Fulghum T G, DiMarco J P, Supple E W, Nash I, Gendlerman J, Eton D F, Newell J B, Zusman R M, Powell W J
J Clin Invest. 1985 Sep;76(3):999-1006. doi: 10.1172/JCI112101.
Since the discovery of prostacyclin (PGI2) in 1976, there has been great interest in its vascular effects and potential clinical applications. High infusion rates of PGI2 markedly depress arterial blood pressure both in animal studies and in clinical trials. This fall in pressure may result entirely from a decrease in arterial resistance. However, it is possible that the administration of PGI2 may decrease ventricular filling due to an increase in vascular capacity. To investigate whether or not PGI2 affects vascular capacity, we infused PGI2 intraarterially at both 10 and 25 micrograms/min into 15 dogs on total cardiopulmonary bypass. These infusions were associated with a 25 +/- 3 mmHg decrease in arterial pressure and an increase in vascular capacity of 155 +/- 29 ml (SE, P less than 0.005). This increase in capacity was greater (P less than 0.02) than the increase of 23 +/- 42 ml resulting from infusions of nitroglycerin into eight dogs at 2 mg/min, which produced a decrease in arterial pressure of 23 +/- 4 mmHg, which was the maximal effect that could be achieved. Neither bilateral cervical vagotomy nor beta adrenergic blockade with propranolol significantly diminished the increase in vascular capacity associated with infusions of PGI2. The results from studies in four eviscerated dogs indicated that PGI2 acts on both splanchnic and extrasplanchnic capacity vasculature. To compare the direct effects of PGI2 with those of nitroglycerin and nitroprusside on venous tone, we used an isolated canine spleen preparation. Infusions of PGI2 (100 mcg/min) increased spleen weight in this preparation by 9.0 +/- 2.4% (n = 10, P less than 0.001); this increase was significantly greater than increases of 3.6 +/- 2.2% (P less than 0.001) and 3.5 +/- 2.3% (P less than 0.001) caused by high dose infusions of nitroglycerin (1 mg/min) and nitroprusside (400 micrograms/min), respectively. Thus, PGI2 substantially increases vascular capacity by a mechanism that appears to involve a direct action on vascular smooth muscle. Furthermore, these results suggest that PGI2 might be useful in clinical conditions in which an increase in vascular capacity is indicated.
自1976年发现前列环素(PGI2)以来,人们对其血管效应和潜在的临床应用产生了浓厚兴趣。在动物研究和临床试验中,高输注速率的PGI2均会显著降低动脉血压。这种血压下降可能完全是由于动脉阻力降低所致。然而,PGI2的给药也可能因血管容量增加而导致心室充盈减少。为了研究PGI2是否会影响血管容量,我们在15只接受全心肺转流的犬只中,以每分钟10微克和25微克的速率动脉内输注PGI2。这些输注与动脉压下降25±3 mmHg以及血管容量增加155±29 ml相关(标准误,P<0.005)。这种容量增加比以每分钟2毫克的速率向8只犬只输注硝酸甘油所导致的23±42 ml的增加更大(P<0.02),后者使动脉压下降23±4 mmHg,这是所能达到的最大效应。双侧颈迷走神经切断术或用普萘洛尔进行β肾上腺素能阻滞均未显著减弱与PGI2输注相关的血管容量增加。对4只去内脏犬只的研究结果表明,PGI2作用于内脏和非内脏容量血管。为了比较PGI2与硝酸甘油和硝普钠对静脉张力的直接作用,我们使用了离体犬脾脏标本。在该标本中,输注PGI2(每分钟100微克)使脾脏重量增加了9.0±2.4%(n = 10,P<0.001);这种增加显著大于高剂量输注硝酸甘油(每分钟1毫克)和硝普钠(每分钟400微克)分别导致的3.6±2.2%(P<0.001)和3.5±2.3%(P<0.001)的增加。因此,PGI2通过一种似乎涉及对血管平滑肌直接作用的机制大幅增加血管容量。此外,这些结果表明PGI2在需要增加血管容量的临床情况下可能有用。