经冠状动脉化学消融治疗室性心动过速的实验研究

Experimental Study on Ablation of Ventricular Tachycardia Induced by Aconitine with Intra-coronary Absolute Alcohol Injection

１５只犬用乌头碱注入心室壁诱发室性心动过速（室速）后，５只不作处理为对照组，１０只实验犬于对角支灌注无水乙醇（１ｍｌ．３０ｓ注完），心电监测６０ｍｉｎ后，其中４只犬再次注射无水乙醇（２ｍｌ，２ｓ内注完）．结果：治疗组与对照组室速持续时间差异有显著性（４７．５±２２．１ｓ、１０３２．１±２９８．５ｓ，Ｐ＜０．００１）．冠状动脉（冠脉）造影及病理检查发现：小量缓慢注射乙醇可造成对角支远端闭塞及心肌非透壁坏死，大量快速注射乙醇则造成左前降支和回旋支闭塞及大面积透壁心肌坏死．实验结果提示，经冠脉注入无水乙醇可有效地终止室速，但应注意乙醇的注射量及注射速度．

In l5 dogs, localized ventricular tachycardia(VT)was induced by injecting aconitine solution into the left ventricule. After the VT induction, no treatment was given in 5dogs and l0 dogs were treated with l ml absolute alcohol injected through cannula over a period of 30 s. After 60 min ECG monitoring, 4 dogs were reinjected with 2 ml absolute alcohol(within 2s)through cannula. Results showed that time of existing VT in two groups were significantly different (47.5±22.1 s vs 1 032±298.5s , P<0. 001). Coronary artery angiography and pathologic examination revealed the occlusion of distal end of diagonal branch and non-transmural myocardial necrosis after slow injection of small does of absolute alcohol. Rapid injection of large dose of absolute alcohol produced total occlusion of left anterior descending coronary artery and partial occlusion of left circumflex coronary artery and transmural myocardial necrosis. It is concluded that intracoronary injection of absolute alcohol can effectively ablate aconitine-induced VT, but the dosage and time of alcohol injection should be carefully controlled.