心机械感受性反射

心机械感受器分布于心房和心室的内膜、心肌和心包膜上,它们兴奋时发放的冲动经迷走有髓纤维、迷走无髓纤维或交感纤维传入。经迷走有髓纤维传入的心感受性反射可引起心率加速和利尿作用。经迷走无髓纤维传入的心感受性反射有调节(抑制)心血管活动及抑制肾素释放的功能;而经交感纤维传入的心感受性反射则调节心血管活动(主要为兴奋性心血管反射)。本文还讨论了心肌缺血时的心反射及其作用机理。     

清醒大鼠室旁核微量注射心房钠尿肽对压力感受性反射敏感性的影响

心房钠尿肽(atriaI natriuretic peptide,ANP)作为一种神经递质或调质可能参与心血管活动的中枢调节。本实验在清醒大鼠室旁核(paraventricular nucleus,PVN)注射ANP,探讨其对压力感受性反射敏感性的影响,并通过侧脑室注射血管升压素受体Ⅰ阻断剂OPC-21268,观察ANP对压力感受性反射敏感性的调节是否与中枢血管升压素有关。实验中观察到,在PVN内微量注射ANP(6、60 ng/0.2μl)可明显提高压力感受性反射敏感性(P<0.05),侧脑室预先注射OPC-21268 (0,45 μg/3 μl)后,ANP对压力感受性反射敏感性的增强作用明显减弱(P<0.05)。静脉注射ANP(60 ng/0.04 ml)不影响压力感受性反射敏感性。上述结果提示,心房钠尿肽对压力感受性反射活动起易化作用,心房钠尿肽的这种中枢作用可能部分通过中枢血管升压素介导。     

卧床前后压力感受性反射机能变化的研究

许多数据表明长期失重以后立位耐力降低可能与压力感受性反射功能的改变有关。本文比较了两组被试者15天低动力卧床前后的立位耐力。以血压调节模型为基础分析了两种不同方式卧床前后单纯立位和下身负压加立位时压力感受性反射功能的改变,并用颈部加压及下身负压对中枢调节功能改变进行了观察。结果表明严格的头低位卧床后,立位耐力下降及压力感受性反射功能改变明显大于半日平卧半日倚坐者。而压力感受性反射功能的改变,特别是中枢神经系统调节功能的紊乱,是卧床后立位耐力降低的主要原因。从这种考虑为基础,作者提出了改变失重或模拟失重状态下的血液分布,调整对压力感受器的刺激,可能是预防心血管失调的有效方法。     

中枢血管紧张素对心血管活动调节作用

血管紧张素(Ang)广泛存在于中枢神经系统和外周组织中,对心血管活动和交感神经活动起重要调节作用。本文介绍了孤束核(NTS)、延髓头端腹侧区(RVLM)、延髓尾端腹侧区(CVLM)和室旁核(PVN)内Ang对心血管活动的影响,Ang对动脉压力感受性反射(ABR)和心交感传入反射(CSAR)的调节作用,肾素-血管紧张素系统的基因敲除研究,以及Ang与高血压和慢性心力衰竭的关系。     

缓冲神经在电针抑制犬急性实验性高血压中的作用

在切除双侧窦神经与主动脉弓神经的慢性犬,血压很快回复至对照水平,但较易波动。在此种犬静脉匀速注射去甲肾上腺素造成高血压状态时,电针“足三里”不再有明显降压作用。在麻醉犬静脉勻速注射去甲肾上腺素时,肾交感冲动随血压上升而受到明显抑制,然后在16分钟内逐渐回升。血压上升时呼出气 CO_2百分比明显升高,伴随动脉血 CO_2分压升高而 O_2分压降低。在切除缓冲神经后再注射去甲肾上腺素时,肾交感冲动未见明显变化。在清醒犬静脉匀速注射去甲肾上腺素时,动脉血 O_2分压也有明显降低,而注射苯肾上腺素时,血 O_2分压很少改变。电针“足三里’对苯肾上腺素性高血压的降压作用不明显。且心得安可阻断电针对去甲肾上腺素性高血压的降压作用。此外,电针能抑制山梗菜碱所致的化学感受性升压反射,此种抑制作用可为静脉注射纳洛酮所阻断。结果表明,去甲肾上腺素除能收缩血管升高血压,增加压力感受性传入冲动外,还能刺激新陈代谢,改变血液气体成分而引起化学感受性升压反射。电针“足三里”主要因能抑制化学感受性反射而能降压,仅有压力感受性传入冲动的增多并不能使电针具有明显降压效应。     

