摘要目的 探讨外科手术中经心外膜探查心包内心脏植物神经节丛的位置和微波消融神经节丛的即时效果.方法 16例接受心脏手术者同期行高频电刺激心包内植物神经节丛.窦性心律者使用同步高频刺激,房颤者使用连续高频刺激,观察出现迷走效应的位置.探查后对房颤病人使用微波消融,消融和电复律后使用同步电刺激原有迷走效应的植物神经节丛,观察有无迷走效应出现.结果 2例病人麻醉后因故不能进行试验被排除.14例在1～5处脂肪颦引出迷走效应.13 例病人在右上肺静脉根部脂肪垫有迷走效应,位于心脏右侧的植物神经节丛发生迷走效应的频率明显高于心脏左侧.消融后,原有迷走效应的植物神经节未再引出迷走效应.结论 自心外膜使用高频电刺激心脏周围脂肪垫可在1处或多处诱发迷走效应,心脏右侧脂肪垫的迷走效应诱发率高于左侧,右上肺静脉周围脂肪垫诱导率最高.心外膜微波消融可以消除迷走效应.

abstractsObjective Epicardial mapping of cardiac intrinsic autonomic ganglions was not standardized. The purpose of the present study is to standardize methods of intra-operative high frequency stimulation (HFS) to the ganglionic plexi and to e valuate the effect of micro-wave epicardial ablation on the plexi. Methods 16 cardiac surgical patients were recruited in the intra-operative HFS study. 12 of them were on sinus rhythm while the other 4 were on AF. HFS was applied to epicardial fat pads on or around the heart by a 2-electrode EP catheter. Atrial EKG and body surface EKG were simultaneously recorded with the HFS signal. After measuring atrial effective refractory period (AERP) , HFS was applied to sinus rhythm patients with the duration of 1/2 and 3/4 AERP. Each HFS episode was coupled by an atrial-pacing signal with 600 ms interval. For AF patients , continuous HFS was applied without coupling to native atrial beats. Vagal response was observed to identify the location of the plexi. Micro-wave ablation was employed for AF patients. After the ablation and cardioversion, synchronized HFS was applied again as we did for patients with sinus rhythm. Results 2 cases were excluded due to complete AV block after anesthesia. Vagal response could be induced in every patient while each patient had different fat pads responding to HFS. PR interval on body surface EKG was increased in the responding fat pads as the duration of HFS increased. 2:1AV conduction block was induced eventually in all sinus patients when HFS duration was increased to 3/4 AERP. For AF patients, average PR interval doubled when the responding fat pads were stimulated by continuous HFS. 13/14 cases (92% ) had vagal response in fat pads around right superior pulmonary vein. The positive vagal response was significantly more prevalent in the fat pads on the right side of the heart than on the left side. No vagal response could be induced again after micro-wave ablation in AF patients. Conclusion Epicardial HFS can effectively locate the gangalionated plexi of intrinsic cardiac autonomic nerve during surgery. Epicardial micro-wave ablation can eliminate the vagal response which had been induced before the ablation.