Involvement of the Neuron-Endocrinium in Endogenous Sudden Death

为了阐明猝死时应激激素对心脏死亡和呼吸性死亡的反应，并以大鼠为研究对象，在脑缺血、主动脉瓣狭窄等病变存在或不存在的情况下，对比检测急性期或死亡后立即出现的肾上腺皮质激素，如皮质酮（CS）、儿茶酚胺（CA）[肾上腺素（EP）、去甲肾上腺素（NE），多巴胺（DA）和环AMP在血液和各器官中的作用。在没有预先存在病变的所谓健康正常状态下，在非麻醉下引起的心脏骤停优先或呼吸暂停优先的情况下，血液CS和CA （EP， NE）显示后者相当于呼吸性死亡的显著高值；肾上腺内CS和CA （EP、NE、DA）的值明显较低……更重要的是，脑内CA （NE、DA）对猝死和心肌内CA的值接近，尤其是NE对呼吸性死亡的值明显较低。非麻醉状态下脑缺血时，猝死时血CS和CA （EP、NE）在呼吸性死亡时趋于较高，而在CA时差异有统计学意义；相反，呼吸性死亡的肾上腺内CS值较低，猝死的CA值相同，脑内和心肌内CA的结果与健康正常情况相同。在非麻醉情况下主动脉瓣狭窄合并心功能障碍的情况下，血液CS和CA以及肾上腺内CS和CA对两种猝死的结果与脑缺血的结果相同；对于呼吸性死亡，脑内CA，尤其是NE显示出稍高的值，心肌内CA的结果与健康正常情况和脑缺血的结果相同。只有心肌内循环AMP显示心脏死亡的显著高水平值。上述结果表明，心脏骤停优先或呼吸暂停优先型猝死时应激激素的动力学根据体液传递系统和神经传递系统以及是否存在任何预先存在的大脑或心脏病变而表现出明显不同的方面，建议定量分析肾上腺和心肌内应激激素及其相关物质可作为猝死发病机制的线索死亡使得区分心脏死亡和呼吸死亡成为可能。少

With a view to elucidating the response of stress hormone at sudden death to heart death and respiratory death and using rats, cardiac arrest-preceding type sudden death due to intravenous injection of KCL and apnea-preceding type sudden death due to intravenous injection of SCC were comparatively examined for measured values at agonal stage or immediately after death under condition of the existence or otherwise of such lesions as cerebral ischemia and aortic stenosis with respect to adrenocortical hormone such as corticosterone(CS), catecholamines(CA)[epinephrine(EP), norepinephrine(NE), dopamine(DA)] and cyclic AMP in blood and various organs. In case of the cardiac arrest-precedence or apnea-precedence caused under non-anesthesia in the so-called healthy normal condition without pre-existent lesions, blood CS and CA (EP, NE) showed significantly high values for the latter precedence equivalent to respiratory death; intraadrenal CS and CA (EP, NE, DA) showed significantly low values … More for the latter precedence, intracerebral CA (NE, DA) showed approximate values for both sudden deaths and intramyocardial CA and especially NE showed remarkably low values for respiratory death. In case of cerebral ischemia under non-anes-thesia, blood CS and CA (EP, NE) at sudden death tended to show higher level of values for respiratory death, but with a significant difference for CA; intraadrenal CS showed contrariwise low level of values for respiratory death, CA showed the same level of values for both sudden deaths and intracerebral and intramyocardial CA gave the same results as in healthy normal condition.In case of aortic stenosis as cardiac dysfunction under non-anesthesia, blood CS and CA and intraadrenal CS and CA gave the same results for both sudden deaths as in case of cerebral ischemia; intracerebral CA and especially NE showed slightly high values for respiratory death, an intramyocardial CA gave the same results as in healthy normal condition and in case of cerebral ischemia.Only intramyocardial cyclic AMP showed significantly high level of values for heart death. The above results revealed that the kinetics of stress hormone at sudden death due to cardiac arrest-precedence or apnea-precedence showed remarkably different aspects according to the humoral transmission system and the neural transmission system and depending upon the existence or otherwise of any pre-existent cerebral or cardiac lesion and suggested that quantitative analysis of intraadrenal and intramyocardial stress hormone and its related substance as a clue to the pathogenesis of sudden death made it possible to differentiate heart death from respiratory death. Less