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糖尿病对去甲肾上腺素引起的离体肠系膜阻力动脉收缩反应中挥发性麻醉剂作用的影响。

Diabetes-associated alterations in volatile anesthetic actions on contractile response to norepinephrine in isolated mesenteric resistance arteries.

机构信息

Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University.

出版信息

Anesthesiology. 2010 Mar;112(3):595-606. doi: 10.1097/ALN.0b013e3181ce9e80.

Abstract

BACKGROUND

Clinical concentrations of volatile anesthetics significantly influence contractile response to the sympathetic neurotransmitter norepinephrine although its precise mechanisms remain unclarified. In this study, we investigated its possible alterations in diabetes, as well as its underlying mechanisms.

METHODS

Isometric force was recorded in small mesenteric arteries from streptozotocin-induced diabetic and age-matched control rats.

RESULTS

The concentration-response curve for acetylcholine-induced endothelium-dependent relaxation was shifted to the right in diabetic arteries compared with controls. The concentration-response curve for norepinephrine-induced contraction was shifted to the left and upward by both endothelial denudation and diabetic induction. In the presence of endothelium, isoflurane or sevoflurane enhanced norepinephrine-induced contraction in control arteries but not in diabetic arteries; however, in its absence, both anesthetics identically inhibited norepinephrine-induced contraction in both groups. In control arteries, the isoflurane- or sevoflurane-induced enhancement was not affected by adrenomedullin22-52, calcitonin gene-related peptide8-37, 18beta-glycyrrhetinic acid, N-nitro l-arginine, ouabain, Ba, indomethacin, losartan, ketanserin, BQ-123, and BQ-788.

CONCLUSIONS

In diabetes, vascular responses to acetylcholine, norepinephrine, and volatile anesthetics are altered in mesenteric resistance arteries, presumably reflecting endothelial dysfunction and possibly underlying circulatory instability during administration of either anesthetic. Some endothelial mechanisms that are impaired in diabetes would be involved in the anesthetic-induced enhancement of norepinephrine-induced contraction. However, the vasoregulatory mechanism mediated by adrenomedullin, calcitonin gene-related peptide, myoendothelial gap junction, nitric oxide, endothelium-derived hyperpolarizing factor, cyclooxygenase products, angiotensin II, serotonin, or endothelin-1, all of which have been suggested to be impaired in diabetes, would not be involved in the enhancement.

摘要

背景

尽管挥发性麻醉剂的临床浓度显著影响了对交感神经递质去甲肾上腺素的收缩反应,但具体机制仍不清楚。在这项研究中,我们研究了糖尿病中可能存在的变化及其潜在机制。

方法

记录链脲佐菌素诱导的糖尿病和年龄匹配的对照组大鼠的小肠系膜动脉的等长力。

结果

与对照组相比,糖尿病动脉中乙酰胆碱诱导的内皮依赖性舒张的浓度-反应曲线向右移位。内皮剥脱和糖尿病诱导使去甲肾上腺素诱导的收缩的浓度-反应曲线向左和向上移位。在内皮存在的情况下,异氟烷或七氟烷增强了对照组动脉中去甲肾上腺素诱导的收缩,但在糖尿病动脉中没有;然而,在内皮不存在的情况下,两种麻醉剂都同样抑制了两组去甲肾上腺素诱导的收缩。在对照组动脉中,异氟烷或七氟烷诱导的增强不受肾上腺髓质素 22-52、降钙素基因相关肽 8-37、18β-甘草次酸、N-硝基-L-精氨酸、哇巴因、Ba、吲哚美辛、洛沙坦、酮色林、BQ-123 和 BQ-788 的影响。

结论

在糖尿病中,肠系膜阻力动脉对乙酰胆碱、去甲肾上腺素和挥发性麻醉剂的血管反应发生改变,可能反映了内皮功能障碍,并可能在给予任一麻醉剂时导致循环不稳定。糖尿病中受损的一些内皮机制可能涉及麻醉剂诱导的去甲肾上腺素诱导收缩的增强。然而,肾上腺髓质素、降钙素基因相关肽、肌内皮缝隙连接、一氧化氮、内皮衍生超极化因子、环氧化酶产物、血管紧张素 II、血清素或内皮素-1 介导的血管调节机制,所有这些都被认为在糖尿病中受损,不参与增强。

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