Caldwell M T, Marks P, Byrne P J, Walsh T N, Hennessy T P
University Department of Surgery, St. Jame's Hospital, Dublin, Ireland.
Surgery. 1994 Nov;116(5):921-4.
Coronary artery disease and gastroesophageal reflux disease frequently coexist, but a direct pathophysiologic link has not been established.
This study examines the effect of myocardial vagal receptor stimulation on lower esophageal sphincter (LES) tone in eight adult mongrel dogs, each acting as its own control. Pharmacologic stimulation was carried out by the application of 1 cm gauze patches soaked in nicotine (200 micrograms/ml) to the epicardium. Epicardial vagal receptors were stimulated mechanically by digital friction.
Pharmacologic stimulation produced a rapid fall in LES tone from a mean (SEM) of 12.6 (1.5) to 8.6 (0.9) sphinctometer units (p = 0.007). Mechanical stimulation also produced a rapid fall from 12.0 (1.5) sphinctometer units to 6.8 (0.7) (p = 0.007). Both were associated with a drop in mean arterial blood pressure and heart rate. Sham patches soaked in sterile water produced no effects.
These data suggest a direct vagal reflex linking the myocardium and the LES that may explain the high incidence of gastroesophageal reflux in patients with heart disease.
冠状动脉疾病与胃食管反流病常同时存在，但尚未建立直接的病理生理联系。
本研究检测了八只成年杂种犬心肌迷走神经受体刺激对食管下括约肌（LES）张力的影响，每只犬均作为自身对照。通过将浸泡在尼古丁（200微克/毫升）中的1厘米纱布贴片敷于心外膜进行药物刺激。通过手指摩擦机械刺激心外膜迷走神经受体。
药物刺激使LES张力迅速下降，从平均（标准误）12.6（1.5）括约肌计单位降至8.6（0.9）（p = 0.007）。机械刺激也使LES张力从12.0（1.5）括约肌计单位迅速降至6.8（0.7）（p = 0.007）。两者均伴有平均动脉血压和心率下降。浸泡在无菌水中的假贴片无作用。
这些数据提示存在一种连接心肌和LES的直接迷走神经反射，这可能解释了心脏病患者胃食管反流的高发生率。
