FUNCTIONAL-SIGNIFICANCE OF THE FRANK-STARLING MECHANISM UNDER PHYSIOLOGICAL AND PATHOPHYSIOLOGICAL CONDITIONS
FUNCTIONAL-SIGNIFICANCE OF THE FRANK-STARLING MECHANISM UNDER PHYSIOLOGICAL AND PATHOPHYSIOLOGICAL CONDITIONS
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DOI：
10.1093/eurheartj/13.suppl_e.7
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发表时间：
1992-11-01
影响因子：
39.3
通讯作者：
KISSLING, G
中科院分区：
文献类型：
--
作者：
JACOB, R;DIERBERGER, B;KISSLING, G
主要根据动物实验结果（狗、猪和大鼠）讨论了 Frank-Starling 机制在生理和病理生理条件下的功能意义。使用弗兰克图可以充分描述个体每搏输出量对舒张末期容积的依赖性。这可以通过改变充盈压（呼吸周期、电容系统中的血管张力、身体位置、循环血量）以及充盈期持续时间（心率和节律、松弛率）和心室顺应性（壁厚、纤维化、挛缩、僵硬）的变化来说明。 Frank-Starling 机制的功能重要性主要在于调整左心室到右心室的输出量。在直立体育锻炼期间，由于外周肌肉泵的作用和静脉张力的增加而导致舒张末期容量的增加，有助于提高每搏输出量。收缩性的降低导致压力-容量图中的操作点向右移动，从而往往会阻止每搏输出量的减少。然而，慢性心力衰竭中循环血量增加的后果通常主要是有害的（充血症状；冠状动脉阻力的心肌成分；心脏能量学）。收缩性降低导致每搏输出量（或每搏做功）和舒张末期输出量之间的关系变平。此外，如果肌节长度储备耗尽，或者由于心室壁松弛受损或扩张性降低而导致肌节延伸不足，则 Starling 机制将无法发挥作用。后者以患有实验性瓣膜上主动脉狭窄的大鼠的扩张纤维化左心室为例进行说明。
The functional significance of the Frank-Starling mechanism under physiological and pathophysiological conditions is discussed, based mainly on animal experiment results (in the dog, pig and rat). The dependence of individual stroke volume on end-diastolic volume can be described adequately using Frank's diagram. This can be illustrated by varying filling pressure (respiratory cycle, vascular tone in the capacitance system, body position, circulating blood volume) and by alterations in the duration of the filling period (heart rate and rhythm, rate of relaxation) and in ventricular compliance (wall thickness, fibrosis; contracture, rigor). The functional importance of the Frank-Starling mechanism lies mainly in adapting left to right ventricular output. During upright physical exercise an increase in end-diastolic volume due to the action of the peripheral muscle pump and increased venous tone can assist in enhancing stroke volume.Reduced contractility leads to a shift of the operating point to the right in the pressure-volume diagram, thus tending to prevent a decrease in stroke volume. However, the consequences of increased circulating blood volume in chronic heart failure are, as a rule, mainly detrimental (congestive symptoms; myocardial component of coronary resistance; cardiac energetics). Reduced contractility results in a flattening of the relation between stroke volume (or stroke work) and end-diastolic volume. Furthermore, the Starling mechanism is prevented from becoming effective if the sarcomere-length reserve is exhausted, or in the presence of inadequate sarcomere extension due to impaired relaxation or reduced distensibility of the ventricular wall The latter is illustrated using the example of a dilated fibrotic left ventricle from a rat with experimental supravalvular aortic stenosis.