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高血压患者的压力感受器重置及压力反射特性的其他决定因素。

Baroreceptor resetting and other determinants of baroreflex properties in hypertension.

作者信息

Korner P I

机构信息

Baker Medical Research Institute, Melbourne, Victoria, Australia.

出版信息

Clin Exp Pharmacol Physiol Suppl. 1989;15:45-64. doi: 10.1111/j.1440-1681.1989.tb02995.x.

DOI:10.1111/j.1440-1681.1989.tb02995.x
PMID:2680189
Abstract
  1. Rapid resetting of the arterial baroreceptor threshold in the normal circulation extends the pressure range over which baroreflexes operate at high gain. During sustained falls and rises in resting blood pressure (BP), changes in reflex threshold may be greater or less than those of the receptors, through interactions with other sources of afferent drive (e.g. cardiac baroreceptors). In chronic hypertension the magnitude of the reflex resetting again corresponds to that of the arterial baroreceptors, probably because of the resetting of the threshold of the cardiac receptors. 2. 'Baroreflexes' in intact animals are compound reflexes with input from both arterial and non-arterial baroreceptors (e.g. cardiac/pulmonary baroreceptors). The steady-state responses can be characterized by BP-autonomic output function curves, which are often sigmoidal, with a well-defined effector response range and gain. Both sets of input contribute to the high gain component close to resting, with the arterial baroreceptors the major source of reflex drive; the non-arterial baroreceptors also contribute over this part of the reflex and their role increases considerably at high and low BP. 3. In chronic mild/moderate hypertension the changes in baroreflex properties are similar to those of moderate acute rises in BP or in cardiac load; heart rate range of the vagal component of the cardiac baroreflex is depressed, gain is slightly enhanced and the Valsalva-total peripheral resistance (TPR) reflex is unaltered. In severe hypertension: (i) vagal heart rate range and gain are further depressed; and (ii) there is depression of the Valsalva-TPR reflex, much as observed in constrictor reflexes during acute hypertension in normal animals. Circulatory disturbances produce engagement of non-arterial baroreceptors more readily in hypertensives than in normotensives; depression of baroreflexes in hypertension is due partly to enhanced drive from these receptors and partly due to reduction in the gain of the arterial baroreceptors. 4. The reflex vagal depression and that of neural constrictor reflexes can be considered as important homeostatic mechanisms that limit the effects of circulatory perturbations on cardiac filling pressures and on excessive rises in vascular resistance.
摘要
  1. 在正常循环中,动脉压力感受器阈值的快速重置扩展了压力反射以高增益运行的压力范围。在静息血压(BP)持续下降和上升期间,通过与其他传入驱动源(如心脏压力感受器)的相互作用,反射阈值的变化可能大于或小于感受器的变化。在慢性高血压中,反射重置的幅度再次与动脉压力感受器的幅度相对应,这可能是由于心脏感受器阈值的重置。2. 完整动物中的“压力反射”是复合反射,来自动脉和非动脉压力感受器(如心脏/肺压力感受器)的输入均有参与。稳态反应可用血压-自主输出功能曲线来表征,这些曲线通常呈S形,具有明确的效应器反应范围和增益。两组输入都对接近静息状态时的高增益部分有贡献,其中动脉压力感受器是反射驱动的主要来源;非动脉压力感受器在这部分反射中也有贡献,并且它们在高血压和低血压时的作用会显著增加。3. 在慢性轻度/中度高血压中,压力反射特性的变化与血压或心脏负荷的中度急性升高时相似;心脏压力反射迷走神经成分的心率范围降低,增益略有增强,瓦尔萨尔瓦动作-总外周阻力(TPR)反射未改变。在重度高血压中:(i)迷走神经心率范围和增益进一步降低;(ii)瓦尔萨尔瓦动作-TPR反射降低,这与正常动物急性高血压期间的收缩反射中观察到的情况非常相似。与正常血压者相比,循环障碍在高血压患者身上更容易使非动脉压力感受器参与进来;高血压中压力反射的降低部分是由于这些感受器的驱动增强,部分是由于动脉压力感受器增益的降低。4. 反射性迷走神经抑制和神经收缩反射的抑制可被视为重要的稳态机制,它们限制了循环扰动对心脏充盈压和血管阻力过度升高的影响。

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