Ca^2＋参链霉素对大鼠颈动脉窦压力感受器反射影响中的作用

在２３只隔离灌流颈动脉窦区的麻醉大鼠上,观察了链霉素（ｓｔｒｅｐｔｏｍｙｃｉｎ,ＳＭ）对动脉压力感受器反射影响的离子机制。结果：（１）用ＳＭ（２００μｍｏｌ／Ｌ）隔离灌流大鼠颈动脉窦区时,压力感受器机能曲线向右上方移位,曲线最大斜率及反射性血压下降幅度均减小（Ｐ〈０．０１）,提示ＳＭ对压力感受器反射的抑制作用;（２）预先灌流高Ｃａ＾２＋溶液（４ｍｍｏｌ／Ｌ）后,可部分消除ＳＭ（２００μｍｏｌ／Ｌ）     

内皮素对麻醉大鼠动脉压力感受器反射的调制作用

在27只隔离灌流颈动脉窦区的麻醉大鼠,观察了内皮素（ET-1）对动脉压力感受器反射的调制作用。结果如下：（1）在颈动脉窦区灌流1nmol／L的ET-1时,压力感受器机能曲线向左下方移位,曲线的最大斜率（PS）由0.40±0.02增至0.51±0.02kPa／kPa（P＜0.01）,压力感受器反射性血压下降幅度（RD）由5.66±0.23增至6.76±0.22kPa（P＜0.01）。由此提示,这一剂量的FT-1对压力感受器反射有易化作用。（2）用10nmol／L的ET-1灌流时,压力感受器机能曲线则向右上方移位,PS降至0.28±0.01kPa／kPa（P＜0.01）,RD降至4．16±0.19kPa（P＜0.01）;100nmol／L的ET-1可使压力感受器机能曲线向右上方移位更为明显,PS降至0.19±0.03kPa（P＜0.001）,RD进一步降至3.33±0.38kPa（P＜0.001）。这些结果表明,上述两种剂量的ET-1对压力感受器反射有抑制作用。（3）ETA受体选择性阻断剂BQ123（0.15μmol／L）可以阻断ET-1（10nmol／L）对压力感受器反射的抑制效应。（4）预先灌流KATP通道阻断剂格列苯脲（10μmol／L）,也可阻断ET-1的效应。综上所述,ET-1对压力感受器反射有双重效应,低剂量时有易化作用,而较高剂量时则有抑制作用,后一作用由ET-1型受体介导并有KATP通道的参与。     

清醒大鼠室旁核灌流谷氨酸受体阻断剂对压力感受性反射的影响

目的:探讨下丘脑室旁核(PVN)内谷氨酸参与压力感受性反射中枢调节的神经化学机制。方法:在清醒大鼠,用脑部微量透析法和高效液相色谱法观察静脉注射苯肾上腺素诱发压力感受性反射对PVN区谷氨酸含量的影响;NMDA受体阻断剂MK-801或非NMDA受体阻断剂CNQX直接灌流PVN区并诱发压力感受性反射,进一步探讨PVN区谷氨酸对压力感受性反射的作用。结果:①静脉注射苯肾上腺素诱发压力感受性反射时,PVN内的谷氨酸含量迅速升高到注射前的384.82%±91.77%(P<0.01)。②PVN区灌流谷氨酸受体阻断剂MK-801或CNQX,同时诱发压力感受性反射,其血压升值明显减少,心率降值明显增加(P<0.01),压力感受性反射的敏感性(△HR/△MAP)明显增加(P<0.01)。结论:PVN内的谷氨酸可能通过离子型谷氨酸受体参与压力感受性反射的中枢调节,而且此调节作用可能是抑制性的。     

