Matheny R G, Shaar C J
Department of Cardiovascular and Thoracic Surgery, St. Vincent Hospital and Health Care Center, Indianapolis, Indiana, USA.
Ann Thorac Surg. 1997 Jun;63(6 Suppl):S28-9. doi: 10.1016/s0003-4975(97)00423-2.
Electrical stimulation of nerves is used to study nervous system and body function relationships. Electrical stimulation of the vagus nerve was used to slow the heart during coronary artery bypass grafting.
A 48-year-old man with multivessel coronary artery disease, scheduled for revascularization, gave informed consent for the surgeon to stimulate his vagus nerve. As part of the operation the left internal mammary artery was harvested as a pedicle and the patient was placed on cardiopulmonary bypass. The vagus nerve was isolated as it crossed the aorta just lateral to the phrenic nerve. Pacing wires were placed (1 cm apart) allowing prodromic conduction. With the patient fully supported by cardiopulmonary bypass and after administration of neostigmine (2.5 mg intravenously) eight separate continuous 5-second electrical pulse trains (25 Hz, 20 V, pulse width of 0.1 ms) were delivered to the nerve with 30-second rest periods between each stimulation. During the periods of stimulation the mammary artery to left anterior descending artery anastomosis was completed.
Electrical stimulation caused cessation of the heartbeat, termination of the same resulted in normal sinus rhythm, although it was slowed by the neostigmine. Suturing of the anastomosis was done during periods of stimulation. Additional anastomoses were completed using cardiopulmonary bypass-delivered cardioplegia and aortic cross-clamping.
Electrical stimulation of the vagus nerve slowed and temporarily arrested the heart for brief periods to allow critical placement of anastomotic sutures.
神经电刺激用于研究神经系统与身体功能之间的关系。在冠状动脉旁路移植术中，迷走神经电刺激被用于减慢心率。
一名48岁患有多支冠状动脉疾病且计划进行血运重建的男性，已签署知情同意书，同意外科医生刺激其迷走神经。作为手术的一部分，切取左乳内动脉作为带蒂血管，患者接受体外循环。在迷走神经跨过主动脉且恰好在膈神经外侧时将其分离。放置起搏电极（相距1厘米）以实现前传传导。在患者完全由体外循环支持且静脉注射新斯的明（2.5毫克）后，向该神经输送8组单独的持续5秒电脉冲序列（25赫兹，20伏，脉冲宽度0.1毫秒），每次刺激之间有30秒的休息时间。在刺激期间完成了乳内动脉至左前降支动脉的吻合。
电刺激导致心跳停止，停止刺激后恢复正常窦性心律，不过因新斯的明作用而减慢。吻合口的缝合在刺激期间完成。使用体外循环提供的心脏停搏液和主动脉阻断完成了其他吻合。
迷走神经电刺激可使心脏在短时间内减慢并暂时停搏，以利于关键吻合缝线的放置。
