自主神经系统对窦性心律震荡的影响

Effects of autonomic nervous system on heart rate turbulence

目的通过心室起搏诱发窦性心律震荡(HRT)模型,观察自主神经对HRT指标的影响。并探讨诱发室性早搏的不同联律间期(CI)及代偿间期(CP)与HRT指标之间的关系。方法15例无器质性心脏病患者,在不使用自主神经阻断药物情况下(基础状态),采用右室心尖部V-S2刺激,联律间期以刺激前平均心动周期的60%感知V波,并逐渐2%递减,直至连续发出10个V-S2刺激,每个S2刺激之间至少间隔有20个VV间期;然后静脉注入艾司洛尔(艾司洛尔状态),待药物作用至高峰后重复上述V-S2刺激;静脉注入阿托品(阿托品状态),待其作用至高峰后再次重复上述刺激;随即再次注入艾司洛尔(联合用药状态)后重复发出10个V-S2刺激。测量并分析四种状态下体表心电图及腔内心电图数据。结果基础状态下RR间期是698.91±75.70ms,震荡初始(TO)为-1.65%±2.29%,震荡斜率(TS)为8.16±4.63ms。而在使用不同的自主神经阻滞药物后,TO显著性增加发生在阿托品状态和联合用药状态,而在艾司洛尔状态无显著变化。TS显著性降低发生在阿托品状态和联合用药状态(P均<0.01),而在艾司洛尔状态无显著变化。基础状态诱发的室性早搏,它的CI与HRT指标并没有相关性(所有的P>0.05),而CP则与HRT指标相关。结论自主神经系统对HRT的影响中,迷走神经起着主导作用;基础状态下CI和HRT指标之间不相关,而CP与之相关。

Objective To study the autonomic nervous system how to effect the induced heart rate turbulence （HRT） and whether we could find correlations between HRT parameters and coupling interval （CI） or compensatory pause （CP）. Methods Fifteen patients without structural heart disease were studied. Systematic introduced ventricular premature beats（VPB） were delivered from the right ventricular apex without antiarrhythmic drugs. The CI was started at 60% of the basic sinus cycle length and decremented in 2% steps until a total of 10 VPB were given. After a complete baseline study, HRT investigations were repeated after sequential sympathetic blockade, parasympathetic blockade, and combined auto- nomic blockade. All signal from the 12-lead ECG, and intracadiac local electrograms were digitally recorded and stored on optic disc, which were analyzed by using online calipers. Results The average R-R interval at baseline was 698.91 ± 75.70 ms, TO was - 1.65% ± 2.29% and TS was 8.16 ± 4.63 ms. After using different autonomic blockade, TO increased after atropine and combined sympathetic and patasympathetie blockade （ all P 〈 0.05 ）, but was unchanged after esmolol. TS decreased after atropine, and combined autonomic blockade but was unchanged after esmlol. HRT at baseline was significantly correlate with CP, but not with CI. ConcIusions Vagal influence is predominant in effects of autonomic nervous system on HRT. HRT at baseline is found to significantly correlate with CP, but without CI. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2006,20 （ 5 ） ： 416 - 419 ]