Randall D C, Evans J M, Billman G E, Ordway G A, Knapp C F
J Auton Nerv Syst. 1981 Feb;3(1):87-99. doi: 10.1016/0165-1838(81)90032-1.
Three basic mechanisms may be involved in the control of cardiac function during acute coronary occlusion: (1) neural; (2) hormonal (circulating catecholamine); and (3) intrinsic (e.g. Frank--Starling law). The response of intact, sedated (Innovar-Vet, 0.08 cc/kg), chronically instrumented dogs to a 5 min left circumflex coronary occlusion was tested to delineate the relative roles of each of the above mechanisms. First, 6 innervated and 6 cardiac denervated dogs were examined. The major difference between groups was that the occlusion-induced tachycardia was significantly smaller in the denervated dogs than in the normally innervated animals (+10 +/- 7 vs +27 +/- 4/min, respectively, (mean +/- S.D.)). Changes in the first time derivative of left ventricular pressure (d(LVP)/dt) were similar (--898 +/- 556 vs --796 +/- 274 mm Hg/sec, denervated vs innervated). Decreases in stroke volume and mean arterial pressure were also similar in the two groups. The occlusion-induced tachycardia was compared in a second group of denervated dogs (n = 5) before and after administration of propranolol to examine the role of circulating catecholamines, and, by exclusion, to observe the response of the heart per se, independently of extrinsic control factors. The heart rate response was similar in both cases (+8 +/- 4 vs +6 +/- 4/min, unblocked vs blocked). Finally, blood pressure was prevented from falling during coronary occlusion in 3 normally innervated dogs by coupling the femoral artery to a reservoir of saline suspended above the animals. Blunting the input to the baroreceptors in this manner did not significantly change the size of the occlusion-induced tachycardia. We conclude that during acute coronary occlusion in dog: (1) the major role of the cardiac nerves involves modulating changes in the chronotropic state of the heart; (2) changes in d(LVP)/dt result principally from intrinsic phenomena linked to ischemia-induced alterations in myocardial performance; (3) changes in circulating catecholamines play only a minor role in controlling the heart during acute coronary occlusion in denervated dog; and (4) receptors located within the heart figure significantly in the etiology of the occlusion-induced tachycardia.
急性冠状动脉闭塞期间,心脏功能的控制可能涉及三种基本机制:(1)神经机制;(2)激素机制(循环儿茶酚胺);(3)内在机制(如Frank-Starling定律)。通过测试完整、镇静(Innovar-Vet,0.08 cc/kg)且长期植入仪器的犬只对左旋支冠状动脉闭塞5分钟的反应,来明确上述每种机制的相对作用。首先,检查了6只神经完整和6只心脏去神经的犬只。两组之间的主要差异在于,去神经犬只中闭塞诱导的心动过速明显小于正常神经支配的动物(分别为+10±7次/分钟和+27±4次/分钟,(平均值±标准差))。左心室压力的一阶导数(d(LVP)/dt)的变化相似(去神经组与神经完整组分别为-898±556和-796±274 mmHg/秒)。两组的每搏输出量和平均动脉压的降低也相似。在第二组去神经犬只(n = 5)中,比较了给予普萘洛尔前后闭塞诱导的心动过速,以研究循环儿茶酚胺的作用,并通过排除法观察心脏本身独立于外在控制因素的反应。两种情况下的心率反应相似(未阻断与阻断分别为+8±4次/分钟和+6±4次/分钟)。最后,通过将股动脉与动物上方悬挂的生理盐水储存器相连,防止了3只正常神经支配犬只在冠状动脉闭塞期间血压下降。以这种方式减弱压力感受器的输入并未显著改变闭塞诱导的心动过速的幅度。我们得出结论,在犬只急性冠状动脉闭塞期间:(1)心脏神经的主要作用涉及调节心脏变时状态的变化;(2)d(LVP)/dt的变化主要源于与缺血诱导的心肌性能改变相关的内在现象;(3)循环儿茶酚胺的变化在去神经犬只急性冠状动脉闭塞期间对心脏的控制中仅起次要作用;(4)心脏内的受体在闭塞诱导的心动过速的病因中起重要作用。