BRAIN-STEM AND BULBOSPINAL NEUROTRANSMITTER SYSTEMS IN THE CONTROL OF BLOOD-PRESSURE
BRAIN-STEM AND BULBOSPINAL NEUROTRANSMITTER SYSTEMS IN THE CONTROL OF BLOOD-PRESSURE
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DOI：
10.1097/00004872-199108000-00001
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发表时间：
1991-08-01
影响因子：
4.9
通讯作者：
PILOWSKY, P
中科院分区：
文献类型：
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作者：
CHALMERS, J;PILOWSKY, P
尽管自17世纪以来，大脑就被认为在心血管系统的控制中起着重要作用[b]，但直到最近120年，延髓的重要性才被明确界定[b] [b] [b] [b] [b] [b] [b] [b] [b] [b] [b] [b]。特别是，在我们对血压中枢控制的理解中，最重要的进展之一是确定髓质腹侧是维持正常和反射性血压控制的关键区域[4,5]。事实上，当我们中的一个人在1975年绘制了一幅最新知识的示意图时，脑干中的孤束核（NTS）被清楚地确定为一个主要的整合中心，接收来自初级传入压力感受器神经元的信息，脊髓中的中外侧细胞柱被清楚地描述为产生交感效应神经元的区域。但两者之间的连接中心被标记为“va- sommotor中枢”，并没有定位于脑干内的任何特定部位（图1a）。来自许多工人群体的研究现在已经清楚地确定了髓质腹侧（RVM）的吻侧部分作为压力区的重要性，球脊髓前交感神经元从这里下降到中外侧细胞柱（图1b）。这些研究也证实了尾侧腹侧髓质（CVLM）是一个抑制区，似乎对吻侧压力区有直接影响（图1b）。从CVLM到中外侧细胞柱的可能直接连接仍然是一个有争议的问题。今天我们面临的一些主要问题是：(1)将压力感受器和NTS的后事信息传递给RVM和CVLM的神经回路是什么？它们使用哪些神经递质？(2) CVLM和RVM之间有什么联系，它们使用哪些神经递质？(3)支配脊髓中外侧细胞柱交感神经节前神经元（SPN）的降球脊髓网络是什么？它们使用哪些神经递质？在每种情况下，这些问题都需要答案，这些答案不仅是解剖学上的，也不是与神经递质有关的纯粹化学上的，而且是功能性的。产生这些答案的主要问题是，由于髓质腹侧区神经元群的明显化学和功能异质性，对特定神经元网络的识别受到阻碍[78]。球脊髓系统多年来一直被认为具有广泛的躯体和自主神经功能，包括呼吸、消化、出汗、瞳孔直径和排尿，除了控制循环或血压外[9-14]。Histochemi -
Although the brain has been considered to be important in the control of the cardiovascular system since the 17th century [1], it is only in the past 120 years that the importance of the medulla oblongata has been clearly defined|| 23]. In particular, one of the most sig nificant advances in our understanding of the central control of blood pressure has been the identification of the ventral medulla as a key area in the maintenance of normal and reflex control of blood pressure [4, 5]. Indeed, when one of us [6] drew a schematic representation of the state of the art knowledge in 1975, the nucleus tractus solitarius (NTS) in the brainstem was clearly identified as a major integrating centre receiving information from primary afferent barorecep-tor neurones, and the intermediolateral cell column in the spinal cord was clearly depicted as the area giving rise to the sympathetic effector neurones, but the connecting centre between these two was labelled the “va-somotor centre'and not localized to any specific site within the brainstem (Fig. 1a). Studies from numerous groups of workers have now clearly established the importance of the rostral part of the ventral medulla (RVM) as a pressor region from which bulbospinal presympathetic neurones descend to the intermedio-lateral cell column (Fig. 1b). These studies have also established the caudal ventrolateral medulla (CVLM) as a depressor region which appears to exert direct influences on the rostral pressor region (Fig. 1b). A possible direct connection from the CVLM to the in-termediolateral cell column remains a matter of some controversy.Some of the main questions that face us today are:(1) What is the neural circuitry involved in relaying affer-ent information from the baroreceptors and the NTS to the RVM and CVLM and which neurotransmitters do they use?(2) What are the connections between the CVLM and RVM and which neurotransmitters do they use?(3) What are the descending bulbospinal net-works innervating the sympathetic preganglionic neurones (SPN) in the intermediolateral cell column of the spinal cord and which neurotransmitters do they use? In each case, the questions require answers which are not just anatomical, nor purely chemical in relation to neurotransmitters, but also functional. The main problem in producing these answers is that the identification of the specific neuronal networks responsible is handicapped by the marked chemical and functional heterogeneity of the neurone popu-lations in the ventral medulla| 78]. Bulbospinal sys-tems have been known for many years to subserve a wide range of somatic and autonomic functions including respiration, digestion, sweating, pupillary diameter and micturition, quite apart from control of circulation or blood pressure [9–14]. Histochemi-