Baroreflex regulation of regional blood flow in congestive heart failure.
Baroreflex regulation of regional blood flow in congestive heart failure.
复制标题
充血性心力衰竭局部血流的压力感受反射调节。
DOI：
10.1152/ajpheart.1990.258.5.h1409
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Colucci,WS
中科院分区：
文献类型：
--
作者：
Creager,MA;Hirsch,AT;Dzau,VJ;Nabel,EG;Cutler,SS;Colucci,WS
在充血性心力衰竭(CHF)患者中，心输出量的分布发生改变。心肺压力感受器和动脉压力感受器通常可以调节局部血流，但它们在心力衰竭中的作用尚不清楚。为探讨压力感受器在心力衰竭局部血流调节中的作用，观察了12例心力衰竭患者下体负压(LBNP)对前臂、肾脏和内脏血流的影响。负荷量为-10和-40毫米汞柱的负荷量可降低中心静脉压，但对收缩压和脉压无影响。肾血流量在下体负压-10 mm Hg时由505+/-63降至468+/-66ml/min(P<0.05)，在下体负压-40 mm Hg时降至376+/-74ml/min(P<0.01)。内脏血流量在下体负压-10 mm Hg时由564+/-76降至480+/-62ml/min(P<0.01)，在下体负压-40 mm Hg时降至303+/-45m l/min(P<0.01)。下体负压-10 mm Hg或-40 mm Hg时，前臂血流量没有减少。为了确定下体负压期间肢体血管收缩的消失是否仅限于压力反射弧区的异常，还是继发于终末器官反应性受损，6名心力衰竭患者和6名正常受试者接受了臂动脉内注射苯肾上腺素。各组大鼠前臂血管阻力均较模型组增加。这些数据表明，压力感受器可以调节充血性心力衰竭患者的内脏和肾脏，但不能调节肢体血管阻力，并可能有助于这种疾病中发生的血流重新分配。
In patients with congestive heart failure (CHF), the distribution of the cardiac output is altered. Cardiopulmonary and arterial baroreceptors normally can regulate regional blood flow, but their contribution in heart failure is not known. To examine the role of baroreceptors in the regulation of regional blood flow in CHF, the effect of lower body negative pressure (LBNP) on forearm, renal, and splanchnic blood flow was evaluated in 12 patients with heart failure. Incremental LBNP at -10 and -40 mmHg decreased central venous pressure but had not effect on systolic blood pressure or pulse pressure. Renal blood flow decreased from 505 +/- 63 to 468 +/- 66 ml/min during LBNP -10 mmHg (P less than 0.05) and to 376 +/- 74 ml/min during LBNP -40 mmHg (P less than 0.01). Splanchnic blood flow decreased from 564 +/- 76 to 480 +/- 62 ml/min during LBNP -10 mmHg (P less than 0.01) and to 303 +/- 45 ml/min during LBNP -40 mmHg (P less than 0.01). Forearm blood flow did not decrease during LBNP -10 mmHg or -40 mmHg. To determine whether the absence of limb vasoconstriction during LBNP was confined to abnormalities in the baroreflex arc or was secondary to impaired end-organ responsiveness, six patients with heart failure and six normal subjects received an intrabrachial artery infusion of phenylephrine. Phenylephrine increased forearm vascular resistance comparably in each group. These data demonstrate that baroreceptors can regulate splanchnic and renal but not limb vascular resistance in patients with congestive heart failure and may contribute to the redistribution of blood flow that occurs in this disorder.