Bode F, Wiegand U, Raasch W, Richardt G, Potratz J
Medizinische Klinik II, Medizinische Universität zu Lübeck, Germany.
Heart. 1998 Jun;79(6):560-7. doi: 10.1136/hrt.79.6.560.
To assess the effect of defibrillation shocks on cardiac and circulating catecholamines.
Prospective examination of myocardial catecholamine balance during dc shock by simultaneous determination of arterial and coronary sinus plasma concentrations. Internal countershocks (10-34 J) were applied in 30 patients after initiation of ventricular fibrillation for a routine implantable cardioverter defibrillator test. Another 10 patients were externally cardioverted (50-360 J) for atrial fibrillation.
Transcardiac noradrenaline, adrenaline, and lactate gradients immediately after the shock.
After internal shock, arterial noradrenaline increased from a mean (SD) of 263 (128) pg/ml at baseline to 370 (148) pg/ml (p = 0.001), while coronary sinus noradrenaline fell from 448 (292) to 363 (216) pg/ml (p = 0.01), reflecting a shift from cardiac net release to net uptake. After external shock delivery, there was a similar increase in arterial noradrenaline, from 260 (112) to 459 (200) pg/ml (p = 0.03), while coronary sinus noradrenaline remained unchanged. Systemic adrenaline increased 11-fold after external shock (p = 0.01), outlasting the threefold rise following internal shock (p = 0.001). In both groups, a negative transmyocardial adrenaline gradient at baseline decreased further, indicating enhanced myocardial uptake. Cardiac lactate production occurred after ventricular fibrillation and internal shock, but not after external cardioversion, so the neurohumoral changes resulted from the defibrillation process and not from alterations in oxidative metabolism.
A dc shock induces marked systemic sympathoadrenal and sympathoneuronal activation, but attenuates cardiac sympathetic activity. This might promote the transient myocardial depression observed after electrical discharge to the heart.
评估除颤电击对心脏及循环中儿茶酚胺的影响。
通过同时测定动脉血和冠状窦血浆浓度，对直流电休克期间心肌儿茶酚胺平衡进行前瞻性研究。在30例患者发生心室颤动后，为进行常规植入式心脏复律除颤器测试，施加体内反搏电击（10 - 34焦耳）。另外10例心房颤动患者接受体外心脏复律（50 - 360焦耳）。
电击后即刻的跨心脏去甲肾上腺素、肾上腺素及乳酸梯度。
体内电击后，动脉血去甲肾上腺素从基线时的平均（标准差）263（128）皮克/毫升升至370（148）皮克/毫升（p = 0.001），而冠状窦去甲肾上腺素从448（292）降至363（216）皮克/毫升（p = 0.01），这反映了从心脏净释放到净摄取的转变。体外电击后，动脉血去甲肾上腺素也有类似升高，从260（112）升至459（200）皮克/毫升（p = 0.03），而冠状窦去甲肾上腺素保持不变。体外电击后全身肾上腺素增加了11倍（p = 0.01），持续时间长于体内电击后的三倍升高（p = 0.001）。两组中，基线时负的跨心肌肾上腺素梯度进一步降低，表明心肌摄取增强。心室颤动和体内电击后出现心脏乳酸生成，但体外心脏复律后未出现，因此神经体液变化是由除颤过程引起的，而非氧化代谢改变所致。
直流电休克可引起显著的全身交感肾上腺和交感神经激活，但会减弱心脏交感神经活动。这可能会促进电击心脏后观察到的短暂心肌抑制。
