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急性尿潴留大鼠中过度的膀胱血管反射导致肾血流动力学降低。

Reduction in renal haemodynamics by exaggerated vesicovascular reflex in rats with acute urinary retention.

作者信息

Chien C T, Yu H J, Cheng Y J, Wu M S, Chen C F, Hsu S M

机构信息

Office for Clinical Research, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

J Physiol. 2000 Jul 15;526 Pt 2(Pt 2):397-408. doi: 10.1111/j.1469-7793.2000.t01-1-00397.x.

Abstract
  1. We examined the possibility that a vesicovascular reflex is exaggerated by acute urinary retention, and that the increase in renal vascular resistance caused by this reflex may lead to renal dysfunction. We evaluated the vesicovascular responses to normal micturition (NM, transcystometric condition) and acute urinary retention (isovolumetric condition mimicking complete bladder-outlet obstruction (CBOO) and partial urethral ligation mimicking partial bladder-outlet obstruction (PBOO)) in anaesthetized female Wistar rats. 2. Acute urinary retention due to CBOO or PBOO provoked a prolonged or increased intravesical pressure, an enhancement in both bladder pelvic afferent and bladder pelvic efferent nervous activity, and an elevation in mean arterial blood pressure. 3. Single-unit analysis showed that these vesicovascular reflexes were triggered by activation of low-threshold and high-threshold bladder mechanoreceptors, but not by renal uretropelvic mechanoreceptors. 4. Bladder contraction in CBOO and PBOO conditions and graded increases in bladder volume significantly reduced renal blood flow and cortical microvascular blood flow. The acute urinary retention-induced renal vasoconstriction was mediated by the renal nerve. Renal denervation, but not bilateral ureteral resection, abolished the renal vasoconstriction associated with the vesicovascular reflexes. 5. These findings indicate that exaggerated activation of bladder afferents exerts a positive feedback effect to increase sympathetic outflow to the kidney further, thereby contributing to significant renal vasoconstriction via a renal nerve-dependent mechanism.
摘要
  1. 我们研究了急性尿潴留是否会夸大膀胱血管反射,以及这种反射引起的肾血管阻力增加是否会导致肾功能障碍。我们评估了麻醉的雌性Wistar大鼠对正常排尿(NM,经膀胱测压条件)和急性尿潴留(模拟完全膀胱出口梗阻(CBOO)的等容条件和模拟部分膀胱出口梗阻(PBOO)的部分尿道结扎)的膀胱血管反应。2. 由CBOO或PBOO引起的急性尿潴留导致膀胱内压延长或升高,膀胱盆腔传入和传出神经活动增强,以及平均动脉血压升高。3. 单单位分析表明,这些膀胱血管反射是由低阈值和高阈值膀胱机械感受器的激活触发的,而不是由肾输尿管盆腔机械感受器触发的。4. CBOO和PBOO条件下的膀胱收缩以及膀胱容量的分级增加显著降低了肾血流量和皮质微血管血流量。急性尿潴留引起的肾血管收缩由肾神经介导。肾去神经支配而非双侧输尿管切除消除了与膀胱血管反射相关的肾血管收缩。5. 这些发现表明,膀胱传入神经的过度激活产生正反馈效应,进一步增加肾脏的交感神经输出,从而通过肾神经依赖机制导致显著的肾血管收缩。

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