Phenylephrine increases T wave shock energy required to induce ventricular fibrillation.
Phenylephrine increases T wave shock energy required to induce ventricular fibrillation.
复制标题
去氧肾上腺素会增加诱发心室颤动所需的 T 波冲击能量。
DOI：
10.1111/j.1540-8167.1998.tb00864.x
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发表时间：
1998
影响因子：
2.7
通讯作者：
Zipes,DP
中科院分区：
文献类型：
--
作者：
Mitrani,RD;Miles,WM;Klein,LS;Zipes,DP
介绍：以前的报告在实验模型中表明，心室颤动阈值（VFT）可以通过操纵心脏神经张力使用代理，如苯丙氨酸。本研究的目的是确定苯乙醯胺是否增加了在人类中诱导VF所需的能量，所述人类使用施加到T波的DC能量进行这种诱导。在这项前瞻性研究中，18名先前植入心律转复除颤器的连续患者在第八次起搏心室复合波后310 msec通过将DC双相电击置于T波中诱导VF。四百毫秒T波冲击能量从0.2 ~ 12 J逐渐调整至诱发持续性VF或室性心动过速。在第一次或第二次VF诱导前以随机方式输注苯丙氨酸，以使收缩压升高20 mmHg以上。诱导VF所需的平均能量在基线时为1.1 J，在苯肾上腺素输注期间增加至1.7 J（P = 0.036）。平均动脉压从88上升到114 mmHg（P < 0.001），平均窦性周期长度从850增加到1070 msec（P < 0.001）。13例窦性周期长度延长的患者中有10例（77%）增加了诱发VF的能量需求，而5例无窦性周期长度延长的患者中只有1例（20%）增加了诱发VF的能量需求（P < 0.05）。结论：苯肾上腺素增加人体VFT可能是通过反射激活压力感受器减少交感神经和/或增加副交感神经心脏传出效应。
Phenylephrine Increases VFT.Introduction: Previous reports in experimental models have suggested that ventricular fibrillation threshold (VFT) can be changed by manipulating cardiac neural tone using agents such as phenylephrine. The purpose of this study was to determine whether phenylephrine increased the energy required to induce VF in humans undergoing such induction using DC energy applied to the T wave.Methods and Results: In this prospective investigation, 18 consecutive patients with previously implanted cardioverter defibrillators had induction of VF by placing DC monophasic shocks into the T wave coupled 310 msec after the eighth paced ventricular complex at 400 msec. The T wave shock energy was titrated from 0.2 to 12 J until sustained VF or ventricular tachycardia was induced. Phenylephrine was infused either before the first or second VF induction in a randomized fashion to increase systolic blood pressure by more than 20 mmHg. The mean energy required to induce VF was 1.1 J at baseline and increased to 1.7 J during phenylephrine infusion (P = 0.036). The mean arterial pressure increased from 88 to 114 mmHg (P < 0.001), and the mean sinus cycle length increased from 850 to 1070 msec (P < 0.001). Ten of 13 (77%) patients with sinus cycle length prolongation bad increased energy requirements to induce VF compared with only 1 of 5 patients (20%) without sinus cycle length prolongation (P < 0.05).Conclusion: Phenylephrine increases VFT in humans presumably by reflex activation of the baroreceptors decreasing sympathetic and/or increasing parasympathetic cardiac efferent effects.