Trempy G A, Nyhan D P, Murray P A
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Anesthesiology. 1994 Sep;81(3):632-40. doi: 10.1097/00000542-199409000-00017.
Arginine vasopressin (AVP) is an important "stress" hormone that is known to play a key role in cardiovascular homeostasis of the systemic circulation. In contrast, the effects of AVP on the pulmonary circulation have not been extensively investigated, and the extent to which general anesthesia alters the pulmonary vascular response to AVP is entirely unknown. Our first objective was to assess the effects of AVP on the pulmonary vascular pressure-flow relation in chronically instrumented conscious dogs in the setting of an acute elevation in pulmonary vasomotor tone. Our second objective was to investigate the effects of halothane and pentobarbital anesthesia on the pulmonary vascular response to AVP after inducing the same degree of pulmonary preconstriction achieved in the conscious state.
Conditioned, mongrel dogs were chronically instrumented to measure the left pulmonary vascular pressure-flow (LPQ) relation. LPQ plots were generated by continuously measuring the pulmonary vascular pressure gradient (pulmonary arterial pressure minus left atrial pressure) and left pulmonary blood flow during gradual (approximately 1 min) inflation of a hydraulic occluder around the right pulmonary artery, which directed total pulmonary blood flow through the left pulmonary circulation. LPQ plots were generated in conscious (n = 10), halothane-anesthetized (n = 9) and pentobarbital-anesthetized (n = 7) dogs. In each condition, LPQ plots were measured at baseline, during the intravenous administration of the thromboxane analog U46619 and during the cumulative administration of AVP (2-19 ng.kg-1.min-1, intravenous) in the presence of U46619 preconstriction.
U46619 caused acute pulmonary vasoconstriction (P < 0.01) in conscious dogs. In this setting of U46619 preconstriction, AVP caused pulmonary vasodilation (P < 0.05) in the conscious state. In contrast, despite identical levels of U46619 preconstriction, the pulmonary vasodilator response to AVP was either reversed to vasoconstriction (P < 0.05) or abolished during halothane and pentobarbital anesthesia.
These results indicate that AVP exerts a significant pulmonary vasodilator response in the setting of acute pulmonary vasoconstriction in conscious dogs. However, the pulmonary vascular response to this stress hormone is markedly altered during halothane and pentobarbital anesthesia.
精氨酸加压素(AVP)是一种重要的“应激”激素,已知其在体循环的心血管稳态中起关键作用。相比之下,AVP对肺循环的影响尚未得到广泛研究,全身麻醉改变肺血管对AVP反应的程度则完全未知。我们的首要目标是评估在肺血管运动张力急性升高的情况下,AVP对长期植入仪器的清醒犬肺血管压力 - 流量关系的影响。我们的第二个目标是研究在诱导出与清醒状态下相同程度的肺预收缩后,氟烷和戊巴比妥麻醉对肺血管对AVP反应的影响。
对条件反射良好的杂种犬进行长期仪器植入,以测量左肺血管压力 - 流量(LPQ)关系。通过在围绕右肺动脉的液压阻塞器逐渐(约1分钟)充气期间连续测量肺血管压力梯度(肺动脉压减去左心房压)和左肺血流量来生成LPQ图,该操作可使全部肺血流通过左肺循环。在清醒犬(n = 10)、氟烷麻醉犬(n = 9)和戊巴比妥麻醉犬(n = 7)中生成LPQ图。在每种情况下,在基线、静脉注射血栓素类似物U46619期间以及在U46619预收缩存在的情况下累积静脉注射AVP(2 - 19 ng·kg⁻¹·min⁻¹)期间测量LPQ图。
U46619在清醒犬中引起急性肺血管收缩(P < 0.01)。在这种U46619预收缩的情况下,AVP在清醒状态下引起肺血管舒张(P < 0.05)。相比之下,尽管U46619预收缩水平相同,但在氟烷和戊巴比妥麻醉期间,肺血管对AVP的舒张反应要么逆转至血管收缩(P < 0.05),要么消失。
这些结果表明,在清醒犬急性肺血管收缩的情况下,AVP发挥显著的肺血管舒张反应。然而,在氟烷和戊巴比妥麻醉期间,肺血管对这种应激激素的反应会发生显著改变。