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目的:探讨特效转复心房颤动药物伊布利特致尖端扭转性室性心动过速(Tdp)的机制。方法:利用兔左室楔形心肌块灌流伊布利特或溶有伊布利特的低钾低镁台氏液。30只新西兰大白兔随机分为正常组、伊布利特组和低钾低镁组,每组10只。正常组灌流台氏液,伊布利特组灌流2 mg/L伊布利特40 min,低钾低镁组灌流同浓度但溶于低钾低镁台氏液的伊布利特。同步记录各组内、外膜下心肌动作电位和容积心电图,观察灌流过程中早后除极(EAD)和Tdp的发生情况,对QT间期以及跨室壁复极离散度(TDR)的影响。结果:伊布利特组QT间期较正常组显著延长[(337±46)ms∶(548±73)ms],TDR也显著增加[(49±15)ms∶(132±36)ms],EAD的发生率为4/10,与正常组比较,均P<0.05;Tdp的发生率为0。低钾低镁组QT间期近一步延长至(652±184)ms、TDR增至(157±59)ms,EAD发生率为5/10,与正常组比较,均P<0.05,与伊布利特组比较,均P>0.05;Tdp的发生率增加为7/10,与正常组、伊布利特组比较,均P<0.05。结论:在伊布利特合并低钾低镁的情况下才易诱发Tdp,电解质正常时不易致心律失常发生。
Objective: To investigate the mechanism of ibuprofen-induced torsades de pointes (Tdp) in the treatment of atrial fibrillation. Methods: Rabbits with left ventricular wedge-shaped myocardial block were infused with ibutilide or with low-potassium, low-magnesium, Ty-toi, solution of ibutilide. Thirty New Zealand white rabbits were randomly divided into normal group, ibutilide group and hypokalemia low magnesium group, 10 rats in each group. In the normal group, rats were drenched with Tyrosine solution, and the ibutilide group was perfused with 2 mg / L ibutilide for 40 min. The rats in the low-potassium and low-magnesium groups were irrigated with ibutilide at the same concentration but in low potassium and low magnesium Tyrosine solution. The intra-and extra-epicardial myocardial action potentials and volumetric electrocardiogram were recorded synchronously, and the effects of early and late depolarizations (EAD) and Tdp during perfusion on the QT interval and transdural repolarization dispersion (TDR) were observed . Results: The QT interval in the ibutilide group was significantly longer than that in the control group [(337 ± 46) ms: (548 ± 73) ms] and TDR was also significantly increased [(49 ± 15) ms: (132 ± 36) ms] The incidence of EAD was 4/10, P <0.05 compared with the normal group, and the incidence of Tdp was 0. The QT interval of hypokalemia and low magnesium group was extended to (652 ± 184) ms, the TDR increased to (157 ± 59) ms, the incidence of EAD was 5/10, P <0.05 compared with the normal group, Litter group, all P> 0.05; the incidence of Tdp increased 7/10, compared with the normal group, the ibutilide group, P <0.05. CONCLUSION: Tdp is easily induced in the combination of low-potassium and low-magnesium in ibutilide, and it is not easy to induce arrhythmia when the electrolyte is normal.