射频消融引起心肌损伤及其对氧自由基和肿瘤坏死因子的影响

Myocardial injury and effects on oxide free radical and tumor necrosis factor-α due to radiofrequency ablation

目的 :观察射频消融对心肌的损伤作用 ,及其对氧自由基和肿瘤坏死因子的影响。方法 :室上速患者 73例分别在血管穿刺术后、心内电生理检查后、射频消融术后即刻和术后 3d检测谷草转氨酶 (GOT)、乳酸脱氢酶(L DH)、羟丁酸脱氢酶 (HBDH)、肌酸磷酸激酶及其同功酶 (CK/CK- MB)、肌红蛋白 (Mb)、一氧化氮 (NO)、丙二醛(MDA)、超氧化物歧化酶 (SOD)和肿瘤坏死因子 (TNF- α)。结果 :射频消融后 ,GOT,L DH,HBDH,Mb和 SOD均有显著意义的升高 ,而尤其以右侧旁路组和房室结双径路组 (AVNRT)升高明显 ,心肌损伤指标中以 Mb的改变最为显著。术后 3d,所有指标均恢复到基线水平。除了右侧旁路的消融 ,CK在手术前后没有差别 ,HBDH,MDA和TNF- α在手术前后没有明显变化。结论 :射频消融可产生心肌损伤 ,心肌酶升高程度与射频消融的总能量成正比。肌红蛋白是反映心肌损伤的敏感指标。射频消融同样可以引起微弱的氧自由基损伤 ,但没有引起全身的 TNF- α水平变化。

AIM:To study the myocardial injury and the effects of oxide free radical and tumor necrosis factor-α due to RFCA. METHODS:In 73 patients afflicted with paroxysmal superventricular tachycardia,the following indicators were detected:GOT,LDH,HBDB,CK/CK-MB,Mb,NO,MDA,SOD and TNF-α after catheterization,endocardial electrophysiological test,RFCA immediately and 3 d after operation respectively.RESULTS:GOT,LDH,HBDH,Mb and SOD increased significantly after RFCA,especially in the subgroups of right atrioventricular bypass and AVNRT,and then dropped to the baseline after 3 d . The increase range of Mb was the greatest among the plasma indicators responding to the myocardial injury. CK didn′t fluctuate noticeably except in the subgroup of right bypass. No differences showed in HBDH,MDA and TNF-α between pre- and post-operation and among any subgroups. CONCLUSION:RFCA can induce the myocardial injury which is in positive proportion to the total radiofrequency energy and is reflected most sensitively by Mb. Though there exists the slight oxide free radial damage,it doesn′t consequently incur the TNF-α change in blood circulation,