Hormonal responses to cardiac tamponade: inhibition of release of atrial natriuretic factor despite elevation of atrial pressures.
Hormonal responses to cardiac tamponade: inhibition of release of atrial natriuretic factor despite elevation of atrial pressures.
复制标题
对心脏压塞的激素反应：尽管心房压力升高，但仍抑制心房钠尿因子的释放。
DOI：
10.1161/01.cir.76.4.884
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发表时间：
1987
期刊：
影响因子：
37.8
通讯作者：
Grekin,RJ
中科院分区：
文献类型：
--
作者：
Mancini,GB;McGillem,MJ;Bates,ER;Weder,AB;DeBoe,SF;Grekin,RJ
心房扩张，而不是心房内压的变化，被认为是心房利钠因子（ANF）释放的主要介质。在心脏填塞期间，心房压力升高，而跨壁压力和心房牵张可能不受影响。在六只开胸犬中研究了心房压力和心房扩张的作用，这些犬接受了心脏填塞和快速容积扩张，作为影响心房内压力和心房牵张的不同手段。在三种干预之前、期间和之后监测血流动力学测量、免疫反应性ANF（ir-ANF）、血浆肾素活性、抗利尿激素、肾上腺素和去甲肾上腺素：（1）填塞，（2）填塞后快速容量负荷，（3）填塞期间容量负荷。容量扩张增加右心房压力，并引起ir-ANF显著升高。由填塞引起的右心房压力升高与容量输注引起的压力升高相当，但在填塞期间未引起ir-ANF增加，并且在填塞期间进行时，ir-ANF对容量负荷的反应被取消。心钠素浓度变化与右心房压力变化之间的关系在无填塞时非常显著，此时心房牵张对容积扩张有自由反应（r = 0.73，p <0.0001），但在牵张被抑制时则无显著性（r =-0.16，p = NS）。这些观察结果强调了考虑心房顺应性、跨壁压和心房牵张对心房压力和ANF释放之间关系的调节作用的重要性。
Atrial distension, rather than change in intra-atrial pressure, has been suggested as a principal mediator of release of atrial natriuretic factor (ANF). During cardiac tamponade, atrial pressures rise whereas transmural pressures and atrial stretch may not be affected. The roles of atrial pressure and atrial distension were investigated in six open-chest dogs subjected to cardiac tamponade and rapid volume expansion as disparate means of affecting intra-atrial pressures and atrial stretch. Hemodynamic measurements, immunoreactive ANF (ir-ANF), plasma renin activity, antidiuretic hormone, epinephrine, and norepinephrine were monitored before, during, and after three interventions: (1) tamponade, (2) rapid volume loading followed by tamponade, and (3) volume loading during tamponade. Volume expansion increased right atrial pressure and caused a significant rise in ir-ANF. Elevations of right atrial pressure caused by tamponade were comparable to those induced by volume infusion, but an increase in ir-ANF was not elicited during tamponade, and the ir-ANF response to volume loading was abolished when performed during tamponade. The relation between the change in ANF concentration and change in right atrial pressure were highly significant in the absence of tamponade, when atrial stretch was freely responsive to volume expansion (r = .73, p less than .0001), but not when stretch was inhibited (r = -.16, p = NS). These observations underscore the importance of considering the modulating effects of atrial compliance, transmural pressure, and atrial stretch on the relation between atrial pressures and ANF release.