發(fā)布時(shí)間：2019-01-11 08:12

【摘要】：目的:探討急性腎損傷早期對(duì)室性心律失常發(fā)生及心功能影響。方法:21只新西蘭大白兔隨機(jī)分配為假手術(shù)組(sham組,n=6),缺血再灌注組(I/R組,n=15),I/R組通過(guò)結(jié)扎雙側(cè)腎動(dòng)靜脈1h,再灌注4h,建立急性腎損傷模型,sham組行不進(jìn)行雙側(cè)腎動(dòng)靜脈結(jié)扎的假手術(shù)。結(jié)果:(1)雙側(cè)腎動(dòng)靜脈結(jié)扎1h再灌注4h可以成功建立腎臟缺血再灌注引起的急性腎損傷模型。(2)I/R組與sham組缺血1h及再灌注4h比較,心率減慢、dERP明顯增加(p0.05),缺血與再灌注前后的QT間期、QTc、ERP相比較無(wú)明顯差異(P0.05)。(3)I/R組與sham組再灌注4h心臟超聲比較,左室舒張末大小、收縮末大小、射血分?jǐn)?shù)各時(shí)間點(diǎn)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(4)I/R組與sham組缺血前BNP、cTn-T濃度差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),腎臟缺血1h及再灌注4h,I/R組BNP、cTn-T濃度明顯高于sham組(p0.001)。(5)sham組整個(gè)實(shí)驗(yàn)過(guò)程中未出現(xiàn)室性性心律失常,I/R組在腎臟缺血1h時(shí)2只兔子出現(xiàn)偶發(fā)室性早搏,再灌注4h時(shí)5只兔子出現(xiàn)頻發(fā)室性早搏。兩組在整個(gè)實(shí)驗(yàn)過(guò)程中未能誘發(fā)室性心動(dòng)過(guò)速、心室顫動(dòng)等惡性心律失常。(6)I/R組腎臟缺血1h及再灌注4h,TNF-、IL-6、CRP濃度與sham組比較均明顯升高(p0.05)。結(jié)論:急性腎損傷早期增加室性心律失常發(fā)生率,其機(jī)制可能與急性腎損傷所致的炎癥反應(yīng)引起心肌細(xì)胞凋亡,增加心肌復(fù)極不同步性增加,進(jìn)一步影響心室不應(yīng)期離散度有關(guān)。但是早期急性腎損傷不會(huì)增加室速、室顫等惡性心律失常發(fā)生率。
[Abstract]:Objective: to investigate the effects of early acute renal injury on ventricular arrhythmia and cardiac function. Methods: Twenty-one New Zealand white rabbits were randomly assigned to sham operation group (sham group, n = 6), ischemia reperfusion group (I / R group, n = 15), and I / R group to establish acute renal injury model by ligating bilateral renal arteriovenous vessels for 1 h and reperfusion for 4 h. Sham group received sham operation without bilateral renal arteriovenous ligation. Results: (1) the acute renal injury induced by renal ischemia and reperfusion could be successfully established by bilateral renal arteriovenous ligation for 1 h and reperfusion for 4 h. (2) the heart rate of I / R group was slower than that of sham group for 1 h and 4 h after reperfusion. DERP increased significantly (p0.05). There was no significant difference in QT interval before and after ischemia and reperfusion between I / R group and sham group (P0.05). (3). The left ventricular end diastolic size and end systolic size were compared between I / R group and sham group for 4 h reperfusion. There was no significant difference in ejection fraction at different time points (P0.05). (4). There was no significant difference in BNP,cTn-T concentration between I / R group and sham group before ischemia (p0. 05), but there was no significant difference in BNP, concentration in renal ischemia 1 h and reperfusion 4 h in I / R group (p0. 05). The concentration of cTn-T was significantly higher than that in the sham group (p0.001). (5) sham group. There was no ventricular arrhythmia in the whole experiment. In the I / R group, two rabbits had occasional ventricular premature beats after 1 hour of renal ischemia. Ventricular premature beats occurred frequently in 5 rabbits after 4 h reperfusion. In both groups, ventricular tachycardia, ventricular fibrillation and other malignant arrhythmias could not be induced during the whole experiment. (6) the concentration of TNF-IL-6 CRP in the I / R group was significantly higher than that in the sham group at 1 h after ischemia and 4 h after reperfusion (p0.05). Conclusion: the incidence of ventricular arrhythmia is increased in the early stage of acute renal injury, and its mechanism may be related to the inflammatory reaction induced by acute renal injury, which may lead to myocardial cell apoptosis and increase myocardial repolarization. Further influence on the dispersion of ventricular refractory period. But early acute renal injury does not increase the incidence of malignant arrhythmias such as ventricular tachycardia and ventricular fibrillation.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R692.5;R541.7

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