Backman S B, Stein R D, Polosa C
Department of Anaesthesia, Royal Victoria Hospital, Montreal, Quebec, Canada.
Anesth Analg. 1999 Feb;88(2):320-5. doi: 10.1097/00000539-199902000-00017.
Detailed information on the outflow pathway of sympathetic vasoconstrictor fibers to the upper extremity is lacking. We studied the organization of the sympathetic innervation of the forelimb resistance vessels and of the sinoatrial (SA) node in the decerebrated, artificially respirated cat. The distal portion of sectioned individual rami T1-8 and the sympathetic chain immediately caudal to T8 on the right side were electrically stimulated while the right forelimb perfusion pressure (forelimb perfused at constant flow) and heart rate were recorded. Increases in perfusion pressure were evoked by stimulation of T2-8 (maximal response T7: 55 +/- 2.3 mm Hg). Responses were still evoked by stimulation of the sympathetic chain immediately caudal to T8 (44 +/- 15 mm Hg). Increases in heart rate were evoked by the stimulation of more rostral rami (T1-5; maximal response T3: 55.2 +/- 8 bpm). These vasoconstrictor and cardioacceleratory responses were blocked by the cholinergic antagonists hexamethonium and scopolamine. Sectioning of the vertebral nerve and the T1 ramus abolished the vasoconstrictor response. Stimulation of the vertebral nerve and of the proximal portion of the sectioned T1 ramus increased perfusion pressure (69 +/- 9 and 34 +/- 14 mm Hg, respectively), which was unaffected by ganglionic cholinergic block. These data suggest that forelimb resistance vessel control is subserved by sympathetic preganglionic neurons located mainly in the middle to caudal thoracic spinal segments. Some of the postganglionic axons subserving vasomotor function course through the T1 ramus, in addition to the vertebral nerve.
Forelimb vasculature is controlled by sympathetic preganglionic neurons located in middle to caudal thoracic spinal segments and by postganglionic axons carried in the T1 ramus and vertebral nerve. This helps to provide the anatomical substrate of interruption of sympathetic outflow to the upper extremity produced by major conduction anesthesia of the stellate ganglion or spinal cord.
目前缺乏关于交感缩血管纤维至上肢流出途径的详细信息。我们研究了去大脑、人工呼吸猫的前肢阻力血管和窦房结的交感神经支配组织。在右侧切断T1 - 8各分支的远端部分以及T8尾侧紧邻的交感干并进行电刺激,同时记录右前肢灌注压(前肢以恒定流量灌注)和心率。刺激T2 - 8可引起灌注压升高(最大反应在T7:55±2.3 mmHg)。刺激T8尾侧紧邻的交感干仍可引起反应(44±15 mmHg)。刺激更靠头侧的分支(T1 - 5)可引起心率加快(最大反应在T3:55.2±8次/分钟)。这些血管收缩和心脏加速反应被胆碱能拮抗剂六甲铵和东莨菪碱阻断。切断椎动脉和T1分支可消除血管收缩反应。刺激椎动脉和切断的T1分支近端可使灌注压升高(分别为69±9和34±14 mmHg),这不受神经节胆碱能阻滞的影响。这些数据表明,前肢阻力血管的控制由主要位于胸段脊髓中下部至尾段的交感节前神经元提供。除椎动脉外,一些支配血管运动功能的节后轴突经T1分支走行。
前肢血管系统由位于胸段脊髓中下部至尾段的交感节前神经元以及经T1分支和椎动脉走行的节后轴突控制。这有助于为星状神经节或脊髓主要传导麻醉导致的上肢交感神经流出中断提供解剖学基础。