动脉压力感受器反射与高血压

关于颈动脉窦和主动脉弓压力感受器反射与高血压关系的研究,近年来已取得了不少进展。本文着重介绍动脉压力感受器反射在血压调控中的作用,分析高血压状态下该反射的机能特征及可能发生变化的各个环节。     

Bezold—Jarisch反射的生理机制与病理生理意义

Bezold-Jarisch反射是源于心脏内感受器的抑制性反射,其感受器主要分布在左心室,化学性和机械性刺激均可使之兴奋。感觉冲动经迷走神经无髓纤维上传,反射地引起交感传出活动减弱和迷走传出活动增强,终致心动徐缓和低血压。急性心肌梗塞、冠脉造影和劳力性晕厥时,有Bezold-Jarisch反射参与;慢性心衰和高血压时,心脏内感受器发生重调,反射的敏感性降低。     

Impact of L-NAME on the cardiopulmonary reflex in cardiac hypertrophy

There is evidence that in cardiac failure, there is defective baroreceptor reflex control of sympathetic nerve activity. Often, cardiac failure is preceded by a state of cardiac hypertrophy in which there may be enhanced performance of the heart. This study investigated whether in two different models of cardiac hypertrophy, there was an increased contribution of nitric oxide (NO) to the low-pressure baroreceptor regulation of renal sympathetic nerve activity (RSNA) and nerve-dependent excretory function. Administration of a volume load, 0.25* body wt/min saline for 30 min, in normal rats decreased RSNA by 40* and increased urine flow by some 9-fold. Following nitro-L-arginine methyl ester (L-NAME) administration, 10 μg·kg(-1)·min(-1) for 60 min, which had no effect on blood pressure, heart rate, or RSNA, the volume load-induced renal sympathoinhibitory and excretory responses were markedly enhanced. In cardiac hypertrophy states induced by 2 wk of isoprenaline/caffeine or 1 wk thyroxine administration, the volume challenge failed to suppress RSNA, and there were blunted increases in urine flow in the innervated kidneys, but following L-NAME infusion, the volume load decreased RSNA by 30-40* and increased urine flow by some 20-fold in the innervated kidneys, roughly to the same extent as observed in normal rats. These findings suggest that the blunted renal sympathoinhibition and nerve-dependent diuresis to the volume load in cardiac hypertrophy are related to a heightened production or activity of NO within either the afferent or central arms of the reflex.     

A Biofeedback System of Baroreceptor Cardiac Reflex Sensitivity

The evidence presently available suggests that the parasympathetic nervous system and sympathetic-parasympathetic interactions could play a role in the pathophysiology of cardiovascular disorders and, specifically, in hypertension. A loss of sensitivity of the baroreceptor reflex is one of the fundamental mechanisms underlying the deficits found in parasympathetic cardiac control. The baroreceptor reflex is a basic mechanism for the regulation of blood pressure, a powerful source of vagal afferent input to the central nervous system, and one of the most important physiological mechanisms affecting efferent cardiac vagal activity. This paper describes a computerized system for the on-line analysis of the baroreceptor cardiac reflex function using the noninvasive spontaneous sequence method in the time domain. The system provides feedback of the baroreceptor reflex sensitivity (the change in heart period per unit change in systolic blood pressure) differentially both when the systolic blood pressure is increasing and when it is decreasing. The accuracy of the described system has been tested against the conventional off-line procedure. None of the parameters supplied by the analysis show a significant difference between the on-line and off-line methods. These results confirm the accuracy of the on-line system to analyze baroreceptor cardiac reflex function.     

