Intact blood pressure, but not sympathetic, responsiveness to sympathoexcitatory stimuli in a patient with unilateral carotid body resection.
Intact blood pressure, but not sympathetic, responsiveness to sympathoexcitatory stimuli in a patient with unilateral carotid body resection.
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DOI：
10.14814/phy2.13212
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发表时间：
2017-04
影响因子：
2.5
通讯作者：
Curry TB
中科院分区：
文献类型：
--
作者：
Larson KF;Limberg JK;Baker SE;Joyner MJ;Curry TB
尽管对颈动脉体（CB）化学感受器的治疗性切除的兴趣迅速增长，但关于单侧CB切除的后果的生理学研究很少。我们报告一例健康的绝经后女性，因副神经节瘤接受单侧CB切除术。术后约4年，分析了她对缺氧、下体负压、冷加压试验（CPT）、缺血性握力运动和运动后缺血（IHE/PEI）的交感神经和血流动力学反应。低血压反应和压力反射敏感性相对正常。对IHE/PEI和CPT的血流动力学反应显示心输出量（从3.9 L/min增加至5.2 L/min [IHE/PEI]和4.9 L/min [CPT]）和血压（从126/72 mmHg增加至161/87 mmHg [IHE/PEI]和171/93 mmHg [CPT]）的特征性增加。然而，在IHE/PEI和CPT期间，肌肉交感神经活动（腓总神经的显微神经造影）较基线降低（爆发发生率最低值分别为基线的45%和40%），总外周阻力未观察到变化（从24 mmHg*min/L降至22 mmHg*min/L [IHE/PEI]和25 mmHg*min/L [CPT]）。这些研究结果表明，尽管交感神经兴奋减弱，但血压反应性完好无损，这可能是由于心输出量增加和/或压力反射对外周交感神经活动的适应性抑制作用。
Despite rapidly growing interest in the therapeutic resection of the carotid body (CB) chemoreceptors, few physiologic studies exist on the consequences of unilateral CB resection. We present a case of an otherwise healthy postmenopausal female who underwent unilateral CB resection for a paraganglioma. Approximately 4 years postoperatively, she underwent analysis of her sympathetic and hemodynamic responses to hypoxia, lower body negative pressure, cold pressor test (CPT), and ischemic hand grip exercise and postexercise ischemia (IHE/PEI). Hypoxic ventilatory response and baroreflex sensitivity were relatively normal. Hemodynamic responses to IHE/PEI and CPT showed characteristic increases in cardiac output (from 3.9 L/min to 5.2 L/min [IHE/PEI] and 4.9 L/min [CPT]) and blood pressure (from 126/72 mmHg to 161/87 mmHg [IHE/PEI] and 171/93 mmHg [CPT]). However, muscle sympathetic nerve activity (microneurography of the peroneal nerve) decreased from baseline during IHE/PEI and CPT (burst incidence nadir of 45% and 40% of baseline, respectively) and there was no observable change in total peripheral resistance (from 24 mmHg*min/L to 22 mmHg*min/L [IHE/PEI] and 25 mmHg*min/L [CPT]). These findings illustrate intact blood pressure responsiveness despite attenuated sympathoexcitation, possibly due to an increase in cardiac output and/or adaptive inhibitory effect of the baroreflex on peripheral sympathetic activity.