INFLUENCE OF THE AUTONOMIC NERVOUS-SYSTEM ON THE Q-T INTERVAL IN MAN
INFLUENCE OF THE AUTONOMIC NERVOUS-SYSTEM ON THE Q-T INTERVAL IN MAN
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DOI：
10.1016/0002-9149(82)90425-8
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发表时间：
1982-01-01
影响因子：
2.8
通讯作者：
PRYSTOWSKY, EN
中科院分区：
文献类型：
--
作者：
BROWNE, KF;ZIPES, DP;PRYSTOWSKY, EN
影响自主神经系统的药物可以直接或通过改变心率来影响Q-T间期。在某些药物干预后，巴泽特修正比率的公式可能具有误导性。这一假设在20名同时接受普萘洛尔(0.15 mg/kg静脉注射)和阿托品(0.03 mg/kg静脉注射)的患者中进行了验证。6例先用普奈洛尔，7例先用阿托品，7例同时用阿托品和心得安。在对照组和药物干预后，直接在窦性心律和固定的心房起搏频率下测量Q-T间期，并用Bazett公式计算。测定6例阿托品与心得安合用后的心室有效不应期。阿托品加普萘洛尔(P<；0.001)后，窦性心动周期长度(836±156~648±84ms)、Q-T间期(367±26~329±26ms)和心房起搏Q-T间期(330±28~315±27ms)缩短，但用Bazett公式校正的Q-T间期(402±33~412±24ms)无明显改变。阿托品与心得安合用后，心室有效不应期由241~20 ms缩短至218±21 ms(p<；0.02)。心得安治疗后窦性心动周期延长(750±97至907±108ms，p&t；0.001)，测量的Q-T间期或心房起搏Q-T间期无明显变化，但校正后的Q-T间期明显缩短(428±15至391±22 ms，p&t；0.001)。阿托品治疗后，窦性心动周期长度、测量的Q-T间期和心房起搏的Q-T间期缩短(p<；0.01)，而校正的Q-T间期延长(375±29至418±28ms，p<；0.01)。Bazett公式错误地预测了服用阿托品、心得安和阿托品加心得安后的Q-T间期。
Drugs that affect the autonomic nervous system can influence the Q-T interval directly or by changing the heart rate. Bazett's formula to correct for rate may be misleading after certain drug interventions. This hypothesis was tested in 20 patients receiving both propranolol (0.15 mg/kg intravenously) and atropine (0.03 mg/kg intravenously). Six patients received propranolol first, 7 patients received atropine first, and 7 patients received atropine plus propranolol simultaneously. During control and after drug intervention, the Q-T interval was measured directly in sinus rhythm and during a fixed atrial paced rate, and was calculated using Bazett's formula. The ventricular effective refractory period was also determined in 6 patients after administration of atropine plus propranolol. The sinus cycle length (836 ± 156 to 648 ± 84 ms, mean ± standard deviation), measured Q-T interval (367 ± 26 to 329 ± 26 ms), and atrially paced Q-T interval (330 ± 28 to 315 ±27 ms) shortened after atropine plus propranolol (p <0.001), but the corrected Q-T interval with use of Bazett's formula did not change (402 ± 33 to 412 ± 24 ms). The ventricular effective refractory period also shortened from 241 to 20 to 218 ± 21 ms after atropine plus propranolol (p <0.02). The sinus cycle length increased after propranolol (750 ± 97 to 907 ± 108 ms, p <0.001), but no change occurred in the measured Q-T interval or atrial paced Q-T interval although the corrected Q-T interval using Bazett's formula was greatly shortened (428 ± 15 to 391 ±22 ms, p <0.001). The sinus cycle length, measured Q-T interval, and atrially paced Q-T interval decreased after atropine (p <0.01), but the corrected Q-T interval lengthened (375 ± 29 to 418 ± 28 ms, p <0.01).In summary, atropine and atropine plus propranolol shorten the Q-T interval independent of rate, demonstrating a direct vagal effect on the Q-T interval. Bazett's formula inaccurately predicts the Q-T interval after administration of atropine, propranolol, and atropine plus propranolol.