The effect of insulin hypoglycaemia on blood flow in intact and sympathectomized extremities in man
The effect of insulin hypoglycaemia on blood flow in intact and sympathectomized extremities in man
复制标题
胰岛素低血糖对人类完整和交感神经切除四肢血流的影响
DOI：
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发表时间：
1957
期刊：
影响因子：
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通讯作者：
A. Paton
中科院分区：
文献类型：
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作者：
By M. J. Allwood;Jean Ginsburg;A. Paton
Lauter & Baumann（1929）首次研究了胰岛素低血糖时外周循环的变化。他们发现低血糖与前臂血流量增加有关，这是由动静脉氧差减小所揭示的。Freeman， Smithwick和White（1934）使用表面温度测量表明，在完整肢体中，皮肤血流量保持正常或升高，但在最近交感神经切除的肢体中，在胰岛素低血糖期间，皮肤血流量明显下降。他们将后者归因于去神经结构对循环肾上腺素的超敏感。Abramson, Schkloven, Margolis & Mirsky（1939）首次在接受胰岛素休克治疗的患者中直接测量血流量。通过静脉闭塞容积描记仪，他们发现流向前臂和小腿的血流量增加，而且，在大多数受试者中，流向手和脚的血流量增加。后者很难与胰岛素低血糖期间肾上腺素释放导致心血管变化的观点相关联（Cannon, McIver & Bliss, 1924; Houssay, Lewis & Mollinelli, 1924），因为现在实验已经知道，人体内肾上腺素输注与皮肤血管收缩有关（Barcroft & Swan, 1953）。鉴于实验肾上腺素输注与肾上腺素释放引起的外周循环变化之间的矛盾观察结果，我们决定研究肾上腺素和交感血管舒缩活性在低血糖外周血管反应中的作用。French & Kilpatrick（1955）最近也做了类似的研究。Ginsburg和Paton（1956）对双侧肾上腺切除受试者低血糖时手部和前臂血流的观察进一步刺激了本研究。
Peripheral circulatory changes during insulin hypoglycaemia were first studied in man by Lauter & Baumann (1929). They found that hypoglycaemia was associated with an increased fcrearm blood flow, as revealed by a diminished arteriovenous oxygen difference. Freeman, Smithwick & White (1934), using surface temperature measurements, showed that skin blood flow remained normal or raised in intact limbs, but decreased markedly during insulin hypoglycaemia in recently sympathectomized extremities. They attributed the latter to supersensitivity of the denervated structures to circulating adrenaline. Volume blood flow was first measured directly in patients undergoing insulin shock therapy by Abramson, Schkloven, Margolis & Mirsky (1939). Using the venous occlusion plethysmograph they found an increased blood flow to the forearm and calf, and, in the majority of subjects, an increased flow to the hand and foot. The latter was difficult to correlate with the idea that adrenaline release is responsible for cardiovascular changes during insulin hypoglycaemia (Cannon, McIver & Bliss, 1924; Houssay, Lewis & Mollinelli, 1924), for it is now known experimentally that adrenaline infusion in man is associated with a vasoconstriction in skin vessels (Barcroft & Swan, 1953). In view of these conflicting observations between experimental adrenaline infusions and peripheral circulatory changes attributed to adrenaline release it was decided to investigate the role of adrenaline and of sympathetic vasomotor activity in peripheral vascular responses to hypoglycaemia. A similar study has recently been made by French & Kilpatrick (1955). The observations of Ginsburg & Paton (1956) on hand and forearm flow during hypoglycaemia in bilaterally adrenalectomized subjects were a further stimulus to this study.