INFLUENCE OF ACETYLCHOLINE ON THE PULMONARY ARTERIAL PRESSURE
INFLUENCE OF ACETYLCHOLINE ON THE PULMONARY ARTERIAL PRESSURE
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乙酰胆碱对肺动脉压的影响
DOI：
10.1136/hrt.19.2.272
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发表时间：
1957
影响因子：
--
通讯作者：
P. Harris
中科院分区：
文献类型：
--
作者：
P. Harris
肺循环血管口径的主动变化是否可由生理或药理刺激引起，仍是一个有争议的问题。在大多数观察中，已知用于测试肺循环的试剂也对体循环有影响，并且通常对心输出量有影响。在这种情况下，肺动脉压容易受到小循环血管管径局部改变以外的因素的影响。为了克服这些困难，决定研究乙酰胆碱对一组患者肺循环压力的影响。Ellis和韦斯（1932）证明了乙酰胆碱在人体血流中的破坏作用，这是由于在长时间静脉输注过程中缺乏累积作用。他们以及卡迈克尔和弗雷泽（1933）观察到，当静脉注射足够剂量的乙酰胆碱时，头部和身体上部会发红，而动脉内注射会引起动脉和小动脉的局部扩张，但没有全身效应。由于乙酰胆碱在血流中很快被破坏，因此可以将其注射到肺动脉中，使其在到达体循环之前失活（Tiffenau和Beauvallet，1944）。通过这种方式，人们希望药物的血管扩张作用仅限于肺循环。在动物中，乙酰胆碱的作用在体循环中最为明显，它会引起广泛的动脉血管舒张，而不管这些血管是由交感神经系统还是副交感神经系统供血（Hunt和Taveau，1906; Dale，1914; Hunt，1917 a和1917 b）。然而，关于该药物在肺循环中的活性的报道一直相互矛盾（Hunt，1917 a; Daly，1932和1933; von Euler，1932;富兰克林，1932; Gaddum和Holtz，1933;约翰逊等人，1937;汉密尔顿等人，1939; Petrovskaia，1939; Foggie，1940; Friedberg等人，1943年; von Euler和Liljestrand，1946年; Dirken和Heemstra，1948年）。
It is still a matter for debate whether active variation in the calibre of the vessels of the pulmonary circulation can be caused by physiological or pharmacological stimuli. In most observations, the agents used to test the pulmonary circulation are known to have an effect also on the systemic circulation and often on the cardiac output. Under these circumstances the pulmonary arterial pressure is liable to be influenced by factors other than local alterations in the calibre of the vessels of the lesser circulation. In an attempt to circumvent these difficulties, it was decided to study the effects of acetylcholine on the pressures in the pulmonary circulation in a group of patients. Ellis and Weiss (1932) demonstrated the destruction of acetylcholine in the blood stream in man by the lack of cumulative action during its prolonged intravenous infusion. They and also Carmichael and Fraser (1933) observed flushing of the head and upper part of the body when acetylcholine was injected in sufficient dosage into a vein, while intra-arterial injection caused a regional dilatation of arteries and arterioles but no general effects. Since acetylcholine is destroyed so rapidly in the blood stream, it might be possible to inject it into the pulmonary artery in such a dose that it was inactivated before reaching the systemic circulation (Tiffenau and Beauvallet, 1944). In this way it was hoped that any vasomotor effect of the drug would be confined to the pulmonary circulation. In animals, the action of acetylcholine is most evident in the systemic circulation, where it causes widespread arterial vasodilatation irrespective of whether these vessels are supplied by the sympathetic or parasympathetic systems (Hunt and Taveau, 1906; Dale, 1914; Hunt, 1917a and 1917b). Reports of the activity of the drug in the pulmonary circulation, however, have been conflicting (Hunt, 1917a; Daly, 1932 and 1933; von Euler, 1932; Franklin, 1932; Gaddum and Holtz, 1933; Johnson et al., 1937; Hamilton et al., 1939; Petrovskaia, 1939; Foggie, 1940; Friedberg et al., 1943; von Euler and Liljestrand, 1946; Dirken and Heemstra, 1948).