论文部分内容阅读
目的探讨猪冠状动脉前降支(LAD)结扎后发生室颤的特点及其相关因素,以期提高猪急性心肌梗死模型的成活率。方法57只小型猪开胸结扎心脏LAD不同位点,对室颤和体重、性别、术前心率、术前左室射血分数(LVEF)、开胸径路(旁正中/肋间)、手术时间、结扎百分位点、术后心率、术后发生室早或短阵室速等因素进行单因素相关分析和Logistic回归分析,进而对室颤的发生时间、室颤前心电图特点等进行评价。结果57例动物手术过程发生室颤18例,死亡11例。室颤均发生在结扎冠脉后35 min内,高峰时间为结扎冠脉后5 min和20 min;心率快于160 bpm或慢于60 bpm时容易诱发室颤。与非室颤组动物比较,室颤组动物的结扎位点高,术后最快心率>60 bpm的动物较多,短阵室速发生率高(P<0.01)。Logistic回归分析显示结扎位点过高是急性心肌梗死后发生室颤唯一的独立危险因素。结论结扎位点过高是猪急性心肌梗死后发生室颤的最重要危险因素;冠脉结扎后30 min内应该严密心电监护,特别注意结扎冠脉后5 min和20 min二个时间点、>160 bpm或<60 bpm二种心率、以及短阵室速等先兆事件。
Objective To investigate the characteristics of ventricular fibrillation (VF) after ligation of coronary anterior descending coronary artery (LAD) and its related factors in order to improve the survival rate of acute myocardial infarction (AMI) model in pigs. Methods Fifty-seven miniature pigs underwent thoracotomy in different sites of LAD. The effects of ventricular fibrillation on body weight, sex, preoperative heart rate, preoperative left ventricular ejection fraction (LVEF), open thoracotomy (midline / intercostal), operation time , Ligation percentage, postoperative heart rate, incidence of postoperative ventricular tachycardia or ventricular tachycardia and other factors were analyzed by single factor correlation and Logistic regression analysis, and then the occurrence of ventricular fibrillation, ventricular fibrillation ECG characteristics before and after evaluation. Results 57 cases of ventricular fibrillation during surgery occurred in 18 cases, 11 patients died. Ventricular fibrillation occurred within 35 min after ligation of the coronary artery, and peak time was 5 min and 20 min after ligation of the coronary artery. Ventricular fibrillation was easily induced when the heart rate was faster than 160 bpm or slower than 60 bpm. Compared with non-VF group, animals in VF group had higher ligation sites, more animals with the fastest heart rate> 60 bpm, and higher incidence of VT (P <0.01). Logistic regression analysis showed that the excessive ligation site was the only independent risk factor of VF after acute myocardial infarction. Conclusion The high ligation site is the most important risk factor for VF in pigs after acute myocardial infarction. Within 30 minutes after coronary artery ligation, the patients should be closely monitored with ECG, with special attention to the two time points of 5 min and 20 min after ligating the coronary artery, > 160 bpm or <60 bpm heart rate, as well as atrial events such as PACV.