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肺迷走传入神经对氟烷麻醉猫气道阻塞所致呼吸窘迫的抑制作用。

The inhibitory influence of pulmonary vagal afferents on respiratory distress induced by airway occlusion in halothane-anesthetized cats.

作者信息

Sakurai Y, Ide T, Aono M, Nishino T

机构信息

Department of Anesthesiology, Chiba University School of Medicine, Japan.

出版信息

Anesth Analg. 1998 Feb;86(2):398-402. doi: 10.1097/00000539-199802000-00034.

Abstract

UNLABELLED

Although the sensation of dyspnea is common, the mechanisms underlying the sensation have not been fully elucidated. Dyspnea, which is a subjective sensation induced by various respiratory and nonrespiratory stimuli, ranges in intensity from an awareness of difficulty in breathing to an incapacitating state of respiratory distress. It need not be an all or none concept when tolerable; however, intolerable dyspnea is often accompanied by some kind of escape response. In a previous study, we developed a new concept of minimum alveolar anesthetic concentration for airway occlusion (MAC-AOR). Using this model, we assessed the influence of pulmonary vagal afferents on respiratory distress induced by airway occlusion. Adult cats (n = 13) of both sexes weighing 2.7-5.6 kg (3.9 +/- 0.3 kg, mean +/- SE) were anesthetized with halothane and tracheally intubated. After determination of MAC-AOR, anesthesia was maintained with the highest concentration of halothane permitting the positive motor response identified by visual inspection or electromyogram (EMG) of the forearm, usually of the head or extremities. Twisting or jerking of the head was considered a positive response, but twitching or grimacing was not. A slight movement of the shoulder and/or the extremities was not considered positive, nor were coughing, swallowing and chewing, or rigidity recognized as the increase of tonic activity on the forearm EMG. The duration from the start of airway occlusion to the onset of the positive response (DOCCL) was considered as behavioral measures of the tolerable limit of respiratory distress. DOCCL was measured before (Control 1), during, and after (Control 2) lung expansion induced by the injection of the inhaled gas of 5 mL/kg or 10 mL/kg (LE5 or LE10) at functional residual capacity level. Subsequently, 6 of 13 cats received bilateral vagotomies, and the same procedure was repeated at the same concentration as stated above. Then, MAC-AOR after vagotomy was determined again. Before vagotomy, the values of DOCCL during lung expansion (238 +/- 30 s during LE5 and 288 +/- 24 s during LE10) were significantly longer than Control 1 (169 +/- 29 s) and Control 2 (154 +/- 29 s) values (P < 0.01). After vagotomy, the effect of lung expansion on DOCCL was totally abolished. MAC-AOR after vagotomy (1.4% +/- 0.1%) was significantly higher than that before vagotomy (1.1% +/- 0.1%) (P < 0.01). We have demonstrated that vagotomy abolishes the prolongation effect of the lung expansion on DOCCL and increases the value of MAC-AOR in this animal model. These results suggest that pulmonary vagal afferents play an important role in relief of respiratory distress developed during airway occlusion.

IMPLICATIONS

In anesthetized cats, we found that lung expansion reduces the tolerable limit to airway occlusion and vagotomy decreased minimum alveolar anesthetic concentration for airway occlusion, which suggests that pulmonary vagal afferents play an important role in relief of respiratory distress.

摘要

未标注

尽管呼吸困难的感觉很常见,但其潜在机制尚未完全阐明。呼吸困难是由各种呼吸和非呼吸刺激引起的主观感觉,其强度范围从意识到呼吸困难到呼吸窘迫的失能状态。在可耐受时,它不一定是全或无的概念;然而,无法耐受的呼吸困难通常伴随着某种逃避反应。在先前的一项研究中,我们提出了气道阻塞时最小肺泡麻醉浓度(MAC-AOR)的新概念。使用该模型,我们评估了肺迷走传入神经对气道阻塞引起的呼吸窘迫的影响。选用体重2.7 - 5.6千克(平均3.9 ± 0.3千克,均值 ± 标准误)的成年猫(n = 13,雌雄不限),用氟烷麻醉并气管插管。在确定MAC-AOR后,用能允许通过视觉检查或前臂肌电图(EMG)识别出阳性运动反应(通常是头部或四肢的反应)的最高浓度氟烷维持麻醉。头部的扭转或抽搐被视为阳性反应,但颤动或做鬼脸则不是。肩部和/或四肢的轻微运动不被视为阳性,咳嗽、吞咽、咀嚼或前臂EMG上张力活动增加所识别的强直也不被视为阳性。从气道阻塞开始到出现阳性反应的持续时间(DOCCL)被视为呼吸窘迫可耐受极限的行为指标。在功能残气量水平注射5毫升/千克或10毫升/千克吸入气体诱导肺扩张(LE5或LE10)之前(对照1)、期间和之后(对照2)测量DOCCL。随后,13只猫中的6只接受双侧迷走神经切断术,并在与上述相同浓度下重复相同程序。然后再次确定迷走神经切断术后的MAC-AOR。在迷走神经切断术前,肺扩张期间的DOCCL值(LE5期间为238 ± 30秒,LE10期间为288 ± 24秒)显著长于对照1(169 ± 29秒)和对照2(154 ± 29秒)的值(P < 0.01)。迷走神经切断术后,肺扩张对DOCCL的影响完全消失。迷走神经切断术后的MAC-AOR(1.4% ± 0.1%)显著高于迷走神经切断术前(1.1% ± 0.1%)(P < 0.01)。我们已经证明,在这个动物模型中,迷走神经切断术消除了肺扩张对DOCCL的延长作用,并增加了MAC-AOR的值。这些结果表明,肺迷走传入神经在缓解气道阻塞期间发生的呼吸窘迫中起重要作用。

启示

在麻醉猫中,我们发现肺扩张降低了气道阻塞的可耐受极限,迷走神经切断术降低了气道阻塞时的最小肺泡麻醉浓度,这表明肺迷走传入神经在缓解呼吸窘迫中起重要作用。

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