The origin of sympathetic outflow in heart failure: the roles of angiotensin II and nitric oxide

The regulation of sympathetic nerve activity in chronic heart failure (CHF) has been an area of renewed investigation. Understanding the central mechanisms that are responsible for sympatho-excitation in this disease state may help in reducing the deleterious effects of chronic sympatho-excitation. This review will summarize our understanding of abnormal reflex control of the circulation in CHF. The roles of the arterial baroreflex, the chemoreflex, the cardiac sympathetic afferent reflex and the cardiopulmonary reflex are discussed. New experimental techniques that allow genetic manipulation of substances such as nitric oxide synthase in discrete areas of the brain aid in clarifying the role of NO in the modulation of sympathetic tone in the CHF state. Lastly, clinical implications of this work are discussed.     

Aspects of cardiovascular reflexes in pathologic states

Cardiovascular reflexes that are mediated by receptors in the heart and blood vessels control a variety of important hemodynamic and humoral functions. The action of these receptors can be shown to be abnormal in several pathologic states. Left atrial receptors exhibit a depressed discharge sensitivity in dogs with chronic congestive heart failure caused by an aortocaval fistula. The reflex effects of atrial receptor stimulation are also depressed in heart failure. Left ventricular receptor stimulation has been implicated in the abnormal vascular responses to exercise in patients with aortic stenosis. The arterial baroreflex control of heart rate is abnormal in animals and humans with various forms of hypertension. Arterial baroreceptors from hypertensive animals show a resetting of their pressure-discharge curve to higher pressures. The arterial baroreflex is also depressed in chronic heart failure. This effect may result from an abnormality of the efferent limb of the reflex arc or from changes in the interaction between baroreceptors and cardiac receptors centrally. A final possibility may be abnormal arterial baroreceptor discharge characteristics in heart failure.     

Oxidative stress impairs cardiac chemoreflexes in diabetic rats

We investigated the effects of diabetes mellitus and antioxidant treatment on the sensory and reflex function of cardiac chemosensory nerves in rats. Diabetes was induced by streptozotocin (STZ; 85 mg/kg ip). Subgroups of sham- and STZ-treated rats were chronically treated with an antioxidant, vitamin E (60 mg/kg per os daily, started 2 days before STZ). Animals were studied 6-8 wk after STZ injection. We measured renal sympathetic nerve activity (RSNA), mean arterial blood pressure (MABP), and cardiac vagal and sympathetic afferent activities in response to stimulation of chemosensitive sensory nerves in the heart by epicardial application of capsaicin (Caps) and bradykinin (BK). In cardiac sympathetic-denervated rats, Caps and BK (1-10.0 microg) evoked a vagal afferent mediated reflex depression of RSNA and MABP, which was significantly blunted in STZ-treated rats (P < 0.05). In vagal-denervated rats, Caps and BK (1-10.0 microg) evoked a sympathetic afferent-mediated reflex elevation of RSNA and MABP, which also was significantly blunted in STZ-treated rats (P < 0.05). Chronic vitamin E treatment effectively prevented these cardiac chemoreflex defects in STZ-treated rats without altering resting blood glucose or hemodynamics. STZ-treated rats with insulin replacement did not exhibit impaired cardiac chemoreflexes. In afferent studies, Caps and BK (0.1 g-10.0 microg) increased cardiac vagal and sympathetic afferent nerve activity in a dose-dependent manner in sham-treated rats. These responses were significantly blunted in STZ-treated rats. Vitamin E prevented the impairment of afferent discharge to chemical stimulation in STZ rats. The following were concluded: STZ-induced, insulin-dependent diabetes in rats extensively impairs the sensory and reflex properties of cardiac chemosensitive nerve endings, and these disturbances can be prevented by chronic treatment with vitamin E. These results suggest that oxidative stress plays an important role in the neuropathy of this autonomic reflex in diabetes.     

