【作者】 齐向前；

【导师】 陶寿淇； 孙瑞龙； 宋有城； 徐义枢； 高润霖； 王方正； 唐承君； 阮英茆；

【作者基本信息】 中国协和医科大学 ， 心脏内科急症， 1993， 博士

【摘要】 一．经冠状动脉化学消融术(TCA)消除实验性梗塞后室性心动过速(VT) 按Harris氏二期结扎法建立犬心肌梗塞模型26只，4～16天后再次开胸以标准心脏程序刺激法诱发VT。26只犬中诱发VT22只(86％)，共41例次，其中持续性VT33例次，非持续性VT8例次。采用心外膜低温(0～2℃)方法标测定位持续性VT起源灶，确定起源灶20例次(61％)，未确定13例次。于VT起源灶心肌供血的小冠状动脉内注射95％乙醇0.3～1.2ml(平均0.6ml)14例，10例(71％)未再诱发出VT。心肌内注射95％乙醇1～3ml9例(包括血管内注射无效4例)，6例未再诱发出VT。 观察TCA对18只正常犬心脏病理生理学影响。组Ⅰ9只犬，小冠状动脉内注射95％乙醇0.4～0.6ml，组Ⅱ9只注射1.0～1.2ml。TCA后CK—MB活性平均峰值组Ⅰ78±63U／L，组Ⅱ155±82 U／L；组Ⅰ室性早搏9例，非持续性VT4例，组Ⅱ室性早搏9例，非持续性VT6例，持续性VT4例；心电图ST段抬高组Ⅰ平均1.2±0.6mm，组Ⅱ4.8±1.9mm(p＜0.01)；透壁性心肌坏死两组各9例。TCA后8小时内组Ⅰ心脏功能指标无明显改变，组Ⅱ左室功能明显低下。心肌坏死面积比值平均组Ⅰ4.5±4.0％，组Ⅱ12.0±4.0％(p＜0.01)。本文实验结果表明TCA消除折返机制的实验性梗塞后VT效果肯定，更多还原

【Abstract】 A study was done on chemical ablation with ethanol in the treatment of ventricular tachycardia (VT) in experimental animals and two patients. Epicardial ice mapping was performed with a probe to localize the site of origin of VT induced by programmed stimulation in 26 dogs 4 ～ 16 days after experimental acute myocardial infarction.In 20 of 33 episodes, a specific area where cooling with the ice probe terminated the VT could be found.Late diastolic activity was recorded from 3 of 6 such sites. The data presented suggested that the mechanism responsible for VT was reentry. After 0.3 ～ 1.2m1 of 95% ethanol was injected into a small coronary artery supplying the arrhythmogenic area, VT was no longer inducible in 10 of 14 dogs. Intramyocardial ethanol (1 ～ 3ml) was injected into the site of origin of VT in 9 dogs. In six of these, VT could not be reinduced. After injection of 0.4～ 1.2ml of 95% ethanol into a small normal coronary artery in 18 dogs, the changes in ECG, CK-MB and pathology werefound to be related to the dose of更多还原