Timmers Henri J L M, Karemaker John M, Wieling Wouter, Marres Henri A M, Folgering Hans T M, Lenders Jacques W M
Department of General Internal Medicine (541), Department of Otorhinolaryngology, University Medical Center St Radboud, Geert Grooteplein Zuid 8, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
J Hypertens. 2003 Mar;21(3):591-9. doi: 10.1097/00004872-200303000-00026.
To investigate whether bilateral carotid body tumor resection invariably and chronically affects arterial baroreflex or peripheral chemoreflex function.
We studied eight consecutive patients (two men and six women; ages 48.1 +/- 11.8 years), a median time of 3.4 years (range 1.3-20.6 years) after bilateral carotid body tumor resection, and 12 healthy control individuals (eight men and four women; ages 53.7 +/- 10.1 years). Baroreflex sensitivity (phenylephrine), blood pressure and its variability (24 h Spacelabs and 5 h Portapres recordings), responses to standard cardiovascular reflex tests and the ventilatory responses to normocapnic and hypercapnic hypoxia were assessed.
Baroreflex sensitivity was lower in patients (6.4 +/- 7.2 ms/mmHg) than in controls (14.7 +/- 6.6 ms/mmHg; P +/- 0.011). Mean office blood pressure and heart rate were normal in patients (123.3 +/- 11.9/79.0 +/- 7.3 mmHg and 67.5 +/- 9.4 beats/min, respectively) and controls (117.8 +/- 10.6/74.0 +/- 6.8 mmHg and 61.1 +/- 9.2 beats/min, respectively). Blood pressure variability was increased during ambulatory measurements. Three patients exhibited orthostatic hypotension. The Valsalva ratio, an index of baroreflex-mediated cardiovagal innervation, was lower in patients (1.4 +/- 0.2) than in controls (1.8 +/- 0.5; P +/- 0.008). The normocapnic ventilatory response to hypoxia was absent in all patients, whereas a small residual response to hypoxia was observed under hypercapnic conditions in two patients.
Bilateral carotid body tumor resection results in heterogeneous expression of arterial baroreflex dysfunction, whereas the normocapnic hypoxic drive is invariably abolished as a result of peripheral chemoreflex failure.
探讨双侧颈动脉体瘤切除是否会始终如一地长期影响动脉压力反射或外周化学反射功能。
我们研究了8例连续患者（2例男性和6例女性；年龄48.1±11.8岁），在双侧颈动脉体瘤切除术后中位时间3.4年（范围1.3 - 20.6年），以及12名健康对照个体（8例男性和4例女性；年龄53.7±10.1岁）。评估了压力反射敏感性（去氧肾上腺素）、血压及其变异性（24小时Spacelabs和5小时Portapres记录）、对标准心血管反射测试的反应以及对正常碳酸血症和高碳酸血症性低氧的通气反应。
患者的压力反射敏感性（6.4±7.2毫秒/毫米汞柱）低于对照组（14.7±6.6毫秒/毫米汞柱；P±0.011）。患者（分别为123.3±11.9/79.0±7.3毫米汞柱和67.5±9.4次/分钟）和对照组（分别为117.8±10.6/74.0±6.8毫米汞柱和61.1±9.2次/分钟）的平均诊室血压和心率均正常。动态测量期间血压变异性增加。3例患者出现体位性低血压。压力反射介导的心脏迷走神经支配指数瓦尔萨尔瓦比值在患者中（1.4±0.2）低于对照组（1.8±0.5；P±0.008）。所有患者对低氧的正常碳酸血症通气反应均缺失，而在高碳酸血症条件下，2例患者观察到对低氧的小残留反应。
双侧颈动脉体瘤切除导致动脉压力反射功能障碍的异质性表达，而正常碳酸血症性低氧驱动由于外周化学反射衰竭而始终被消除。
