Changes Of Autonomic Nerve Function And Intervention During Ischemia-reperfusion Of Right Coronary Artery

First partChanges of autonomic nerve function and arrhythmia during ischemia-reperfusion of right coronary artery(RCA)and the intervention of Atropine in rabbitObjective To investigate the occurrence of arrhythmia and autonomic nerve function during ischemia-reperfusion of right coronary artery(RCA)and the effects of atropine on arrhythmia,autonomic nerve function and myocardial injury after reperfusion.Methods Eighteen New Zealand white rabbits were selected and divided into three groups: sham operation group(SH,n=6),ischemia-reperfusion group(IR,n=6)and atropine group(AT,n=6).Acute ischemia-reperfusion model of right coronary artery was established by ligation and release of right coronary artery in rabbit,To analyse effects of ischemia reperfusion of right coronary artery on arrhythmia,heart rate variability index(SDNN,r MSSD,PNN50),deceleration capacity of rate(DC)and serum norepinephrine(NE),epinephrine(E),creatine kinase isoenzyme(CK-MB).After atropine pretreatment,to observe changes after reperfusion about arrhythmia,heart rate variability index(SDNN,r MSSD,PNN50),heart rate deceleration(DC)and serum norepinephrine(NE),epinephrine(E),creatine-kinase-isoenzyme(CK-MB).Result 1.1 The ischemia-reperfusion model of the right coronary artery was established in the ischemia-reperfusion group(IR)and the atropine group(AT).It was confirmed that the ischemia-reperfusion model of right coronary artery was established successfully by changes of electrocardiogram,local myocardium color,and creatine kinase isoenzyme(CK-MB)after postoperative catheter insertion into the right coronary artery.CK-MB[(68.317.49)ng/m Lvs.(38.86 ± 10.83)ng/ml,t=-5.477,P=0.000] significantly increased after 120 minutes reperfusion of RCA in IR group than after 150 minutes surgery of RCA in the SH group,and the difference was statistically significant(P<0.05).CK-MB had not changed in IR group than AT group after 30 min ischemia of RCA(P>0.05).1.2 The arrhythmia of ischemia-reperfusion with RCA:There were4 cases(67%)of bradyarrhythmia after ischemia of RCA in IR group,3cases(50%)with tachyarrhythmia,2 cases of bradyarrhythmia +tachyarrhythmia(33.3%),and 1 case of no arrhythmia(16.7%).There were 5 cases of bradyarrhythmia(83.33%)after ischemia of RCA in AT group,3 cases of tachyarrhythmia(50%),3 cases(50%)with bradyarrhythmia + tachyarrhythmia,and 1 case with no obvious arrhythmia(16.7%).There were 3 cases of bradyarrhythmia recovered during 30 minutes after reperfusion of RCA in IR group,1 case of bradyarrhythmia was not recovered(as sinus bradycardia).There were4 cases of bradyarrhythmia and 1 case of tachyarrhythmia recovered during 10 minutes after reperfusion of RCA in IR group,1 case of bradyarrhythmia did not recover(as sinus bradycardia).1.3 Comparison of heart rate variability index and heart ratedeceleration during ischemia-reperfusion of RCA:SDNN,r MSSD,PNN50 and DC were significantly increased after 30 minutes ischemia of RCA than before in IR group,and the difference was statistically significant(P<0.05).SDNN,r MSSD,PNN50 and DC were also significantly increased in IR group than sham operation group after30 minutes ischemia of RCA,and the difference was statistically significant(P<0.05).The r MSSD,PNN50 and DC were decreased significantly after 120 minutes reperfusion than 30 minutes ischemia of RCA in IR group,and the difference was statistically significant(P<0.05).The SDNN showed a downward trendence after 120 minutes reperfusion than 30 minutes ischemia of RCA in IR group,but the difference was not statistically significant(P>0.05).The SDNN was significantly increased after 120 minutes reperfusion than before ischemia of RCA in IR group,and the difference was statistically significant The r MSSD,PNN50 and DC were all increased after 120 minutes reperfusion than before ischemia of RCA in IR group,but the(P<0.05).difference was not statistically significant(P>0.05).The SDNN,r MSSD,PNN50 and DC were also increased in IR group than sham operation group after 150 minutes ischemia of RCA,but the difference was not statistically significant(P>0.05).1.4 Comparison of serum NE and E during ischemia-reperfusion of RCA:Serum NE and E were significantly increased after 30 minutes ischemia of RCA than before in IR group,and the difference was statistically significant(P<0.05).Serum NE and E also increased significantly in IR group than sham operation group after 30 minutes ischemia of RCA,and the difference was statistically significant(P<0.05).Serum NE and E had not significantly changed after 120 minutes reperfusion than 30 minutes ischemia of RCA in IR group(P>0.05).Serum NE and E were increased after 120 minutes reperfusion than before ischemia of RCA in IR group,but the difference was not statistically significant(P>0.05).Serum NE increased in IR group than sham operation group after 150 minutes ischemia