發(fā)布時(shí)間：2018-12-27 08:46

【摘要】：目的對(duì)于起源于心室肌深部的室性心律失常,經(jīng)特殊針式灌注導(dǎo)管行無(wú)水酒精化學(xué)消融是一種潛在選擇。然而,目前有關(guān)無(wú)水酒精化學(xué)消融所致的心肌損傷特點(diǎn)尚不清楚,本研究旨在觀察經(jīng)心外膜途徑行無(wú)水酒精灌注消融的心肌損傷形態(tài)和注射酒精劑量與心肌損傷范圍之間的量效關(guān)系。方法選取6只健康成年家豬(體重35-39Kg,年齡9-12個(gè)月)的新鮮離體心臟,以左心室的游離壁和心尖為研究區(qū)域。實(shí)驗(yàn)組選取10個(gè)注射點(diǎn),分別注射不同劑量的無(wú)水酒精,對(duì)照組選取2個(gè)注射點(diǎn)注射不同劑量的生理鹽水。完成注射后,4個(gè)心臟標(biāo)本行TTC染色,肉眼觀察并測(cè)量心肌損傷范圍,計(jì)算損傷心肌體積,對(duì)無(wú)水酒精注射劑量與心肌損傷范圍的關(guān)系行相關(guān)性分析。其余2個(gè)心臟標(biāo)本行HE染色和TUNEL染色。對(duì)HE染色組織切片于光鏡下觀察兩組心肌損傷區(qū)形態(tài)改變。對(duì)TUNEL染色組織切片掃描和分析,求出兩組心肌細(xì)胞凋亡率。結(jié)果肉眼下實(shí)驗(yàn)組所有注射點(diǎn)均可觀察到不同范圍的心肌壞死,對(duì)照組未見(jiàn)心肌損傷。損傷形態(tài)在每一層面呈沿心肌纖維走向的類橢圓形,空間上為類橢球體。HE染色光鏡下,實(shí)驗(yàn)組均可見(jiàn)心肌纖維呈凝固性壞死改變,大部分心肌細(xì)胞核固縮,核周可見(jiàn)明顯空暈,部分細(xì)胞核碎裂、核消失,可見(jiàn)空泡征。對(duì)照組心肌細(xì)胞排列整齊,肌質(zhì)均勻,細(xì)胞核形態(tài)規(guī)則。根據(jù)心肌組織切片TUNEL染色掃描結(jié)果,實(shí)驗(yàn)組和對(duì)照組心肌細(xì)胞凋亡率有統(tǒng)計(jì)學(xué)差異(84.99±2.87%VS4.56±3.36%,P0.001)。無(wú)水酒精注射劑量(ml)和心肌損傷體積(mm3)之間呈顯著正相關(guān),y=864.14x-165.17(R2=0.93124,P0.001)。注入心室肌的無(wú)水酒精劑量X(ml)與心肌損傷的深度(mm)、最大直徑(mm)、最小直徑(mm)的線性關(guān)系分別是8x+3.4,6.2x+2.1,8.3x+5.6。結(jié)論無(wú)水酒精化學(xué)消融致心肌壞死切實(shí)可行,其心肌損傷形態(tài)呈類橢球體,且心肌損傷體積與無(wú)水酒精的注射劑量呈顯著相關(guān)。
[Abstract]:Objective to study the potential choice of anhydrous alcohol ablation via a special needle catheter for ventricular arrhythmias originating in the deep ventricular muscle. However, the characteristics of myocardial injury caused by chemical ablation of anhydrous alcohol are unclear. The purpose of this study was to observe the morphologic changes of myocardial injury and the dose-effect relationship between the dose of alcohol injection and the extent of myocardial injury after anhydrous alcohol perfusion ablation via epicardial pathway. Methods fresh isolated hearts of 6 healthy adult domestic pigs (body weight 35-39 kg, age 9-12 months) were selected and the free wall and apex of left ventricle were used as the study area. In the experimental group, 10 injection sites were selected and different doses of anhydrous alcohol were injected respectively. In the control group, 2 injection sites were used to inject different doses of normal saline. After the injection, 4 hearts were stained with TTC. The extent of myocardial injury was observed and measured with the naked eye, and the volume of injured myocardium was calculated. The relationship between the injection dose of anhydrous alcohol and the extent of myocardial injury was analyzed. The other two hearts were stained with HE and TUNEL. The morphologic changes of myocardial injury area in two groups were observed under light microscope with HE staining tissue sections. The apoptotic rate of cardiomyocytes in the two groups was obtained by scanning and analyzing the TUNEL staining tissue sections. Results Myocardial necrosis was observed at all injection points in the experimental group under the naked eye, but no myocardial injury was observed in the control group. The injured morphology was ellipsoid along the direction of myocardial fiber on each plane, and was ellipsoid in space. Under the HE staining light microscope, the myocardial fibers showed coagulative necrosis in the experimental group, and most of the myocardial nuclei were pyknosis. Around the nucleus, there were obvious empty halos, some nuclei were broken apart, the nucleus disappeared, and vacuole sign could be seen. In the control group, the cardiomyocytes were arranged neatly, the muscle cytoplasm was uniform, and the nuclear morphology was regular. According to the results of TUNEL staining in myocardial tissue sections, there was a statistical difference between the experimental group and the control group (84.99 鹵3.36 鹵3.36). There was a significant positive correlation between the injection dose of absolute alcohol (ml) and myocardial injury volume (mm3), y=864.14x-165.17 (R2C0.93124P0.001). The linear relationship between the absolute alcohol dose (X (ml) injected into ventricular muscle and the maximum diameter of myocardial injury (mm), the maximum diameter (mm),) and the minimum diameter (mm) of (mm), were 8x3.4 鹵6.2x 2.1 鹵8.3x 5.6respectively. Conclusion the myocardial necrosis induced by chemical ablation of anhydrous alcohol is feasible. The myocardial injury is ellipsoid, and the volume of myocardial injury is significantly correlated with the injection dose of anhydrous alcohol.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.7

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