Bischoff K O
Fortschr Med. 1982 Sep 16;100(35):1618-21.
Using His-bundle-electrography and programmed atrial stimulation the effects of different catecholamines (dopamine, dobutamine, orciprenaline), parasympatholytics like atropine, ipratropiumbromide and the xanthine derivative aminophylline have been studied on the conduction system of the human heart in 119 patients with and without different disturbances of rhythm. In contrast to dopamine a moderate effect was found by dobutamine (3 or 6 micrograms/kg/min) in patients with sinus node dysfunction and delayed AV-conduction. In comparison it must by pointed out, that orciprenaline has the greatest positive dromotropic and chronotropic effect on sinus and AV-node. No effect was seen by these catecholamines on electrophysiological properties of the atrium and the intraventricular conduction (HPS). Particularly the fatigue-phenomenon of the Tawara-fibers were not influenced. 0,24 g aminophylline has only a minimal electrophysiological effect, only the sino-atrial conduction time was shortened significantly. The parasympathomimetic agents atropine (1,0; 2 mg i.v.) and ipratropiumbromide (0,5; 1 mg i.v.) are able to improve the sinuatrial and AV-dysfunction. In some patients, however, paradoxical effects were seen in patients with sick sinus syndrome. The refractory periods of the HPS were not influenced - otherwise a secondary impulse - generator was accelerated, which seems to indicate that the AV-node is localized in the NH-region.
运用希氏束电图和程控心房刺激技术，研究了不同儿茶酚胺类药物（多巴胺、多巴酚丁胺、奥西那林）、抗副交感神经药物如阿托品、异丙托溴铵以及黄嘌呤衍生物氨茶碱对119例有或无不同节律紊乱患者心脏传导系统的影响。与多巴胺不同，多巴酚丁胺（3或6微克/千克/分钟）对窦房结功能障碍和房室传导延迟的患者有中等程度的影响。相比之下，必须指出的是，奥西那林对窦房结和房室结具有最大的正性变传导作用和变时作用。这些儿茶酚胺对心房电生理特性和心室内传导（希氏束-浦肯野系统）无影响。特别是对房室束纤维的疲劳现象无影响。0.24克氨茶碱仅有最小的电生理作用，仅显著缩短了窦房传导时间。拟副交感神经药物阿托品（静脉注射1.0；2毫克）和异丙托溴铵（静脉注射0.5；1毫克）能够改善窦房和房室功能障碍。然而，在一些病态窦房结综合征患者中观察到了矛盾效应。希氏束-浦肯野系统的不应期未受影响——否则次级冲动发生器会加速，这似乎表明房室结位于希氏束-浦肯野区域。