of RCA,and the difference was statistically significant(P<0.05);Serum E also increased in IR group than sham operation group after 150 minutes ischemia of RCA,but the difference was not statistically significant(P>0.05).1.5 Comparison of heart rate variability index and heart rate deceleration force during the intervention of atropine after reperfusion of RCA:SDNN,r MSSD,PNN50 and DC were significantly decreased in AT group during the intervention of atropine than IR group after 120 minutes reperfusion of RCA,and the difference was statistically significant(P<0.05).1.6 Comparison of serum NE,E during the intervention of atropine after reperfusion of RCA:Serum NE and E increased significantly in AT group during the intervention of atropine than IR group after 120 minutes reperfusion of RCA,and the difference was statistically significant(P<0.05).1.7 Comparison of myocardial injury during the intervention of atropine after reperfusion of RCA:Serum CK-MB decreased in AT group during the intervention of atropine than IR group after 120 minutes reperfusion of RCA,but the difference was not statistically significant(P>0.05).Conclusion 1.The cardiac autonomic nerve function changed during the ischemia-reperfusion of right coronary artery.The activity of sympathetic nerve and vagus nervec were increased afterischemia,but the activity of vagus nerve increased more than sympathetic nerve.The activity of vagus nerve decreased after reperfusion than before,vagus nerve overactivation might be the main manifestation during ischemia-reperfusion of right coronary artery.The activity of vagus nerve decreased after reperfusion than before,vagus nerve overactivation might be the main manifestation during ischemia-reperfusion of right coronary artery.2.Bradyarrhythmia might be the main manifestation of arrhythmia after ischemia of right coronary artery.There was no new manifestation of arrhythmia after reperfusion of right coronary artery,and bradyarrhythmia gradually recovered after reperfusion of right coronary artery.3.The intervention of atropine could quickly make the bradyarrhythmia restored during ischemia of right coronary artery,But the intervention of atropine could not obviously reduce myocardial injury after reperfusion of right coronary artery.The second partRelationship between traditional Chinese medicine syndrome differentiation of patients with acute right coronary artery infarction and Heart Rate VariabilityObjective To investigate the relationship between traditional Chinese medicine syndromes of patients with acute right coronary artery infarction and heart rate variability,and to understand the changes of autonomic nervous function in different traditional Chinese medicine syndromes.Methods Thirty-nine patients diagnosed as acute right coronary artery infarction were enrolled in the department of cardiology,central theater command general hospital of the Chinese People’s Liberation Army from December 2016 to December 2018.According to the dialectical classification of traditional Chinese medicine,it is divided into the empirical syndrome group,the deficiency syndrome group,and the empirical and deficiency syndrome group.Dynamic electrocardiogram examination for all patients at7-10 days after emergency percutaneous coronary intervention.It was analyzed that the relationship between heart rate variability time domain indicators(SDNN,r MSSD)and traditional Chinese medicine syndromes.Results 2.1 There are 6 cases in the excess syndrome group(15.38%),23 cases(58.97%)in syndrome of deficiency-excess complex group,and 10 cases(25.64%)in the deficiency syndrome group.The main excess syndrome group was blood stasis and phlegm obstruction syndrome,which has a total of 4 cases(10.26%),followedby 2 cases(5.13%)were phlegm obstruction syndrome and blood stasis syndrome.The syndrome of deficiency-excess complex was mainly caused by syndrome of blood stasis and phlegm obstruction due to yang deficiency,which has a total of 15 cases(38.46%),followed by syndrome of blood stasis and phlegm obstruction due to yin deficiency,syndrome of blood stasis and phlegm obstruction due to qi deficiency in a total of 8 cases(20.51%).The deficiency syndrome was mainly yang deficiency syndrome and syndrome of sudden collapse of heart yang,a total of 7 cases(17.95%),followed by a total of3 cases(3.16%)of yin deficiency syndrome and qi deficiency syndrome.2.2 The excess syndrome group,the deficiency syndrome group,and the syndrome of deficiency-excess complex group are compared with heart rate variability indicators,SDNN and r MSSD.The excess syndrome group was the highest,followed by the deficiency syndrome group,finally the syndrome of deficiency-excess complex group,but the difference was not statistically significant(P>0.05).Conclusion Syndrome of patients with acute myocardial infarction of RCA may be mainly syndrome of deficiency-excess complex,followed by deficiency syndrome,and the excess syndrome is the least.