Invited review: aging and the cardiovascular system.

Aging is associated with complex and diversified changes of cardiovascular structure and function. The heart becomes slightly hypertrophic and hyporesponsive to sympathetic (but not parasympathetic) stimuli, so that the exercise-induced increases in heart rate and myocardial contractility are blunted in older hearts. The aorta and major elastic arteries become elongated and stiffer, with increased pulse wave velocity, evidence of endothelial dysfunction, and biochemical patterns resembling early atherosclerosis. The arterial baroreflex is sizably altered in aging, but different components are differentially affected: there is a definite impairment of arterial baroreceptor control of the heart but much better preserved baroreceptor control of peripheral vascular resistance. Alterations at the afferent, central neural, efferent, and effector organ portions of the reflex arch have been claimed to account for age-related baroreflex changes, but no conclusive evidence is available on this mechanistic aspect. Reflexes arising from cardiopulmonary vagal afferents are also blunted in aged individuals. The cardiovascular and reflex changes brought about by aging may have significant implications for circulatory homeostasis in health and disease.     

Effect of aging on baroreflex function in humans

Arterial blood pressure (BP) is regulated via the interaction of various local, humoral, and neural factors. In humans, the major neural pathway for acute BP regulation involves the baroreflexes. In response to baroreceptor activation/deactivation, as occurs during transient changes in BP, key determinants of BP, such as cardiac period/heart rate (via the sympathetic and parasympathetic nervous system) and vascular resistance (via the sympathetic nervous system), are modified to maintain BP homeostasis. In this review, the effects of aging on both the parasympathetic and sympathetic arms of the baroreflex are discussed. Aging is associated with decreased cardiovagal baroreflex sensitivity (i.e., blunted reflex changes in R-R interval in response to a change in BP). Mechanisms underlying this decrease may involve factors such as increased levels of oxidative stress, vascular stiffening, and decreased cardiac cholinergic responsiveness with age. Consequences of cardiovagal baroreflex impairment may include increased levels of BP variability, an impaired ability to respond to acute challenges to the maintenance of BP, and increased risk of sudden cardiac death. In contrast, baroreflex control of sympathetic outflow is not impaired with age. Collectively, changes in baroreflex function with age are associated with an impaired ability of the organism to buffer changes in BP. This is evidenced by the reduced potentiation of the pressor response to bolus infusion of a pressor drug after compared to before systemic ganglionic blockade in older compared with young adults.     

Cardiac sympathetic afferent stimulation augments the arterial chemoreceptor reflex in anesthetized rats.

Chronic heart failure (CHF) is well known to be associated with both an enhanced chemoreceptor reflex and an augmented cardiac "sympathetic afferent reflex" (CSAR). The augmentation of the CSAR may play an important role in the enhanced chemoreceptor reflex in the CHF state because the same central areas are involved in the sympathetic outputs of both reflexes. We determined whether chemical and electrical stimulation of the CSAR augments chemoreceptor reflex function in normal rats. Under anesthesia, renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) were recorded. The chemoreceptor reflex was tested by unilateral intra-carotid artery bolus injection of potassium cyanide (KCN) and nicotine. We found that 1) left ventricular epicardial application of capsaicin increased the pressor responses and the RSNA responses to chemoreflex activation induced by both KCN and nicotine; 2) when the central end of the left cardiac sympathetic nerve was electrically stimulated, both the pressor and the RSNA responses to chemoreflex activation induced by KCN were increased; 3) pretreatment with intracerebroventricular injection of losartan (500 nmol) completely prevented the enhanced chemoreceptor reflex induced by electrical stimulation of the cardiac sympathetic nerve; and 4) bilateral microinjection of losartan (250 pmol) into the nucleus tractus solitarii (NTS) completely abolished the enhanced chemoreceptor reflex by epicardial application of capsaicin. These results suggest that both the chemical and electrical stimulation of the CSAR augments chemoreceptor reflex and that central ANG II, specially located in the NTS, plays a major role in these reflex interactions.     

