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麻醉犬心律失常后肾血管收缩的机制

Mechanism of postarrhythmic renal vasoconstriction in the anesthetized dog.

作者信息

Katholi R E, Oparil S, Urthaler F, James T N

出版信息

J Clin Invest. 1979 Jul;64(1):17-31. doi: 10.1172/JCI109436.

Abstract

The mechanism of postarrhythmic renal vasoconstriction was studied in 28 dogs anesthetized with pentobarbital sodium (30 mg/kg i.v.). Rapid atrial or ventricular pacing or induction of atrial fibrilation were used to produce at least 20% prompt decrease in cardiac output and mean arterial blood pressure. Return to control cardiac output and blood pressure occurred within 3 minutes after cessation of the arrhythmia, but renal blood flow remained significantly decreased (26%) with gradual recovery by 17.7 +/- 6.6 min. Infusion of phentolamine (0.25 mg/min) into the renal artery, intravenous hexamethonium (l mg/kg), adrenal demedullation, or cooling the cervical vagi prevented postarrhythmic renal vasoconstriction. In contrast, renal denervation, intravenous bretylium (10 mg/kg), intravenous atropine (0.5 mg/kg) or intrarenal SQ 20881 (0.20 mg/min) has no effect on postarrhythmic renal vasoconstriction. Intravenous propranolol (0.5 mg/kg) intensified postarrhythmic renal vasoconstriction. These data suggested that the postarrhythmic renal vasoconstrictive response required intact vagi and was due to alpha adrenergic stimulation by adrenal catecholamines. However, femoral arterial catecholamine levels were not elevated above control during postarrhythmic renal vasoconstriction. We therefore sought local vascular pathways by which catecholamines might reach the kidneys. An adrenorenal vascular network was found in each dog. Collection of catecholamines from these vessels during postarrhythmic renal vasoconstriction in six dogs revealed catecholamine concentrations threefold higher than simultaneously collected femoral arterial catecholamines levels. Because ligation of these vessels abolished postarrhythmic renal vasoconstriction in each dog, we conclude that postarrhythmic renal vasconstriction is due to adrenal catecholamines reaching the kidneys through an adreno-renal vascular network and that the response requires intact vagi.

摘要

在28只戊巴比妥钠(30毫克/千克静脉注射)麻醉的犬中研究了心律失常后肾血管收缩的机制。采用快速心房或心室起搏或诱发心房颤动,使心输出量和平均动脉血压迅速下降至少20%。心律失常停止后3分钟内心输出量和血压恢复至对照水平,但肾血流量仍显著降低(26%),并在17.7±6.6分钟时逐渐恢复。向肾动脉内输注酚妥拉明(0.25毫克/分钟)、静脉注射六甲铵(1毫克/千克)、肾上腺去髓质或冷却颈迷走神经可预防心律失常后肾血管收缩。相反,肾去神经支配、静脉注射溴苄铵(10毫克/千克)、静脉注射阿托品(0.5毫克/千克)或肾内注射SQ 20881(0.20毫克/分钟)对心律失常后肾血管收缩无影响。静脉注射普萘洛尔(0.5毫克/千克)可加剧心律失常后肾血管收缩。这些数据表明,心律失常后肾血管收缩反应需要完整的迷走神经,且是由于肾上腺儿茶酚胺的α肾上腺素能刺激所致。然而,在心律失常后肾血管收缩期间,股动脉儿茶酚胺水平并未高于对照水平。因此,我们寻找儿茶酚胺可能到达肾脏的局部血管途径。在每只犬中均发现了肾上腺-肾血管网络。在6只犬心律失常后肾血管收缩期间从这些血管中收集的儿茶酚胺浓度比同时收集的股动脉儿茶酚胺水平高3倍。由于结扎这些血管可消除每只犬心律失常后肾血管收缩,我们得出结论,心律失常后肾血管收缩是由于肾上腺儿茶酚胺通过肾上腺-肾血管网络到达肾脏,且该反应需要完整的迷走神经。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e6f1/372086/af302cc47db6/jcinvest00679-0031-a.jpg

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