探讨长期口服血管紧张素II的1型受体拮抗剂缬沙坦对兔心肌梗死后室性心律失常发生的影响及其可能机制。
Toexploreinfluenceoflong-termoralvalsartan-angiotensinIItype1receptorblockeronventriculararrhythmiaaftermyocardialinfarction(MI)inrabbitsanditspossiblemechanism.24只新西兰大白兔随机分为假手术对照组(n=8)、心肌梗死组(n=8)和缬沙坦组(n=8)。假手术对照组只开胸不结扎左冠状动脉前降支，心肌梗死组和缬沙坦组分别结扎左冠状动脉前降支。缬沙坦组术后第二天用缬沙坦(10mg·kg-1·d-1)灌胃，三组共喂养12周。三组分别在心肌梗死前、梗死12周后记录左心室内、中、外层心室肌细胞单相动作电位（MAP），并记录心肌梗死12周后诱发的恶性心律失常次数。
Atotalof24NewZealandrabbitswererandomlydividedintoshamoperationgroup(n=8),MIgroup(n=8)andvalsartangroup(n=8)accordingtonumbertable.Shamoperationgrouponlyreceivedthoracotomywithoutligationofanteriordescendingbranchofleftcoronaryartery(LAD),whileMIgroupandvalsartangroupreceivedligationofanteriordescendingbranchofLAD.Valsartangroupreceivedvalsartangavage(10mg·kg-1·d-1)sincetheseconddayafteroperation,threegroupsallwerefedfor12weeks.Monoactivepotential(MAP)ofleftventricularmyocardialcellsofsubendocardialmyocardium（innerlayermyocardium）,subepicardialmyocardium（outerlayermyocardium）andmiddlelayermyocardiumwererecordedbeforeMIand12weeksafterMI,andtimesofprovocativemalignantarrhythmiaswererecordedon12weeksafterMIinthreegroups.1.心肌梗死12周后，缬沙坦组室速/室颤（VT/VF）的发生次数较心肌梗死组显著减少［(3.1±0.8)次比(12.7±1.5)次，P＜0.05］；2.心肌梗死组左室三层心肌细胞从MAP起始到复极完成90%的时间（APD90）较心肌梗死前明显延长［（.2±22.1）ms,（.0±25.8）ms,（.6±22.6）ms比（.1±23.2）ms,（.2±23.4）ms,（.0±21.7）ms,P＜0.05或0.01］；缬沙坦组左室三层心肌细胞APD90与心肌梗死前相比没有明显差异（P均＞0.05）；且心肌梗死组跨壁复极离散度(TDR)较假手术对照组、缬沙坦组明显延长［（37.2±10.2）比（18.8±6.2）比（23.9±7.7），P＜0.05或0.01］；缬沙坦组与假手术对照组之间TDR比较无显著性差异（P＞0.05）。
1.Ventriculartachycardiaorfibrillation(VT/VF)episodesweremarkedlydecreasedinVALgroupthanthatinMIgroupon12weeksafterMI［(3.1±0.8)vs.(12.7±1.5),P0.05］;2.AfterMI12w,theactionpotentialdurationto90%repolarization(APD90)ofthree-layerventricularmyocytesinMIgroupwasprolongedthanthatbeforeMI［（.2±22.1）ms,（.0±25.8）ms,（.6±22.6）msvs.（.1±23.2）ms,（.2±23.4）ms,（.0±21.7）ms,P＜0.05or0.01］；buttherewerenosignificantdifferenceinAPD90ofthreelayersventricularmyocytesbetweenbeforeandafterMIinvalsartangroup(P0.05all);Comparedwithshamoperationgroupandvalsartangroup,therewassignificantprolongedintransmuraldispersionofrepolarization(TDR)［(18.8±6.2)vs.(23.9±7.7)vs.(37.2±10.2),P0.05or0.01］inMIgroup;TherewasnosignificantdifferenceinTDRbetweenvalsartangroupandshamoperationgroup(P0.05).长期口服缬沙坦明显降低兔心肌梗死后恶性室性心律失常的发生次数，这可能与改善兔心肌梗死后跨壁复极离散度有关。
Long-termoralvalsartancansignificantlyreducemalignantventriculararrhythmiaincidenceinrabbitsafterMI,whichmayberelatedtoimprovingTDRinrabbitsafterMI.作者：陈志楠,丁世芳,龚志刚,卢青
单位：医院心内科
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