ROLE OF THE PARASYMPATHETIC SYSTEM IN AIRWAY-OBSTRUCTION DUE TO EMPHYSEMA
ROLE OF THE PARASYMPATHETIC SYSTEM IN AIRWAY-OBSTRUCTION DUE TO EMPHYSEMA
复制标题
DOI：
10.1056/nejm198408163110701
复制
发表时间：
1984-01-01
影响因子：
158.5
通讯作者：
SKORODIN, MS
中科院分区：
文献类型：
--
作者：
GROSS, NJ;SKORODIN, MS
为探讨副交感神经和交感神经机制在肺气肿患者气道阻塞中的相对作用，采用超大剂量抗胆碱能药物和肾上腺素能药物顺序及联合应用。连续注射1种药物以达到平台期的支气管扩张；然后再注射另一种药物。抗胆碱能药(甲硝酸阿托品)所达到的平台显著高于肾上腺素能药(沙丁胺醇)。当首先给予肾上腺素能药时，随后使用抗胆碱能药可实现额外的支气管扩张。当首先给予抗胆碱能药物时，随后给予肾上腺素能药物并不能实现额外的支气管扩张。当两种药物同时给药时，支气管扩张的程度实际上与单独使用抗胆碱能药物的程度相同。对小气道和大气道功能和肺容量敏感的测试得出了基本上相同的结果。因此，仅使用抗胆碱能药物即可获得所有可实现的支气管扩张。这两类药物在肺气肿中通过共同的胆碱能途径产生明显的支气管扩张，并支持副交感神经活动是这种疾病中呼吸道阻塞的休眠可逆成分的概念。
To study the relative contributions of parasympathetic and sympathetic mechanisms in airway obstruction in patients with emphysema, supramaximal doses of anticholinergic and adrenergic agents were given in sequence and in combination. Serial doses of 1 agent were administered to achieve a plateau of bronchodilatation; after that the other agent was administered. The plateau achieved with the anticholinergic agent (atropine methonitrate) was significantly higher than that achieved with the adrenergic agent (salbutamol). When the adrenergic agent was given first, additional bronchodilatation was achieved with subsequent use of the anticholinergic agent. When the anticholinergic agent was given first, no additional bronchodilatation was achieved with subsequent administration of the adrenergic agent. When both agents were given simultaneously, the degree of bronchodilatation was virtually identical to that obtained with the anticholinergic agent alone. Tests sensitive to small-airway and large-airway function and lung volumes gave essentially the same results. Thus, all achievable bronchodilatation was obtained with the anticholinergic agent alone. The 2 classes of agents evidently produce bronchodilatation through a common cholinergic pathway in emphysema, and support the concept that parasympathetic activity is the dormant reversible component of airway obstruction in this disease.