Raven P B
Yale J Biol Med. 1986 May-Jun;59(3):267-79.
The concept that a specific level of central venous pressure (CVP) limits man's adjustment to heat stress has been debated. Evidence was presented that identifies a true limit of adjustment as being more related to factors affecting evaporative cooling, such as level of hydration, release of active vasodilation substance (AVS), and sweat gland fatigue. However, it was conceded that decreases in CVP and subsequent low-pressure baroreceptor activation modify cutaneous blood flow and subsequently reduce conductance of heat from the core to the periphery. It was suggested that CVP merely reflects a downstream pressure, which must be allowed to reach a pressure lower than that observed in the peripheral venous bed during active cutaneous vasodilation, to insure adequate venous return. However, a loss of evaporative cooling has been observed during prolonged progressive dehydration of subjects in the supine position, resulting in 3 to 4 percent loss of total body weight. This loss of evaporative cooling was not apparent when euhydration was maintained. As it was unlikely that CVP was reduced in these experiments in the supine position, it was concluded that CVP was not the limiting factor in man's adjustment to heat stress.
关于中心静脉压(CVP)的特定水平会限制人体对热应激的适应这一概念一直存在争议。有证据表明,确定真正的适应极限更多地与影响蒸发散热的因素有关,如水合作用水平、活性血管舒张物质(AVS)的释放以及汗腺疲劳。然而,人们承认CVP的降低以及随后低压压力感受器的激活会改变皮肤血流量,进而减少从核心到外周的热传导。有人提出,CVP仅仅反映了下游压力,在活跃的皮肤血管舒张过程中,必须允许其达到低于外周静脉床所观察到的压力,以确保足够的静脉回流。然而,在仰卧位受试者长时间进行性脱水过程中观察到了蒸发散热的丧失,导致总体重减轻3%至4%。当保持正常水合状态时,这种蒸发散热的丧失并不明显。由于在这些仰卧位实验中CVP不太可能降低,因此得出结论,CVP不是人体对热应激适应的限制因素。