1、9 p ? 3a 钱 俊 综述 张亚臣 审校(上海交通大学医学院附属新华医院心内科, 上海 200092)Mechanisms, Types and Treatment ofReperfusion Arrhythm iaQ IAN Jun, ZHANG Y a-chen(Department of Cardiology,X inhuaHospitalAffiliated toSchool of Medicine, Shanghai Jiaotong University, Shanghai 200092, China)cI|: 1004-3934( 2008) 04-0567-04 ms |:
2、 R541. 7 DS M : AK1: 急性心肌梗死患者在经皮冠状动脉介人治疗术和溶栓治疗中常可见再灌注心律失常,其发生与多种因素相关: 氧自由基a钙离子a细胞间耦联a自主神经及体液系统等b再灌注心律失常有多种类型及特点b再灌注心律失常的出现可作为判断再灌注较为可靠的指标b1oM: p ;9Abstract: R eperfusion arrhythm ia is common a fter percutaneous corona ry intervention, and fibr inolytic therapy in pa tients w ith acutem yoca rd ia l
3、 infarction. M any factors a re assoc iated w ith its occurrence such as oxy rad ica,l Ca2+ , couple betw een ce lls, and ischem ic precond-ition. T he re are severa l types and features o f reperfusion arrhythm ia. The occurrence of reperfusion arrhy thm ia is a relativ ely reliable index fo rjudg
4、ing reperfusion.K ey words: reperfusion a rrhy thm ia; reperfusion a rrhy thm ia; acute myocardial infa rction; acute m yo ca rdia l infarction M , $ ( AM I)1 ZT: 3 ( PC I)a U b “ * 9,KvK “ , ?, 9 p b9 p ( RA ) 3 u5 HW = , ,y1 7b0TaY P 97? 3 3 a3M/ p b VC F i1 p, iV ( i ) i( i), i .El h CBV Va E, ?
5、3 qr50% 80%, “-T3 Y1SBb “ -?CF i1 pKn,7BV V VT/C 9 V LSbAM I? 3 H, a a 3 M, V? 3 p b73 9 RA, b uY1“5ilbB , AM I 5a e, ST 7 C A9aBV p VRA 1b$ V,9 3 $,9 RABV 2b “ -?CRA91?a% =Ca2 +a% =K + y ( y 1 3 bv (?|R RAyb/C 9 H? 3 p Bezo ld-JarischQ 1, /Cs s ,9 # %n,O s ,Q ; H,% = -l , V P l V RAbW it 11DADsG cA
6、M PbFTF 4 VYVFA1 s8,F b,EcAMP 3,E% =,EDADs,y7E ?, OF VE9 p bN a+ -C a2+ Ca2+yb7M g2+ N a+ -K+ -ATP y0,% = 0Yi, e% =K+ ,% =K +#% y 1il; M g2+ ? F4, V%C a2+ = , 9 Ca2+1T 12 ,9F 3 ,h i p ? 3bRA60%* “1 13 ,7M g2 +5 P%4M HsY| )aKa 0 i0,0 , 14b#$PC I - V 4 , K + , IC a2+,(?,5 VrRAbRA, 01 MTb1 V % # N a+ /
7、Ca2+, ?, - P% = 9F, P db b79 VYV 0. 1 3, H VYVG w 71 3b%WM ,B% VY #%,9 V$ #% Yb S% %W.l 4b% _s, H,# 1 #%s7,t h .,9FAPD90(VT 7S90% HW) a9F (B_s,9F_.E,t RA?3 15b V,.M ( V i o -y|Ry,9Vt 3 y y ? 3 I,9 V =y|Rb Hq/M1,9Vi %K+ bW ( ,. bW (B9B /,i|R i7/ A1HqbT+# . |R i p 1y b =_ K ( Ik1 )%#T 1Tb uIk1 /, V/,
8、L= s“T,N 3.ps1 p9F,6 u% W_ ( Ito )vl9is, i#P iWIto9is, 3 s9F |R 16 , V ? 9|R i p 0$bPenny 9 ?C asa1? 3 M/ .B,|R4 $, 3 i p b“ -?C % V 9 “,CX % 9 h Sh M1bAM I? 3 %$,9 P 5 55 3Q, %5 8 , H = % , PY3 h, 9( no-reflow )C 17b f F % 3 (B,RA? 3b 9, % Vs ly0bly0VOl dbi F,4 %= %*, s l H,C9, 8, RA i; l H ?C9, 5
9、# , RA i*r# i1 p; ? C9, 3 q B, RAVC,Bb k#v “5V ,9 HW*, y, RA? 3 qb A U3 FO 9 v, p 1 i ; ,9 , p 1 i*a i.EbRA? 3A9 ui? V, 20 30 m in RA? 3 qKb “ - ?T HWW H 3 p ? 3bRAF i1 pKn, O+s, VT 9 V LSbBV V VT/C 9 V LSb?C3 hM9 H p ? 3 q A FbV ? a i 3 1b3 sS“ , VA) bClowns) i*r iV F p 0 b i MC i H “; C i.E,V8R br
