Osmosensitive mechanisms contribute to the water drinking-induced pressor response in humans
Osmosensitive mechanisms contribute to the water drinking-induced pressor response in humans
复制标题
DOI：
10.1212/01.wnl.0000176060.90959.36
复制
发表时间：
2005-09-27
期刊：
影响因子：
9.9
通讯作者：
Jordan, J
中科院分区：
文献类型：
--
作者：
Lipp, A;Tank, J;Jordan, J
背景：饮水通过一种未知的机制在多系统萎缩患者中引起交感神经介导的升压反应。我们推测胃肠扩张、低收缩刺激或两者都参与了水诱导的升压反应。方法：我们比较了10例可能存在多系统萎缩的患者对生理盐水和水的血压反应。患者表现为中度至重度自主神经功能障碍。连续记录心电图和手指动脉压，单盲法分别给予生理盐水和蒸馏水500mL。在5分钟内通过预先插入的鼻胃管输液。结果：用水后10分钟内血压开始升高，20分钟后达到最大值。注射生理盐水后血压无明显变化。用水20min后血压变化为8+/-9/2+/-5 mm Hg，给生理盐水20min后血压变化为-1+/-11/-1+/-7 mm Hg(P=0.02)。心率不随任何一种干预措施而改变。结论：摄入水比摄入生理盐水引起更大的升压反应。因此，胃扩张可能不是水诱导升压反应的关键机制。相反，这种反应可能是通过胃肠道、门静脉和肝脏的渗透敏感性传入结构来调节的。
Background: Water drinking elicits a sympathetically mediated pressor response in multiple-system atrophy patients through an unknown mechanism. We reasoned that gastrointestinal distention, hyposomotic stimulation, or both contribute to the water-induced pressor responseMethods: We compared the response to normal saline and water on blood pressure in 10 patients with probable multiple-system atrophy. Patients featured moderate to severe autonomic dysfunction. EKG and finger arterial blood pressure were recorded continuously, and 500 mL normal saline and distilled water were each given in a single-blinded fashion. Fluids were applied through a previously inserted nasogastric tube within a 5-minute period.Results: Blood pressure began to increase within 10 minutes after water administration and reached a maximum after 20 minutes. Blood pressure did not change after saline administration. The blood pressure change after 20 minutes was 8 +/- 9/2 +/- 5 mmHg with water and -1 +/- 11/- 1 +/- 7 mmHg with normal saline administration (p = 0.02 between interventions). Heart rate did not change with either intervention.Conclusion: Ingestion of water elicits a greater pressor response than the ingestion of normal saline. Thus, gastric distention is probably not the crucial mechanisms for the water-induced pressor response. Instead, the response may be mediated through osmosensitive afferent structures in the gastrointestinal tract, portal vein, and liver.