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目的:探讨长期口服血管紧张素II 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。方法:24只新西兰大白兔随机分为假手术组(SHAM组,n=8)、心肌梗死组(MI组,n=8)和缬沙坦组(VAL组,n=8)。SHAM组只开胸不结扎左冠状动脉前降支,MI组和VAL组分别结扎左冠状动脉前降支,VAL组术后第二天用缬沙坦(10 mg/kg/天)灌胃,三组共喂养12周。三组兔分别在心肌梗死前、心肌梗死12周后记录左心室内、中、外膜层心室肌细胞单相动作电位(APD90)、跨壁复极离散度(TDR),并记录心肌梗死12周内诱发的恶性心律失常次数。结果:(1)心肌梗死12周后,MI组三层左心室肌APD90较心肌梗死前明显延长(259.20±22.10vs 230.10±23.20,288.00±235.80vs 244.20±23.40,244.60±22.60vs 229.00±21.70,P<0.05);VAL组三层心室肌APD90较MI组显著缩短,与心肌梗死前相比无明显差异(241.50±22.90vs 235.30±21.20,258.30±26.60vs 245.80±25.60,236.10±22.80vs 225.60±21.90,P>0.05)。(2)MI组TDR较SHAM明显延长(37.20±10.20vs 18.80±6.20,P<0.05),VAL组明显缩短,与SHAM组之间差异无统计学意义(18.80±6.20vs 23.90±7.70,P>0.05)。(3)VAL组室速/室颤发生次数较MI组明显减少(3.10±0.80vs 12.70±1.50,P<0.05)。结论:长期服用缬沙坦能明显降低心肌梗死兔恶性室性心律失常的发生次数,可能与其改善心肌梗死后的TDR有关。
Objective: To investigate the effect of long-term oral administration of angiotensin II type 1 receptor antagonist valsartan on ventricular arrhythmias after myocardial infarction in rabbits and its possible mechanism. Methods: Twenty-four New Zealand white rabbits were randomly divided into sham operation group (SHAM group, n = 8), myocardial infarction group (MI group, n = 8) and valsartan group (val group, n = 8). The anterior descending branch of left anterior descending coronary artery was occluded only in the SHAM group, and the left anterior descending coronary artery was ligated in the MI and VAL groups. The valsartan (10 mg / kg / day) The three groups were fed for 12 weeks. Three groups of rabbits were used to record the APD90 and TDR of the left ventricular, middle and adventitial layers before myocardial infarction and 12 weeks after myocardial infarction respectively. The myocardial infarction 12 Week induced malignant arrhythmia frequency. Results: (1) After 12 weeks of myocardial infarction, APD90 of left ventricular myocardium in MI group was significantly longer than before AMI (259.20 ± 22.10 vs 230.10 ± 23.20, 288.00 ± 235.80 vs 244.20 ± 23.40, 244.60 ± 22.60 vs 229.00 ± 21.70, P <0.05). Compared with MI group, the level of APD90 in the three layers of ventricular myocardium in VAL group was significantly shorter than that in MI group (241.50 ± 22.90 vs 235.30 ± 21.20,258.30 ± 26.60 vs 245.80 ± 25.60, 236.10 ± 22.80 vs 225.60 ± 21.90, P> 0.05). (2) TDR in MI group was significantly longer than that in SHAM group (37.20 ± 10.20 vs 18.80 ± 6.20, P <0.05), and the VAL group was significantly shorter than that in SHAM group (18.80 ± 6.20 vs 23.90 ± 7.70, P> 0.05). (3) The number of ventricular tachycardia / ventricular fibrillation in VAL group was significantly lower than that in MI group (3.10 ± 0.80 vs 12.70 ± 1.50, P <0.05). Conclusion: Long-term administration of valsartan can significantly reduce the incidence of malignant ventricular arrhythmias in myocardial infarction rabbits, which may be related to the improvement of TDR after myocardial infarction.