ELECTROPHYSIOLOGY OF NORMAL SINUS NODE WITH AND WITHOUT AUTONOMIC BLOCKADE
ELECTROPHYSIOLOGY OF NORMAL SINUS NODE WITH AND WITHOUT AUTONOMIC BLOCKADE
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DOI：
10.1161/01.cir.65.6.1236
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发表时间：
1982-01-01
期刊：
影响因子：
37.8
通讯作者：
NARULA, OS
中科院分区：
文献类型：
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作者：
ALBONI, P;MALCARNE, C;NARULA, OS
对20名15-67岁(平均44.+-)的正常人进行了自主神经阻断前后窦房结(SN)功能的分析。16年)。对SN周期长度(SNCL)、SN恢复时间(SNRT)、校正SNRT(CSNRT)和窦房结传导时间(SACT)等各项电生理指标进行分析。多次心房起搏后测量CSNRT。SACT分析采用两种方法(SM[Strauss方法]和NM[Narula方法])。在控制措施后，静脉注射产生自主神经阻断。心得安(0.02 mg/kg)和阿托品(0.04 mg/kg)。然后重复测量SNCL、SACT和CSNRT。在对照期间，平均静息SN周期长度为625-920ms(平均76.1+-)。93毫秒)(。+-。最大CSNRT为167-325ms，平均262.+-。SM的SACT为97-200ms，平均154.+-。30ms)和NM 92-193 ms(平均148+-)。28毫秒)。自主神经阻断后SNCL为470~732ms，平均619±-。71ms)；CSNRT 110~240ms(平均167±-)。39 ms)；SM的SACT为63~147 ms(平均106±-)。24毫秒)和NM 57-142毫秒(平均100+-)。25ms)。在自主神经阻断后，正常CSNRT和伴有SM的SACT的上限分别为354 ms和214 ms。在正常人中，CSNRT主要由SAC组成，少数由SN自律性抑制构成，尽管后一结论是推测的，需要实验验证；如果迷走神经阻断后的窦性心率低于预测的固有心率，则可能是SN自律性的内在异常。当心得安是禁忌药时，单用阿托品可能会暴露出固有的SN异常。
Sinus node (SN) function was analyzed with and without autonomic blockade in 20 normal subjects, ages 15-67 yr (mean 44 .+-. 16 yr). Various electrophysiologic measures of SN function, SN cycle length (SNCL), SN recovery time (SNRT), corrected SNRT (CSNRT) and sinoatrial conduction time (SACT), were analyzed. CSNRT was measured after atrial pacing a multiple rates. SACT was analyzed using 2 methods (SM [Strauss method] and NM [Narula method]). After control measurements, autonomic blockade was produced by i.v. propranolol (0.02 mg/kg) and atropine (0.04 mg/kg). Measurements of SNCL, SACT and CSNRT were then repeated. During control, the mean resting SN cycle length was 625-920 ms (mean 761 .+-. 93 ms) (.+-. SD); the maximal CSNRT was 167-325 ms (mean 262 .+-. 46 ms); the SACT by SM was 97-200 ms (mean 154 .+-. 30 ms) and by NM 92-193 ms (mean 148 .+-. 28 ms). After autonomic blockade, the SNCl was 470-732 ms (mean 619 .+-. 71 ms); CSNRT 110-240 ms (mean 167 .+-. 39 ms); SACT by SM was 63-147 ms (mean 106 .+-. 24 ms) and by NM 57-142 ms (mean 100 .+-. 25 ms). The upper limits of normal CSNRT and SACT with SM (based on mean plus 2 SD) are 354 ms and 214 ms during control and 245 ms and 154 ms, respectively, after autonomic blockade. In normal patients, the CSNRT is mostly constituted by SAC and, to a lesser amount, by the depression of SN automaticity, although the latter conclusions are speculative and require experimental verification; and intrinsic abnormality of SN automaticity is suggested if the sinus rate after vagal blockade alone is slower than the predicted intrinsic heart rate. When propranolol is contraindicated, atropine alone may unmask intrinsic SN abnormalities.