Department of Anesthesiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Eur J Anaesthesiol. 2009 Sep;26(9):766-71. doi: 10.1097/EJA.0b013e32832a58fa.
Recent studies showed that ischaemic postconditioning converted persistent ventricular fibrillation to sinus rhythm. The influence of anaesthetic postconditioning on ventricular fibrillation has not yet been determined. In the present study, we studied the possible effect of sevoflurane postconditioning on persistent reperfusion-induced ventricular fibrillation in the isolated rat heart model.
Isolated Langendorff-perfused rat hearts (n=80) were subjected to 40 min of global ischaemia and reperfusion. The hearts with persistent ventricular fibrillation (n=16) present after 15 min of reperfusion were then randomly assigned into one of the two groups: controls (n=8), reperfusion was continued for 25 min without any intervention, and sevoflurane postconditioning (n=8), rat hearts in the sevoflurane postconditioning group were exposed to sevoflurane at a concentration of 8.0% for 2 min followed by 23 min of reperfusion. As for the third group, the rest of the hearts were included in the nonpersistently fibrillating hearts group (n=64). Left ventricular pressures, heart rate, coronary flow, electrogram and infarct size were measured as variables of ventricular function and cellular injury, respectively.
Conversion of ventricular fibrillation into regular rhythm was observed in all hearts subjected to sevofluane postconditioning. Regular beating was maintained by all anaesthetic postconditioned hearts during the subsequent reperfusion. None of the hearts in the control group had normal rhythm at the end of the experiment. At the end of reperfusion, the coronary flow was increased in sevoflurane postconditioned hearts compared with the hearts that did not develop persistent ventricular fibrillation.
Sevoflurane postconditioning possesses strong antiarrhythmic effect against persistent reperfusion-induced ventricular fibrillation. Anaesthetic postconditioning may have the potential to be an antiarrhythmic therapy for reperfusion-related arrhythmias.
最近的研究表明，缺血后处理可将持续性室颤转化为窦性节律。麻醉后处理对室颤的影响尚未确定。本研究旨在探讨七氟醚后处理对离体大鼠心脏模型持续性再灌注诱导室颤的可能影响。
采用离体 Langendorff 灌流大鼠心脏（n=80）进行 40 分钟的缺血-再灌注。再灌注 15 分钟后出现持续性室颤（n=16）的心脏随机分为两组：对照组（n=8），继续再灌注 25 分钟，无任何干预；七氟醚后处理组（n=8），七氟醚后处理组大鼠心脏暴露于 8.0%七氟醚 2 分钟，然后再灌注 23 分钟。第三组为非持续性室颤组（n=64），其余心脏纳入该组。左心室压力、心率、冠脉流量、心电图和梗死面积分别作为心室功能和细胞损伤的变量进行测量。
所有接受七氟醚后处理的心脏均观察到室颤转化为规则节律。所有接受麻醉后处理的心脏在随后的再灌注期间均保持规则跳动。对照组所有心脏在实验结束时均未恢复正常节律。再灌注结束时，七氟醚后处理组的冠脉流量较未发生持续性室颤的心脏增加。
七氟醚后处理对持续性再灌注诱导的室颤具有较强的抗心律失常作用。麻醉后处理可能具有作为再灌注相关心律失常的抗心律失常治疗的潜力。
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