Masaki Y, Furukawa T, Watanabe M, Ichikawa G
Department of Otorhinolaryngology, Juntendo University School of Medicine, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 1999 Jul;102(7):891-7. doi: 10.3950/jibiinkoka.102.891.
Dizziness or syncope may occur during treatment of nasal disease. These symptoms are considered imputable to the vagovagal reflex, which is partly involved in neurogenic syncope. In response to trigeminal nerve stimulation, the vagus nerve causes a sudden fall in heart rate and blood pressure. Elevation in blood adrenaline level during pain or tension was noted, and its effects on vagovagal reflexes were studied.
Ten cats were used in the experiment. The vagus nerve was exposed on the right side of the neck by making an incision in the trachea, and a platinum electrode was attached to the vagus nerve on nerve's distal side. The head was tilted a 30 degree angle. The cats were divided into control and adrenaline-treated groups, and changes in cerebral blood flow, heart rate, and arterial pressure were compared between the two groups after electric stimulation of the vagus nerve. Cerebral blood flow was measured by the hydrogen clearance method. 1) Control group The vagus nerve was electrically stimulated for 1 minute. 2) Adrenaline-treated group The vagus nerve was electrically stimulated for 1 minute following 30 seconds of intravenous administration of adrenaline.
Cerebral blood flow was significantly decreased in both the control and adrenaline-treated groups after electric stimulation, but the decrease was significantly greater in the latter group at all sites of measurement. Whereas heart rate and arterial pressure were significantly decreased in the control group, these variables in the adrenaline-treated group showed no significant change despite the greater decrease in cerebral blood flow.
Heart rate, blood pressure, and cerebral blood flow were all significantly decreased after electric stimulation of the vagus nerve. These changes were considered owing to a fall in blood pressure due to vasodilation resulting from bradycardia and a relative decrease in sympathetic nervous tension resulting from electric stimulation. On the other hand, in the adrenaline-treated group, neither heart rate nor blood pressure showed any significant change, but cerebral blood flow was significantly decreased at all sites of measurement despite an adrenaline load. This contradictory results may be accounted for by the powerful beta 2-activity of adrenaline. The greater decrease in cerebral blood flow in the adrenaline-treated than in the control group can be attributed to decreased peripheral vascular resistance by its beta 2-activity. In the field of otorhinolaryngology the trigeminal region is often involved in the treatment of nasal disorders so that vagovagal reflexes are often encountered. The results of this study counsels caution in the treatment involving the trigeminal region.
鼻部疾病治疗期间可能会出现头晕或晕厥。这些症状被认为可归因于迷走-迷走反射,该反射部分参与神经源性晕厥。对三叉神经刺激做出反应时,迷走神经会导致心率和血压突然下降。研究发现疼痛或紧张时血中肾上腺素水平升高,并对其对迷走-迷走反射的影响进行了研究。
实验使用10只猫。通过在气管处做切口暴露右侧颈部的迷走神经,并在神经远端连接铂电极。将头部倾斜30度角。将猫分为对照组和肾上腺素处理组,电刺激迷走神经后比较两组脑血流量、心率和动脉压的变化。脑血流量通过氢清除法测量。1)对照组:电刺激迷走神经1分钟。2)肾上腺素处理组:静脉注射肾上腺素30秒后电刺激迷走神经1分钟。
电刺激后对照组和肾上腺素处理组的脑血流量均显著降低,但在所有测量部位,后者降低幅度明显更大。对照组心率和动脉压显著降低,而肾上腺素处理组尽管脑血流量下降幅度更大,但这些变量无显著变化。
电刺激迷走神经后,心率、血压和脑血流量均显著降低。这些变化被认为是由于心动过缓导致血管扩张引起血压下降以及电刺激导致交感神经张力相对降低所致。另一方面,在肾上腺素处理组中,心率和血压均无显著变化,但尽管有肾上腺素负荷,所有测量部位的脑血流量仍显著降低。这种矛盾的结果可能是由于肾上腺素强大的β2活性所致。肾上腺素处理组脑血流量下降幅度大于对照组,可归因于其β2活性导致外周血管阻力降低。在耳鼻咽喉科领域,三叉神经区域常参与鼻部疾病的治疗,因此常遇到迷走-迷走反射。本研究结果提示在涉及三叉神经区域的治疗中应谨慎。