10、5“ H r b F p 0 n 5yb V9F; f5; T; p T9,# bM ann ing 23A U 5yaB s8E4a RA rTb M YV“5# L, ?C1 b“4 :SODaCATa!;t VRAb 0 g Vh RA? 3b 5 14B1s8 F4 I ,f6 b, ,$ 9 p J . “5$Y,2003, 15( 1) : 45-47. 2 Ste inberg JS, H ochm an JS, M organ CD, et a.l Effects of thrombo lyt ic therapy ad-m inistered 6 to 24 hours af
11、term yocardia l infarction on the s igna-l av eraged ECG.Resu lts o f a m ulticenter random ized tria.l LATE ancilla ry study investig ato rs.La te Asessm ent of thrombo ly lic e fficacy J. Circulat ion, 1994, 90( 2) : 746-752. 3 f 7). “5 p M . : 2 S/ , 2001. 119-1200. 4 !,- B, ,.$ 9 p J.5h, 1992, 2
12、9: 84-87. 5 W estlinW, M ullane K. D oes captorpril a ttenuate reperfusion- induced m yo ca rdia ldysfunc tion by seav eng ing free rad ical J. Circu lat ion, 1998, 77( suppl I) : 1-6. 6 Ondre j S, G irm a A. Effec ts of m elaton in on ischem ia and reperfusion in jury o f theheart J . Card iovasc D
13、 rugs T her, 2001, 15( 3): 251-257. 7 u ,;.# 9 p M1“ J.D 75h, 2005, 7: 3-7. 8 Dem iryurek AT, Cakic i I, W ainwright CL, et a.l Effec ts of free radica l productionand scavengers on occ lusion-reperfusion induced arrhythm ias J . Pharm aco lRes, 1998, 36( 6) : 433-439. 9 Yoshida Y, H ira iM, Yam ada
14、 T, et a.l A ntiarrhythm ic efficacy of dipyridam o le intreatm ent o f repe rfusion arrhy thm ias: ev idence for cAM P-m ediated triggered a c-tiv ity as a m echanism responsible for reperfusion arrhy thm ia s J . C ircula tion,2000, 101( 6): 624. 10 Ferrier GR, M o ffatM P, Luka sA. Po ssible m ec
15、han ism s o f v entricu lar arrhy thm -ias e lic ited by ischem ia follow ed by reperfusion: studies on isolated can ine ven-tricula r t issues J . C irc Res, 1985, 56: 184-194. 11 W it AL, R osenM R. A fter depo larizations and trigge red ac tiv ity. In F ozzardH A,H aber E, Jenning RB, K atz AM, M
16、 o rg an E eds. T he H eart and CardiovascularSy stem M . N ew York. NY: Raven P resS Pub lishers, 1986. 1449-1490. 12 W, , ,. AM I i?RAT J. “55h, 2000, 4( 16); 158. 13 K , W, H ,. 9#(? p #569#5hZ2008 M29 4 Adv CardiovascDis, July 2008, Vol. 29,No. 4T J.5, 1997, 12( 5): 375. 14 . p 0 Z J .S L = S, 1
17、999, 19( 3) :140. 15 SpackM S, H e idlag e JF. The sto chastic nature o f ca rd iac propagat ion a t a m icro-scopic lev e.l E lectrica l description of m yocardia l architecture and its app licationto conduction J . C irc Res, 1995, 76: 366-380. 16 A lm ond F, A lvarez JL, K auzier JM, e t a.l Ioni
