心肌成形术后电刺激的多步骤方法。

Milwaukee Heart Institute of Sinai Samaritan Medical Center, Wisconsin 53402-0342, USA.

J Card Surg. 2000 May-Jun;15(3):199-208. doi: 10.1111/j.1540-8191.2000.tb00457.x.

UNLABELLED

Still a controversial procedure, cardiomyoplasty (CMP) improves the failing heart's ability to contract by using a latissimus dorsi muscle (LDM), but to date, hemodynamic results correlate poorly with clinical improvement. The following two causes for apprehension bar attempting to change the conventional electrical stimulation (ES) protocol to improve CMP results: (1) fear of beginning ES for LDM-assisted contraction immediately postmobilization and CMP and (2) fear of stopping or slowing ES during sleep periods.

METHODS

In ten different experimental series, I used animal models of CMP to determine how to apply ES to newly mobilized LDM, how to begin partial cardiac assist immediately post-CMP, and how to suspend ES for 12 hours daily.

RESULTS

From my experimental series I noted the following three results. (1) Different ES regimens applied 1 hour postmobilization changed the contractile force (CF). After a 30-minute fatigue test, CF decreased by 34% +/- 3% with continuous ES at 30 contractions per minute (cpm), by 23% +/- 2% with continuous ES at 15 cpm, by 25% +/- 5% with ES in a work-rest regimen at 30 cpm, and by 8% +/- 3% with ES in a work-rest regimen at 15 cpm. (2) Imitation of partial cardiac assist immediately postmobilization slightly decreased CF. Sixteen days postmobilization, during a 30-minute fatigue test in animals in which ES had been started immediately after mobilization, CF decreased by only 6% +/- 3% and did not change when ES was combined with imitation of cardiac assist for 30 minutes twice daily (work-rest regimen). (3) ES cessation for 24 hours daily or 12 hours daily in CMP model created no difference in ejection fraction (EF) with ES (54% +/- 4% vs 53% +/- 5%, respectively (or in left ventricular end-diastolic volume (LVEDV, 234.3 ml +/- 1.0 ml vs 24.8 mL +/- 0.6 mL, respectively) or in LV end-systolic volume (LVESV; 12.1 mL +/- 0.7 mL vs 12.8 mL +/- 0.7 mL, respectively).

CONCLUSION

For improving angiographic potential in the LDM, ES can be started safely immediately post-CMP at 15 cpm (a 1:4 or 1:5 regimen) and single impulses per burst. For partial cardiac assist and for improving LDM performance, cardiac assist can be used for 30 minutes twice daily immediately post-CMP. To rest the muscle and save it from overuse, muscle contraction can be either stopped or slowed down during hours of sleep.

未标注

心肌成形术（CMP）仍是一种存在争议的手术，它通过使用背阔肌（LDM）来提高衰竭心脏的收缩能力，但迄今为止，血流动力学结果与临床改善之间的相关性较差。有以下两个令人担忧的原因阻碍了尝试改变传统电刺激（ES）方案以改善CMP结果：（1）担心在CMP和LDM动员后立即开始进行ES以辅助收缩，以及（2）担心在睡眠期间停止或减慢ES。

方法

在十个不同的实验系列中，我使用CMP动物模型来确定如何将ES应用于新动员的LDM，如何在CMP后立即开始部分心脏辅助，以及如何每天暂停ES 12小时。

结果

从我的实验系列中，我注意到以下三个结果。（1）在动员后1小时应用不同的ES方案改变了收缩力（CF）。经过30分钟的疲劳测试，每分钟30次收缩（cpm）的持续ES使CF降低了34%±3%，每分钟15次收缩的持续ES使CF降低了23%±2%，每分钟30次收缩的工作-休息方案的ES使CF降低了25%±5%，每分钟15次收缩的工作-休息方案的ES使CF降低了8%±3%。（2）动员后立即模拟部分心脏辅助会使CF略有降低。动员后16天，在动员后立即开始ES的动物进行30分钟疲劳测试时，CF仅降低了6%±3%，当ES与每天两次模拟心脏辅助30分钟（工作-休息方案）相结合时，CF没有变化。（3）在CMP模型中，每天停止ES 24小时或12小时，与有ES时相比，射血分数（EF）没有差异（分别为54%±4%对53%±5%），左心室舒张末期容积（LVEDV，分别为234.3 ml±1.0 ml对24.8 mL±0.6 mL）或左心室收缩末期容积（LVESV；分别为12.1 mL±0.7 mL对12.8 mL±0.7 mL）也没有差异。