【摘要】 在 13只犬的低能量心脏除颤实验中 ,应用病理检查、除颤心电图记录以及除颤前后肌酸磷酸激酶及其同工酶 (CPK和CPK MB)测定三种方法探测心肌损伤。肉眼观察和显微镜检查见到 5只犬 (除颤 7～ 2 1次 ,能量 10～ 4 0J)电极处心脏轻度充血 ,2只犬 (除颤 9～ 2 0次 ,能量 2 0～ 5 0J)心肌苍白、心内膜附有血栓 ,6只犬 (除颤 7～ 2 9次 ,能量 10～ 60J)心内膜水肿、血栓形成、局部心肌断裂和退行性变、心肌间质出血等病理变化。记录到 4只犬 (除颤 8～2 4次 ,能量 2 0～ 5 0J)除颤放电后ST段压低或ST段抬高心电图波形。测得 2只犬 (除颤 10～ 19次 ,能量 5～ 4 0J)除颤后CPK和CPK MB有轻度升高 ( 1只CPK由 10 4升至 110IU ,另 1只CPK MB由 4 7.1升至 60 .9IU)。本实验提示 :低能量心脏除颤可导致心肌损伤 ;损伤可能由热和电等因素造成 ;损伤程度与除颤能量和除颤脉冲间隔时间等因素有关 ;损伤范围为局灶性且可能愈合。更多还原

【Abstract】 During low energy defibrillation experiments in 13 dogs,three methods for the detection of myocardial injury were used:pathologic examination,defibrillation electrocardiogram recording,and creatine phosphokinase (CPK) and CPK-MB determination before and after defibrillation.In visual observation and microscopic examination,5 dogs (7～21 shocks,10～40 J) showed slight hyperemia in the area around electrodes,2 dogs (9～20 shocks,20～50 J) showed pale myocardium,and endocardium with thrombi.Also,pathologic changes including endocardial edema,thrombosis,localized fragmentation of myocardium and retrograde changes,and myocardial interstitial hemorrhage were found in 6 dogs (7～29 shocks,10～60 J).ST-T segment changes in electrocardiographic patterns were recorded after defibrillation charges in 4 dogs(8～24 shocks,20～50 J).CPK and CPK-MB showed slight elevation in 2 dogs (10～19 shocks ,5～40 J) after receiving defibrillation shocks,with CPK elevated from 104 to 110 IU in one,and CPK-MB from 47.1 to 60.9 IU in the other.This study suggests the following:low energy defibrillation may cause myocardial injury,with heat and electricity as possible causative factors;the degree of injury is related to the energy used for defibrillation and the time intervals between shocks;the injury is localized,and may heal.更多还原