Cardiac sympathetic afferent stimulation impairs baroreflex control of renal sympathetic nerve activity in rats

It is well known that cardiac sympathetic afferent reflexes contribute to increases in sympathetic outflow and that sympathetic activity can antagonize arterial baroreflex function. In this study, we tested the hypothesis that in normal rats, chemical and electrical stimulation of cardiac sympathetic afferents results in a decrease in the arterial baroreflex function by increasing sympathetic nerve activity. Under alpha-chloralose (40 mg/kg) and urethane (800 mg/kg i.p.) anesthesia, renal sympathetic nerve activity, mean arterial pressure, and heart rate were recorded. The arterial baroreceptor reflex was evaluated by infusion of nitroglycerin (25 microg i.v.) and phenylephrine (10 microg i.v.). Left ventricular epicardial application of capsaicin (0.4 microg in 2 microl) blunted arterial baroreflex function by 46% (maximum slope 3.5 +/- 0.3 to 1.9 +/- 0.2%/mmHg, P < 0.01). When the central end of the left cardiac sympathetic nerve was electrically stimulated (7 V, 1 ms, 20 Hz), the sensitivity of the arterial baroreflex was similarly decreased by 42% (maximum slope 3.2 +/- 0.3 to 1.9 +/- 0.4%/mmHg; P < 0.05). Pretreatment with intracerebroventricular injection of losartan (500 nmol in 1 microl of artificial cerebrospinal fluid) completely prevented the impairment of arterial baroreflex function induced by electrical stimulation of the central end of the left cardiac sympathetic nerve (maximum slope 3.6 +/- 0.4 to 3.1 +/- 0.5%/mmHg). These results suggest that the both chemical and electrical stimulation of the cardiac sympathetic afferents reduces arterial baroreflex sensitivity and the impairment of arterial baroreflex function induced by cardiac sympathetic afferent stimulation is mediated by central angiotensin type 1 receptors.     

Altered autonomic control in conscious transgenic rabbits with overexpressed cardiac Gsalpha

Both enhanced sympathetic drive and altered autonomic control are involved in the pathogenesis of heart failure. The goal of the present study was to determine the extent to which chronically enhanced sympathetic drive, in the absence of heart failure, alters reflex autonomic control in conscious, transgenic (TG) rabbits with overexpressed cardiac Gsalpha. Nine TG rabbits and seven wild-type (WT) littermates were instrumented with a left ventricular (LV) pressure micromanometer and arterial catheters and studied in the conscious state. Compared with WT rabbits, LV function was enhanced in TG rabbits, as reflected by increased levels of LV dP/dt (5,600 +/- 413 vs. 3,933 +/- 161 mmHg/s). Baseline heart rate was also higher (P < 0.05) in conscious TG (247 +/- 10 beats/min) than in WT (207 +/- 10 beats/min) rabbits and was higher in TG after muscarinic blockade (281 +/- 9 vs. 259 +/- 8 beats/min) or combined beta-adrenergic receptor and muscarinic blockade (251 +/- 6 vs. 225 +/- 9 beats/min). Bradycardia was blunted (P < 0.05), whether induced by intravenous phenylephrine (arterial baroreflex), by cigarette smoke inhalation (nasopharyngeal reflex), or by veratrine administration (Bezold-Jarisch reflex). With veratrine administration, the bradycardia was enhanced in TG for any given decrease in arterial pressure. Thus the chronically enhanced sympathetic drive in TG rabbits with overexpressed cardiac Gsalpha resulted in enhanced LV function and heart rate and impaired reflex autonomic control. The impaired reflex control was generalized, not only affecting the high-pressure arterial baroreflex but also the low-pressure Bezold-Jarisch reflex and the nasopharyngeal reflex.