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犬心肌梗死后心力衰竭模型中脊髓刺激可改善心室功能并减少室性心律失常
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Spinal Cord Stimulation Improves Ventricular Function and Reduces Ventricular Arrhythmias in a Canine Postinfarction Heart Failure Model
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Lopshire JC, Zhou X, Dusa C
2010/3/4 14:18:32
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打印|
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Circulation,
2009,
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View at Publisher
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Background:
Spinal cord stimulation (SCS) reduces the incidence of ventricular tachyarrhythmias in experimental models. This study investigated the effects of long-term SCS on ventricular function in a postinfarction canine heart failure model.
Methods and Results:
In stage 1, dogs underwent implantable cardioverter-defibrillator implantation and embolization of the left anterior descending artery followed by right ventricular pacing (240ppm) for 3 weeks to produce heart failure. In stage 2, 28 surviving animals were assigned to the SCS (delivered at the T4/T5 spinal region for 2 hours 3 times a day), medicine (MED; carvedilol therapy at 12.5mg PO BID), or control (CTRL; no therapy) group for the initial phase 1 study. In a subsequent phase 2 study, 32 stage 1 survivors were equally randomized to the SCS, MEDS (carvedilol plus ramipril 2.5mg PO QD), SCS plus MEDS (concurrent therapy), or CTRL group. Animals were monitored for 5 weeks (phase 1) or 10 weeks (phase 2). In stage 3, all phase 1 animals underwent circumflex artery balloon occlusion for 1 hour. In the SCS group, left ventricular ejection fraction was 65±5% at baseline, 17±3% at the end of stage 1, and 47±7% at the end of stage 2. In the MED group, left ventricular ejection fraction was 61±4% at baseline, 18±3% at the end of stage 1, and 34±4% at the end of stage 2. In the CTRL group, left ventricular ejection fraction was 64±5% at baseline, 19±5% at the end of stage 1, and 28±3% at the end of stage 2. Left ventricular ejection fraction was significantly improved in the SCS compared with the MED and CTRL groups (P<0.001 for both). The mean number of spontaneous nonsustained ventricular tachyarrhythmias during stage 2 and the occurrence of ischemic ventricular tachyarrhythmias during stage 3 also were significantly decreased in the SCS (27±17 and 27%, respectively; P<0.03) and MED (58±42 and 33%; P<0.05) versus CTRL (88±52 and 76%) group. After 10 weeks in the phase 2 studies, the greatest recovery in ejection fraction was noted in the SCS (52±5%) and SCS+MEDS (46±4%) groups compared with the MEDS (38±2%) and CTRL (31±4%) groups.
Conclusions:
SCS significantly improved cardiac contractile function and decreased ventricular arrhythmias in canine heart failure.
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疾病资源中心
病例分析 [栏目介绍]
上海复旦大学附属中山医院消化科 刘黎黎 高虹
患者，男性，19岁，因“上腹痛20余天”于2005年12月15日入院。患者22天前开始出现中上腹持续剧烈疼痛，伴大便次数增多，3～4次/天，不成形，黑色，后出现呕吐，呕吐物为黄绿色胆汁样物质，有时低热，诊断性腹穿抽出少量淡血性液体，外院腹部平片示：小肠梗阻。查血见白细胞18.0×109/L，N 88.4%，尿蛋白(＋)，于12天前行剖腹探查术，术中见腹腔内有淡血性液体200 ml，见小肠节段性病变，未见肠坏死及穿孔，行腹腔冲洗引流术，术后予地塞米松、制酸、生长抑素、营养补液、抗感染治疗后，未见好转而转入我院。
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