Ullman J E, Hjelmqvist H, Rundgren M
Department of Anaesthesiology, Karolinska Hospital, Stockholm, Sweden.
Acta Physiol Scand. 1996 Jun;157(2):265-74. doi: 10.1046/j.1365-201X.1996.497242000.x.
Intracerebroventricular (i.c.v.) infusion of hypertonic NaCl improves the tolerance to haemorrhage in sheep. Since i.c.v. angiotensin II (ANG II) shares many of the effects of hypertonic NaCl on fluid balance control and blood pressure, we aimed to determine whether i.c.v. ANG II would also be effective in that regard. Six adult conscious ewes were bled from the jugular vein until the mean arterial pressure suddenly dropped to between 45 and 50 mmHg, during an i.c.v. infusion of ANG II (2 pmol kg-1 min-1) which commenced 30 min prior to start of blood removal and continued until end of retransfusion about 80 min after haemorrhage. A corresponding haemorrhage in the same animals during an i.c.v. infusion of 0.9% NaCl served as controls. Significantly more blood had to be withdrawn to induce hypotension when ANG II was given i.c.v. (22.3 +/- 1.8 vs. 12.6 +/- 1.2 mL kg-1). The degree of hypotension and the recovery rate of the blood pressure did not differ between the experiments. The increased tolerance to blood loss by ANG II i.c.v. was accompanied by a reinforced elevation of the systemic vascular resistance and a larger decline of the cardiac output. The plasma norepinephrine concentration was significantly increased immediately after haemorrhage during i.c.v. ANG II, but not in control experiments. The overall vasopressin response to the hypotensive blood loss was not affected by ANG II, but high plasma levels were obtained already during the non-hypotensive stage of haemorrhage. The i.c.v. infusion of ANG II caused a significant lowering of the plasma protein concentration before start of bleeding and accentuated the haemodilution caused by the haemorrhage. We conclude that central administration of ANG II increases the tolerance to haemorrhage in sheep but with concomitant haemodynamic changes which appear unfavourable regarding cardiac load and tissue perfusion.
脑室内(i.c.v.)输注高渗氯化钠可提高绵羊对出血的耐受性。由于脑室内血管紧张素II(ANG II)在液体平衡控制和血压方面具有许多与高渗氯化钠相同的作用,我们旨在确定脑室内注射ANG II在这方面是否也有效。对6只成年清醒母羊进行颈静脉放血,直到平均动脉压突然降至45至50 mmHg之间,在此期间进行脑室内ANG II(2 pmol kg-1 min-1)输注,该输注在放血开始前30分钟开始,并持续到出血后约80分钟再输血结束。在脑室内输注0.9%氯化钠时,对同一动物进行相应的放血作为对照。当脑室内给予ANG II时,需要抽取更多的血液才能诱发低血压(22.3±1.8 vs. 12.6±1.2 mL kg-1)。实验之间的低血压程度和血压恢复率没有差异。脑室内给予ANG II导致对失血的耐受性增加,同时全身血管阻力增强,心输出量下降幅度更大。在脑室内给予ANG II的出血后,血浆去甲肾上腺素浓度立即显著升高,但在对照实验中未出现这种情况。ANG II对低血压性失血的总体血管加压素反应不受影响,但在出血的非低血压阶段血浆水平就已经升高。脑室内输注ANG II在出血开始前导致血浆蛋白浓度显著降低,并加重了出血引起的血液稀释。我们得出结论,中枢给予ANG II可增加绵羊对出血的耐受性,但同时伴随着血流动力学变化,这对心脏负荷和组织灌注似乎不利。