results:In this study,TDR level was found to be increased to 50.42 ±4.2 ms in Ibutilide group A and 67.12 ±12.62 ms in Ibutilide group B, significantly higher than the control group.Amiodarone was found to be able to decrease TDR level to 16.8 ±3.3 ms in both amiodarone combined with Ibutilide group A and B.Based on the results,Ibutil-ide was used after the administration of amiodarone,and it was found that TDR level maintained at 27.22 ±5.1 ms in amiodarone combined with Ibutilide group A,and 32.21 ±5.2 ms in amiodarone combined with Ibutilide group B,significantly lower than that of the control group.In the arrhythmias experiment, we observed that arrhythmia occurred significantly less in amiodarone group B(0/7)than Ibutilide group B(5/7).Conclusion:Amiodarone may be given orally for a period of time or up to 4 weeks before Ibutil-ide is given,which can effectively lower the risk of Tdp that might be caused by Ibutilide.This might im-prove the safety of Ibutilide.
