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目的 研究心肌梗死急性期经皮给予小剂量东莨菪碱能否增加心脏迷走神经的张力。方法 30例首次急性心肌梗死 (AMI)患者 ,窦性心律 ,未用任何影响窦房结的药物 ,随机分为东莨菪碱组和安慰剂组 ,双盲法给药。治疗前后用数字化 2 4小时Holter记录测定心率变异性时域参数。用苯肾上腺素法测定压力反射敏感性。结果 治疗前心率变异性参数和压力反射敏感性在两组间无明显差异。经皮东莨菪碱治疗明显增加心率变异的时域参数 [RR间期标准差均值 (SDNN) ,RR间期均值标准差 (SDANN)和相邻RR间期差值的均方根 (rMSSD) ]和频域参数 [总功率谱 (TP ,0 - 0 4 0Hz)、低频 (LF ,0 4 0 - 0 15Hz)和高频 (HF ,0 15 - 0 4 0Hz) ]及压力反射敏感性。结论 心肌梗死急性期应用小剂量东莨菪碱透皮治疗可显著增加心脏迷走神经张力 ,改善自主神经失衡。
Objective To study whether acute administration of scopolamine transdermally can increase cardiac vagal tone. Methods Thirty patients with first acute myocardial infarction (AMI) undergoing sinus rhythm without any drugs affecting the sinus node were randomly divided into scopolamine group and placebo group, and were administered by double-blind method. The 24 h Holter recording was used to determine the time-domain parameters of heart rate variability before and after treatment. Determination of baroreflex sensitivity by phenylephrine method. Results There was no significant difference in heart rate variability and baroreflex sensitivity between the two groups before treatment. The time-domain parameters (SDNN, SDANN, and rMSSD) of the frequency of heart rate variability significantly increased after transcutaneous scopolamine treatment and frequency Domain parameters [total power spectrum (TP, 0 - 0 4 0Hz), low frequency (LF, 0 40 0 - 0 15Hz) and high frequency (0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0] Conclusion Acute myocardial infarction with low-dose scopolamine transdermal delivery can significantly increase cardiac vagal tone and improve autonomic imbalance.