Kaseda S, Zipes D P
Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis 46223.
Am J Physiol. 1988 Sep;255(3 Pt 2):H534-9. doi: 10.1152/ajpheart.1988.255.3.H534.
Supersensitivity of the sinus (SAN) and atrioventricular (AVN) nodes to acetylcholine (ACh) after parasympathetic denervation has not been demonstrated conclusively. In this study, we denervated the SAN and AVN by surgically removing parasympathetic ganglia and painting the area with phenol. Sham dogs underwent thoracotomy without denervation. Four to 9 days later, vagal denervation was proved by supramaximal bilateral vagal stimulation, which prolonged the sinus cycle length (SCL) only 32 +/- 7% (mean +/- SE) and the AVN conduction time (AH interval) 15 +/- 7% in denervated dogs. We tested for supersensitivity by obtaining dose-response curves to ACh (1 ml, 10(-8.0) to 10(-4.0) M in 10(0.5) steps) infused over 15 s into the sinus nodal and posterior septal arteries in open chest-denervated (Den) dogs and in sham-operated (Sham) dogs that were anesthetized with alpha-chloralose. ACh concentration (Log[ACh], M) required to prolong SCL 50, 100, and 300% was -5.7 +/- 0.1, -5.6 +/- 0.1, and -5.4 +/- 0.1 in 10 Sham dogs vs. -6.4 +/- 0.1 (P less than 0.001), -6.3 +/- 0.1 (P less than 0.001) and -6.1 +/- 0.1 (P less than 0.001) in 11 Den dogs. ACh concentration necessary to produce second degree and complete AV block was -5.7 +/- 0.1 and -5.3 +/- 0.1 in 11 Sham dogs vs. -6.3 +/- 0.1 (P less than 0.001) and -5.8 +/- 0.1 (P less than 0.01) in 10 Den dogs. Because significantly lower doses of ACh prolonged SCL or produced AV block in Den compared with Sham dogs, we conclude that dogs with vagally denervated SAN and AVN develop a supersensitive response to ACh.
副交感神经去神经支配后,窦房结(SAN)和房室结(AVN)对乙酰胆碱(ACh)的超敏反应尚未得到确凿证实。在本研究中,我们通过手术切除副交感神经节并用苯酚涂抹该区域来使窦房结和房室结去神经支配。假手术组犬只接受开胸手术但不进行去神经支配。4至9天后,通过双侧超强迷走神经刺激证实迷走神经去神经支配,在去神经支配的犬只中,这仅使窦性周期长度(SCL)延长32±7%(平均值±标准误),房室结传导时间(AH间期)延长15±7%。我们通过获取在开胸去神经支配(Den)犬只和用α-氯醛糖麻醉的假手术(Sham)犬只中,经15秒注入窦房结动脉和后间隔动脉的ACh(1毫升,浓度从10^(-8.0)至10^(-4.0) M,以10^(0.5)为步长)的剂量反应曲线来测试超敏反应。使SCL延长50%、100%和300%所需的ACh浓度(Log[ACh],M)在10只假手术犬中分别为-5.7±0.1、-5.6±0.1和-5.4±0.1,而在11只去神经支配犬中分别为-6.4±0.1(P<0.001)、-6.3±0.1(P<0.001)和-6.1±0.1(P<0.001)。产生二度和完全性房室传导阻滞所需的ACh浓度在11只假手术犬中分别为-5.7±0.1和-5.3±0.1,而在10只去神经支配犬中分别为-6.3±0.1(P<0.001)和-5.8±0.1(P<0.01)。因为与假手术犬相比,去神经支配犬中显著更低剂量的ACh就能延长SCL或产生房室传导阻滞,所以我们得出结论,迷走神经去神经支配的窦房结和房室结犬对ACh产生超敏反应。