臺灣博碩士論文加值系統

肺靜脈袖套是由心肌細胞組成，可能對某些心律不整之生成扮演角色，過去某些文獻顯示，在正常狗及兔子之肺靜脈袖套發現有高比例的內生性自發節律與觸激性活性。但是，其他研究群卻有截然相反的結果：在正常狗、兔子、及大白鼠之肺靜脈袖套心肌細胞，未發現有內生性自發節律。本研究目的是要進一步探討此爭論之疑團。
本研究採用新的實驗設計，利用離體實驗模式，檢驗兔子之整體肺靜脈袖套的電氣收縮活性。此管狀肺靜脈袖套模式包括一小塊左心房組織、肺靜脈孔、及肺靜脈袖套。雙極電極從左心房釋放電刺激，傳至肺靜脈袖套引起其周狀收縮。收縮力及細胞內動作電位被紀錄作為分析之用。
不正常的內生性自發節律與觸激性收縮活性是否真的存在及發生在肺靜脈袖套上，雖然過去十年一直是個爭議的話題，在本研究中我們以nicardipine及verapamil作探討，當鈣濃度過多所導致的觸激性收縮活性發生後，在肺靜脈袖套中給予nicardipine或verapamil可有效抑制觸激性收縮活性。因nicardipine及verapamil治療潛力也是值得進一步探討。

Pulmonary vein sleeves are composed of cardiac muscles cells and play certain roles in the arrhythmogenesis of certain atrial arrhythmias. In literatures, it has been demonstrated that there exist a high proportion of intrinsic pacemakers and triggered activities in pulmonary vein sleeves of dogs and rabbits. By contrast, other research groups discovered a contradictory finding: under normal condition, there are no intrinsic pacemakers in cardiac myocytes of pulmonary vein sleeves of dogs, rabbits and rabbits. The main purpose of the present study is to explore and elucidate this discrepancy and controversy.
A new experimental methodology was adopted in this study. Using an in-vitro experimental model, electrophysiological contractile characteristics were examined. The new methodology of intact-ring of pulmonary vein sleeves included a small piece of left atrial tissue, free wall of left atria attached to pulmonary vein orifice and its sleeves. Bipolar electrodes were delivered to the intact tissue at left atrial free wall. The electrical stimuli propagated into pulmonary vein sleeves and elicited its circumferential contraction as a whole. The contractile force and intracellular action potentials could be recorded for further analysis.
Whether intrinsic abnormal automaticity (pacemakers) and triggered activities do exist in pulmonary vein sleeves remains to be debated and determined. This contradiction became a controversy and gradually became a riddle and myth. In the present study, we again demonstrated that the finding of intrinsic pacemakers in pulmonary vein sleeves is due to a serious experimental artifact. In this study, using pulmonary vein sleeves model, effects of nicardipine and verapamil were investigated. In the presence of calcium overload and subsequent after-contractions and triggered activities in pulmonary vein sleeves of rabbits, nicardipine or verapamil significantly inhibited such phenomenon. Such pharmacological effects of nicardipine and verapamil imply a potential role of nicardipine and verapamil in clinical atial arrhythmias.

感謝詞 II
摘要 III
Summary IV
目錄 VI
圖目錄 VIII
表目錄 IX
介紹 1
材料與方法 3
實驗目的 5
定性測試 5
Verapamil對胞內高鈣狀態下肺靜脈袖套的收縮之影響 6
Verapamil各種濃度對5赫茲的穩態測試 7
胞內高鈣狀態下改變電刺激模式對肺靜脈袖套收縮比較 8
Nicardipine對肺靜脈袖套的收縮力影響 8
改變對肺靜脈袖套電刺激及nicardipine濃度的比較 9
增加Isoproterenol及Ca的濃度對於Nicardipine的影響 9
討論 10
主要發現 10
Verapamil與Nicardipine在肺靜脈袖套上的作用 10
結論 11
參考文獻 38

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