本文選題：心房顫動 + 起搏��； 參考：《南京醫(yī)科大學(xué)》2007年碩士論文

【摘要】： 第一部分開胸建立山羊心房顫動模型可行性的研究 【目的】探討開胸縫合起搏電極于左心耳快速起搏建立持續(xù)性心房顫動(AF)模型的可行性�！痉椒ā可窖�18只，平均體重(15±6)kg，隨機分為房顫組(12只)與假手術(shù)對照組(6只)。左側(cè)第五肋間切口，開胸暴露心臟，縫合起搏電極于左心耳。房顫組起搏電極尾端連接高頻脈沖發(fā)生器，假手術(shù)組直接將電極縫埋于皮下。術(shù)后支持治療一周，后以400次／分頻率左心耳連續(xù)起搏12周，誘導(dǎo)心房顫動。心電圖記錄山羊的體表肢體導(dǎo)聯(lián)心電圖變化，電生理檢查心房有效不應(yīng)期(AERP)改變。房顫持續(xù)時間大于15分鐘定義為持續(xù)性房顫。HE染色后光學(xué)顯微鏡觀察左心房組織學(xué)變化，電鏡觀察左心房超微結(jié)構(gòu)的變化。【結(jié)果】房顫組1只山羊術(shù)后死亡，12周連續(xù)起搏后2(18.18％)只山羊自發(fā)形成房顫，心電圖顯示典型的心房顫動表現(xiàn)。房顫組8／11(72.73％)只山羊經(jīng)程序電刺激誘導(dǎo)出持續(xù)性房顫，3／11(27.27％)只山羊誘導(dǎo)出非持續(xù)性房顫。電生理檢查AF組AERP縮短。光學(xué)顯微鏡觀察對照組細胞排列整齊，房顫組心肌細胞排列紊亂，胞漿淡染。電鏡檢查對照組心肌纖維Z線清晰，房顫組心肌纖維溶解明顯，閏盤受損，Z線消失；線粒體增多、體積變大，內(nèi)質(zhì)網(wǎng)模糊、有的出現(xiàn)空泡樣改變。【結(jié)論】開胸左心耳起搏能誘導(dǎo)多數(shù)山羊發(fā)生持續(xù)性心房顫動，是一種新的、比較可靠的持續(xù)性房顫動物模型建立方法。 第二部分心房顫動轉(zhuǎn)復(fù)竇性心律后組織學(xué)重構(gòu)逆轉(zhuǎn)的研究 【目的】觀察心房顫動(房顫，AF)的組織學(xué)重構(gòu)在轉(zhuǎn)復(fù)并維持竇性心律后能否逆轉(zhuǎn)�！痉椒ā可窖�18只，分為假手術(shù)對照組、AF組和AF復(fù)律組。開胸縫合起搏電極于左心耳，400次／分快速起搏12周建立AF模型。分別于手術(shù)前、AF3個月及轉(zhuǎn)復(fù)竇性心律3個月后超聲心動圖測量左心房內(nèi)徑(LAD)、左室射血分數(shù)(LVEF)等指標(biāo)。取左心房組織，電鏡觀察心房肌超微結(jié)構(gòu)的改變，Masson染色觀察纖維化程度，，半定量逆轉(zhuǎn)錄-聚合酶鏈反應(yīng)(RT-PCR)檢測MMP-2 mRNA含量的變化�！窘Y(jié)果】AF組心肌細胞溶解、線粒體增大等超微結(jié)構(gòu)改變明顯；心房顯著擴大；心肌間質(zhì)內(nèi)膠原沉積增加，MMP-2 mRNA表達水平上調(diào)(從0.40±0.12上升至0.70±0.16，P＜0.05)。AF復(fù)律組超微結(jié)構(gòu)的改變基本恢復(fù)至正常，LAD明顯縮小但未降至對照組水平，纖維化程度減輕，MMP-2 mRNA由0.70±0.16降為0.52±0.10(P＜0.05)，但與對照組相比仍明顯升高，差異有顯著意義�！窘Y(jié)論】AF轉(zhuǎn)復(fù)并維持竇性心律后，組織學(xué)重構(gòu)緩慢逆轉(zhuǎn)，且在程度上不一定能完全恢復(fù)。
[Abstract]:The first part: feasibility study on establishing Goat Atrial Fibrillation Model with Thoracotomy [objective] to investigate the feasibility of establishing the model of persistent atrial fibrillation (AF) with open chest suture pacing electrode in the left atrial appendage. [methods] 18 goats with an average body weight of 15 鹵6 kg were randomly divided into atrial fibrillation group (n = 12) and sham operation control group (n = 6). Left fifth intercostal incision, open chest to expose heart, suture pacing electrode in left atrial appendage. In the atrial fibrillation group, the end of the pacing electrode was connected to the high frequency pulse generator, and the slotted electrode was buried directly in the sham operation group. Atrial fibrillation was induced by 400 / min left atrial appendage pacing for 12 weeks. Electrocardiogram (ECG) recorded the changes of electrocardiogram (ECG) and electrophysiological examination (AERP). The duration of atrial fibrillation longer than 15 minutes was defined as the histological changes of left atrium observed by optical microscope after persistent atrial fibrillation. The ultrastructure of left atrium was observed by electron microscope. [results] one goat in the AF group died after 12 weeks of continuous pacing. The goat spontaneously