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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2000年第5期

页码:

349-352

栏目:

论著

出版日期:

2000-10-25

文章信息/Info

Title:

The basic and clinical investigation in acute inferior myocardial infarction

作者:

陈士良;  冯胜强

解放军305 医院心内科, 北京100017

Author(s):

CHEN Shi-liang; 　FENG Sheng-qiang

No.305 Hospital of PLA,Beijing 100017,China

关键词:

心肌梗死; 急性; 下壁; 心脏传导阻滞; 动物实验; 临床研究

Keywords:

myocardial infarction; acute; inferior; heart block; animal expe riment; clinical investigation

分类号:

R544.4　

DOI:

-

文献标识码:

A

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AVB的持续时间。

Abstract:

AIM To investigate factors effecting to atrioventricular cond uc tion function in acute inferior myocardial ischemia. METHODS:Animal ex periments 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 an d HV interval,AV interval were measured respectively. In clinical experiments,pa tients complicated with acute inferior myocardial infarction underwent coronary angiography in acute or sub-acute phase. RESUTLS:①The transfer fun ction 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 st imulation to AV interval characterized as a second-order delay system,the gain increased by constant pacing from 32% to 46%. ② Atrioventricular conduction pro longed directly or indirectly after right coronary artery occulded,and prolonged directly or indirectly after right coronary artery occluded,and prolonged more s ignificantly after rapid atrial pacing. The prolonged AV was recovered after rep erfusion. The regulation of vagal nerve on AV was increased but that of s ympathetic nerve on AV conduction was decreased after right coronary artery occu lded. 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 r elated to the occlusion of and reperfusion of the infarct-related artery,wherea s the disappearance of AV block indicated the reopening of occluded coronary a r tery. The occurrence of AV block didn′t change but the durance of AV block was shortened after thrombolytic therapy.

参考文献/References

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备注/Memo

备注/Memo:

收稿日期：1999-12-07.基金项目：全军医药卫生科研基金部分资助课题(No. 98M 158)

常用功能

更新日期/Last Update: 2000-10-25