Zuckerman R L, Wheeler D M
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Anesth Analg. 1991 May;72(5):596-603. doi: 10.1213/00000539-199105000-00005.
The combination of catecholamines and halothane has long been recognized as arrhythmogenic. The purpose of this study was to evaluate whether the mechanism of this interaction originates at the single cell level. The incidence of spontaneous contractile waves occurring between stimulated beats (interbeat waves), early aftercontractions, and late aftercontractions was measured in rat myocytes exposed to sympathomimetics with and without halothane. Each of these endpoints in single cells has the potential to produce arrhythmias in multicellular preparations. Interbeat waves and late aftercontractions were observed with isoproterenol (1 X 10(-7) M) and norepinephrine (1-3 X 10(-7) M). The incidence of these phenomena was significantly reduced in the presence of 0.30 mM halothane. Early aftercontractions occurred in the presence of isoproterenol (1 X 10(-7) M), norepinephrine (1-3 X 10(-7) M), and phenylephrine (5-10 X 10(-6) M). There was a statistically significant decrease in the incidence of early aftercontractions in the presence of 0.30 mM halothane. These results indicate that the mechanism behind the clinically observed increased arrhythmogenicity of catecholamines with halothane does not arise at the level of single ventricular cells because halothane inhibited sympathomimetic-induced arrhythmogenic activity in this model. The probable mechanisms rather include altered impulse propagation, which might lead to phenomena such as reentry.
长期以来,人们一直认为儿茶酚胺与氟烷联用会引发心律失常。本研究的目的是评估这种相互作用的机制是否源于单细胞水平。在暴露于拟交感神经药且有或无氟烷的大鼠心肌细胞中,测量刺激搏动之间出现的自发收缩波(搏动间波)、早期后除极和晚期后除极的发生率。单细胞中的每一个此类终点都有可能在多细胞制剂中引发心律失常。在异丙肾上腺素(1×10⁻⁷ M)和去甲肾上腺素(1 - 3×10⁻⁷ M)作用下观察到搏动间波和晚期后除极。在存在0.30 mM氟烷的情况下,这些现象的发生率显著降低。早期后除极发生在异丙肾上腺素(1×10⁻⁷ M)、去甲肾上腺素(1 - 3×10⁻⁷ M)和去氧肾上腺素(5 - 10×10⁻⁶ M)作用时。在存在0.30 mM氟烷的情况下,早期后除极的发生率有统计学意义的下降。这些结果表明,临床观察到的儿茶酚胺与氟烷联用导致心律失常性增加背后的机制并非源于单个心室细胞水平,因为在该模型中氟烷抑制了拟交感神经药诱导的心律失常活性。可能的机制反而包括冲动传导改变,这可能导致诸如折返等现象。