Jacobsen T N, Kassis E, Amtorp O
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Am J Cardiol. 1993 Aug 15;72(5):418-22. doi: 10.1016/0002-9149(93)91133-3.
Patients with heart failure have impaired baroreflex control of the peripheral circulation with attenuated vasoconstrictor response during orthostatic stress. The aim of this study was to test if this impaired baroreflex control not only affects the arterial, but also the capillary bed. Blood flow and capillary filtration were measured in the forearm (plethysmography) in 7 normal subjects and 7 patients with mild congestive heart failure (New York Heart Association functional class II). Measurements were done with the subjects supine and during head-up tilt at 45 degrees. While supine, forearm vascular resistance and capillary filtration coefficient did not differ significantly between the groups. In the control subjects, tilt decreased capillary filtration coefficient by 14 +/- 3% (p < 0.02), and increased forearm vascular resistance by 88 +/- 37% (p < 0.02); in contrast, patients with heart failure had an increase in capillary filtration coefficient of 26 +/- 5% (p < 0.02) and only increased the forearm vascular resistance by 10 +/- 1%, (p = NS, p = 0.26). Our data provide evidence that patients with mild heart failure, in contrast to normal subjects, increase the peripheral capillary filtration during orthostatic stress. The data indicate that impaired baroreflex mechanisms might influence the capillary filtration and it is suggested that impaired baroreflex control of the peripheral circulation can contribute to formation of edema in patients with heart failure.
心力衰竭患者在体位性应激期间压力反射对周围循环的控制受损，血管收缩反应减弱。本研究的目的是检验这种受损的压力反射控制是否不仅影响动脉，还影响毛细血管床。对7名正常受试者和7名轻度充血性心力衰竭患者（纽约心脏协会心功能II级）的前臂进行血流量和毛细血管滤过的测量（体积描记法）。测量在受试者仰卧位和头高位倾斜45度时进行。仰卧位时，两组之间的前臂血管阻力和毛细血管滤过系数无显著差异。在对照组中，倾斜使毛细血管滤过系数降低14±3%（p<0.02），前臂血管阻力增加88±37%（p<0.02）；相比之下，心力衰竭患者的毛细血管滤过系数增加26±5%（p<0.02），而前臂血管阻力仅增加10±1%（p=无显著性差异，p=0.26）。我们的数据表明，与正常受试者相比，轻度心力衰竭患者在体位性应激期间会增加外周毛细血管滤过。数据表明，受损的压力反射机制可能影响毛细血管滤过，提示压力反射对周围循环的控制受损可能促成心力衰竭患者水肿的形成。
