Mark A L
J Am Coll Cardiol. 1983 Jan;1(1):90-102. doi: 10.1016/s0735-1097(83)80014-x.
The concept of depressor reflexes originating in the heart was introduced by von Bezold in 1867 and was later revived by Jarisch. The Bezold-Jarisch reflex originates in cardiac sensory receptors with nonmyelinated vagal afferent pathways. The left ventricle, particularly the inferoposterior wall, is a principal location for these sensory receptors. Stimulation of these inhibitory cardiac receptors by stretch, chemical substances or drugs increases parasympathetic activity and inhibits sympathetic activity. These effects promote reflex bradycardia, vasodilation and hypotension (Bezold-Jarisch reflex) and also modulate renin release and vasopressin secretion. Conversely, decreases in the activity of these inhibitory sensory receptors reflexly increase sympathetic activity, vascular resistance, plasma renin activity and vasopressin. Long regarded as pharmacologic curiosities, it is now clear that reflexes originating in these inhibitory cardiac sensory receptors are important to the pathophysiology of many cardiovascular disorders. This paper reviews the role of inhibitory cardiac sensory receptors in several clinical states including 1) bradycardia, hypotension and gastrointestinal disorders with inferoposterior myocardial ischemia and infarction, 2) bradycardia and hypotension during coronary arteriography, 3) exertional syncope in aortic stenosis, 4) vasovagal syncope, 5) neurohumoral excitation in chronic heart failure, and 6) the therapeutic effects of digitalis.
源于心脏的减压反射概念由冯·贝佐尔德于1867年提出，后由亚里什重新提出。贝佐尔德 - 亚里什反射起源于心脏感觉感受器，通过无髓迷走传入通路传导。左心室，尤其是下后壁，是这些感觉感受器的主要所在位置。通过拉伸、化学物质或药物刺激这些抑制性心脏感受器会增加副交感神经活动并抑制交感神经活动。这些效应会促进反射性心动过缓、血管舒张和低血压（贝佐尔德 - 亚里什反射），还会调节肾素释放和血管加压素分泌。相反，这些抑制性感觉感受器活动的降低会反射性地增加交感神经活动、血管阻力、血浆肾素活性和血管加压素。长期以来一直被视为药理学上的奇闻，现在很清楚，源于这些抑制性心脏感觉感受器的反射对许多心血管疾病的病理生理学很重要。本文综述了抑制性心脏感觉感受器在几种临床状态中的作用，包括1）伴有下后壁心肌缺血和梗死的心动过缓、低血压和胃肠道疾病，2）冠状动脉造影期间的心动过缓和低血压，3）主动脉瓣狭窄时的劳力性晕厥，4）血管迷走性晕厥，5）慢性心力衰竭中的神经体液兴奋，以及6）洋地黄的治疗作用。
