Norrsell H, Eliasson T, Mannheimer C, Augustinsson L E, Bergh C H, Andersson B, Waagstein F, Friberg P
Department of Medicine, Ostra Hospital, Göteborg, Sweden.
Eur Heart J. 1997 Dec;18(12):1890-6. doi: 10.1093/oxfordjournals.eurheartj.a015197.
Spinal cord stimulation has been used in the treatment of intractable angina pectoris since the beginning of the 1980s. This study was designed to investigate whether the documented anti-ischaemic effects of spinal cord stimulation are mediated through a decrease in sympathetic activity.
Ten patients with a spinal cord stimulator implanted as anti-anginal treatment were included in the study. Atrial pacing until the patient experienced moderate angina was performed and after 50 min rest the procedure was repeated during spinal cord stimulation. Total body and cardiac norepinephrine spillover was calculated and the former was found to have increased during pacing (47%, P = 0.02). When spinal cord stimulation was applied, total body norepinephrine spillover decreased at a comparable pacing rate (18%, P = 0.02). Cardiac norepinephrine spillover was not affected during the procedure.
The results of this study indicate that the anti-ischaemic effect of spinal cord stimulation is not due to reduced cardiac sympathetic activity. However, spinal cord stimulation decreases overall sympathetic activity which may benefit the heart, possibly by reducing oxygen demand.
自20世纪80年代初以来，脊髓刺激已被用于治疗顽固性心绞痛。本研究旨在调查脊髓刺激所记录的抗缺血作用是否通过交感神经活动的降低来介导。
本研究纳入了10例植入脊髓刺激器作为抗心绞痛治疗的患者。进行心房起搏直至患者出现中度心绞痛，休息50分钟后在脊髓刺激期间重复该操作。计算全身和心脏去甲肾上腺素溢出量，发现起搏期间前者增加（47%，P = 0.02）。当应用脊髓刺激时，在可比的起搏速率下全身去甲肾上腺素溢出量减少（18%，P = 0.02）。心脏去甲肾上腺素溢出量在该过程中未受影响。
本研究结果表明，脊髓刺激的抗缺血作用并非由于心脏交感神经活动降低。然而，脊髓刺激可降低总体交感神经活动，这可能对心脏有益，可能是通过降低氧需求实现的。
