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对呼吸暂停的反应中肾交感神经活动和血压的反射性刺激。

Reflex stimulation of renal sympathetic nerve activity and blood pressure in response to apnea.

作者信息

O'Donnell C P, Schwartz A R, Smith P L, Robotham J L, Fitzgerald R S, Shirahata M

机构信息

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.

出版信息

Am J Respir Crit Care Med. 1996 Dec;154(6 Pt 1):1763-70. doi: 10.1164/ajrccm.154.6.8970368.

Abstract

The purpose of this study was to examine the role of afferent input in the reflex modulation of renal sympathetic nerve activity (SNA) in response to apnea. Apneas of 20-, 40-, and 60-s duration were induced in the anesthetized, paralyzed cat (n = 7) ventilated with either room air or 100% oxygen. While receiving room air, there were increases (p < 0.005) in renal SNA of 34.5 +/- 4.2%, 53.3 +/- 6.4%, and 59.9 +/- 7.2% of maximum during the 20-, 40-, and 60-s apneas, respectively. There were corresponding increases (p < 0.025) in mean arterial pressure (Pa) of 9 +/- 3, 30 +/- 9, and 45 +/- 12 mm Hg during the 20-, 40-, and 60-s apneas while receiving room air, respectively. The effect of 100% oxygen was to reduce (p < 0.0001) the renal SNA response to apnea, at a matched level of PaCO2, by at least 80%, and to eliminate any increase in Pa. During the first breath of the postapneic period, there was a partial inhibition of renal SNA. During the second and third breaths of the postapneic period, there was a marked fall in renal SNA that was associated with a precipitous decline in directly recorded carotid chemoreceptor activity (n = 2). The magnitude of the fall in renal SNA after apnea was related to the degree of postapneic hypertension. We conclude that hypoxic chemoreceptor stimulation is the predominant factor generating the renal SNA response to apnea, with modulating inputs from thoracic afferents and arterial baroreceptors likely contributing to the marked inhibition of renal SNA immediately after the apnea.

摘要

本研究的目的是探讨传入神经输入在肾交感神经活动(SNA)对呼吸暂停的反射调节中的作用。在麻醉、麻痹的猫(n = 7)中诱发持续20秒、40秒和60秒的呼吸暂停,分别用室内空气或100%氧气进行通气。在吸入室内空气时,在20秒、40秒和60秒呼吸暂停期间,肾SNA分别增加至最大值的34.5±4.2%、53.3±6.4%和59.9±7.2%(p < 0.005)。在吸入室内空气时,在20秒、40秒和60秒呼吸暂停期间,平均动脉压(Pa)分别相应增加9±3、30±9和45±12 mmHg(p < 0.025)。100%氧气的作用是在匹配的PaCO2水平下,将肾SNA对呼吸暂停的反应降低至少80%(p < 0.0001),并消除Pa的任何增加。在呼吸暂停后时期的第一次呼吸时,肾SNA受到部分抑制。在呼吸暂停后时期的第二次和第三次呼吸时,肾SNA显著下降,这与直接记录的颈动脉化学感受器活动的急剧下降有关(n = 2)。呼吸暂停后肾SNA下降的幅度与呼吸暂停后高血压的程度有关。我们得出结论,低氧化学感受器刺激是产生肾SNA对呼吸暂停反应的主要因素,来自胸段传入神经和动脉压力感受器的调节性输入可能导致呼吸暂停后立即对肾SNA的显著抑制。

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