Kondo K, Kasai S, Mito M
Second Department of Surgery, Asahikawa Medical College, Japan.
Nihon Geka Gakkai Zasshi. 1991 Jun;92(6):707-15.
Possible abnormalities in the sympathetic nervous system responsible for circulatory disturbances with obstructive jaundice were investigated by determining the reactions of the heart and peripheral blood vessels using alpha.beta receptor stimulants or blockers. Mongrel dogs were randomly assigned to three groups: untreated (UT) and sham-operated (SO) controls and 3-week-old bile duct ligated (BDL). Under anesthesia with Nembutal, circulatory parameters and blood catecholamine concentration were measured. In term of alpha- and beta-adrenergic reactions, reactions in the sympathetic nervous system to alpha- and beta-receptor stimulants were examined. Mean arterial pressure (MAP) and heart rate were used as an alpha-adrenergic parameter and a beta-adrenergic parameter, respectively. The hemodynamic study in BDL group was characterized by a reduction in MAP (p less than 0.05), total peripheral resistance (p less than 0.005) and left ventricular stroke work (LVSW) (p less than 0.05) and by an increase in cardiac index (p less than 0.05). The blood norepinephrine concentration was significantly increased in jaundice (p less than 0.01). Reaction to the beta-receptor stimulant was significantly decreased in BDL group. In response to the alpha-receptor stimulant, lower reactivity was found in some animals in BDL group in comparison to SO group. Taking this into consideration with the increase in blood norepinephrine and the decrease in LVSW, the presence of abnormalities particularly in the beta-adrenergic system (receptor, cardiac muscle etc.) in jaundice is suggested to be a characteristic feature of reactions in the sympathetic nervous system. Such abnormalities are speculated to be responsible for postoperative shock.
通过使用α、β受体兴奋剂或阻滞剂来测定心脏和外周血管的反应,研究了与梗阻性黄疸引起的循环障碍相关的交感神经系统可能存在的异常情况。杂种犬被随机分为三组:未治疗(UT)组、假手术(SO)对照组和3周龄胆管结扎(BDL)组。在戊巴比妥麻醉下,测量循环参数和血儿茶酚胺浓度。就α和β肾上腺素能反应而言,检测了交感神经系统对α和β受体兴奋剂的反应。平均动脉压(MAP)和心率分别用作α肾上腺素能参数和β肾上腺素能参数。BDL组的血流动力学研究表现为MAP降低(p<0.05)、总外周阻力降低(p<0.005)和左心室搏功(LVSW)降低(p<0.05),以及心脏指数升高(p<0.05)。黄疸时血去甲肾上腺素浓度显著升高(p<0.01)。BDL组对β受体兴奋剂的反应显著降低。对α受体兴奋剂的反应方面,与SO组相比,BDL组部分动物的反应性较低。考虑到血去甲肾上腺素的增加和LVSW的降低,提示黄疸时交感神经系统尤其在β肾上腺素能系统(受体、心肌等)存在异常是反应的特征。推测这些异常是术后休克的原因。