18、c bas is o f ventricular arrhy thm iasin rem odeled ra ,t during long- term m yocard ial infarct ion J . Cardiovasc R es,1999, 42: 402-415. 17 W et lin W, Mu llane K. Do es captorpril attenuate reperfus ion-inducedm yo ca rdia ldy sfunction by seaveng ing free radica l J. C ircula tion, 1998, 77( su
19、ppl I) : 1-6. 18 Aucham pa ch JA. E ffect o f the pla te le-t ac tivat ing fa ctor antagonist RP 59227( Tu lopa fant) on m yocardial ischem ia / reperfusion in jury and neu troph il func-tion J . Bas ic R es Cardio ,l 1998, 93: 361. 19 V egh O, Ra rratt JR. N oradrena line, infused loca lly, reduces
20、 a rrhy thm ia severityduring coronary artery occ lusion in anaesthetized dog s J . Ca rd iovasc R es,2002, 55( 1): 53-63. 20 H assanabad ZF. Coronary endothe lial dysfunc tion increases the severity o f is-chaem ia- induced ventricular arrhy thm ia s in rat iso lated perfused hearts J .Basic R es C
21、ardio1, 1998, 93: 24.l 21 il. “5m QM .: S/ D, 1997.71. 22 Esentle P, G iam bartolom ei A, G ensin iGG, e t a.l Co ronary repe rfusion andbezo ld- jarisch reflex( brady cardia and hypotension) J . Am J Ca rd io,l 1983,52( 3) : 221. 23 M anning AS, H earse D J. Reperfus ion induced arrhy thm ias: m ec
22、hanism s andpreven tion J . J Mo l Ce ll Ca rdio,l 1984, 16: 497. 24 R aker M. Beta-blockade in heart failure: basic concepts and c lin ical results J . Am J H ype rte rs, 1998, 11( 1P t2): 23S-37S.收稿日期: 2007-10-10 修回日期: 2007-12-24(本文编辑: 郭 宪)# !9Z*孟培娜 综述 严 激* 审校(安徽医科大学附属省立医院心血管内科, 安徽 合肥, 230001)Opti
23、mum Design forCardiacResynchronization TherapyM ENG Pe-i na, YAN Ji(CardiologyDepartment of AnhuiProvincialHospital, Hefei 230001, China)cI|: 1004-3934( 2008) 04-0570-04 ms |: R541. 6; R 318. 11 DS M : AK1: 心脏再同步化治疗心力衰竭取得良好疗效, 但仍有部分顽固性心力衰竭患者反应较差, 研究者通过一系列临床研究优化心脏再同步化治疗,希望更多患者从中获益b现就心脏再同步化治疗心力衰竭的优化设计
24、进展作一综述b1oM: # ; Abstract: Cardiac resynchroniza tion therapy is effec tive for m ost hea rt failure patients. R ecently, resea rche rs have optim ized cardiacresynch ronization therapy through a series of c lin ica l stud ies. T his article rev iew s the new est clinical studies for optim ized card
25、iac resynchron-ization therapy in heart fa ilure pa tients.K ey words: cardiac resynchron ization the rapy; heart fa ilu re# ( CRT) ( )1YV ia iWa i = l ,4# ?a a I#bv? “5 1, 2V CRT V “5,4 3 ,h qb s%NQ bN, kCRT !9, ?VmbCNZTB8 b1 bW1. 1 i iU r: iUl PL%,# “5 4N)T i b 7, “5 v?CU r bB“ 3-5V .diU r/DP .E,F 3 y,T r Y,x V ?(? ,7 i ?P i ?p ?Z#0b Tan tengco 3 24 M( ( M -19. 5 ) (? # r , ( 9. 5 M,?CU r VIP i ?p, HFP i ?#570#5hZ2008 M29 4 Adv CardiovascDis, July 2008, Vol. 29,No. 4*YT:, q, V 3 =,D Sv 8 D = S