developed atrial fibrillation. The electrocardiogram showed the typical manifestation of atrial fibrillation. In the atrial fibrillation group (8 / 1172.73), continuous atrial fibrillation was induced by programmed electrical stimulation in 3 / 1127.27 goats. Electrophysiological examination showed that AERP was shortened in AF group. The cells of the control group were arranged neatly under optical microscope, and the cardiomyocytes of the AF group were disordered and the cytoplasm was light stained. Electron microscopic examination showed that the Z line of myocardial fiber in control group was clear, and that in atrial fibrillation group, the myocardial fiber dissolved obviously, the damaged Z line of intercalated disc disappeared, the mitochondria increased, the volume of mitochondria increased, the endoplasmic reticulum was blurred, [conclusion] Open left atrial auricle pacing can induce persistent atrial fibrillation in most goats, which is a new and reliable method to establish animal model of persistent atrial fibrillation. The second part of the study on the reversal of histological remodeling after atrial fibrillation was converted to sinus rhythm [objective] to observe whether the histological remodeling of atrial fibrillation (AF) could be reversed after the restoration and maintenance of sinus rhythm. [methods] Eighteen goats were divided into sham operation control group (AF group) and AF group (AF group). Open chest suture pacing electrode was used in 12 Zhou Jianli AF model. Left atrial diameter (lad) and left ventricular ejection fraction (LVEF) were measured by echocardiography at 3 months before operation and 3 months after sinus rhythm conversion. The ultrastructural changes of atrial muscle were observed by electron microscope. The degree of fibrosis was observed by Masson staining. The changes of MMP-2 mRNA content were detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). [results] Myocardial cells in AF group were dissolved. The ultrastructural changes such as mitochondrial enlargement and atrial enlargement were obvious. Collagen deposition in myocardium increased the expression of MMP-2 mRNA (from 0.40 鹵0.12 to 0.70 鹵0.16) (P < 0.05). The ultrastructural changes in the cardiomyocyte interstitial collagen deposition group returned to normal, but not to the control group. The degree of fibrosis of MMP-2 mRNA decreased from 0.70 鹵0.16 to 0.52 鹵0.10 (P < 0.05), but it was still significantly higher than that of the control group. [conclusion] after AF was restored and maintained sinus rhythm, the histological remodeling was reversed slowly, and the degree could not be completely recovered.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R541.75;R-332

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相關(guān)期刊論文 前2條

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