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早期在离体心脏和麻醉开胸动物的实验表明,冠脉血流(CBF)主要是由心肌代谢需要所调节;植物神经系统对冠状血管床只有轻微的作用~1。故注意力多集中在体液因素的调节。但最近在清醒动物的研究看到,植物神经系统对CBF有一定的影响作用,甚至可以对抗体力劳动时心肌代谢增加所引起的冠脉舒张效应~2。一些所谓“异型心绞痛”病例的分析重新引起对神经系统与CBF间相互关系的兴趣。这样,了解植物神经系统与CBF的关系,对于各型心绞痛患者选择更有效的治疗方案是有参考价值的。一、冠脉血流的控制 CBF也象身体其他部位的血管床一样,是直接与灌流压阶(即中央冠状动脉压与右心房压间的压差)成正比,与冠脉床的阻力成反比,也即阻力越大CBF越少。现将影响CBF的一些因素分述如下:
Early experiments in isolated hearts and anesthetized thoracic animals have shown that coronary blood flow (CBF) is primarily regulated by myocardial metabolic needs; the autonomic system has only a modest effect on coronary vascular beds. Therefore, attention is more focused on the regulation of humoral factors. However, recent studies on conscious animals have shown that the autonomic nervous system has a certain effect on CBF and can even counteract the coronary diastolic effect caused by increased myocardial metabolism during manual labor. Analysis of some so-called “abnormal angina” cases has revived interest in the interrelationship between the nervous system and CBF. In this way, to understand the relationship between autonomic nervous system and CBF, for all types of angina patients choose more effective treatment is of reference value. First, the control of coronary blood flow CBF, like other parts of the body of the vascular bed, is directly proportional to the perfusion pressure step (ie, the central coronary artery pressure and right atrial pressure), and coronary resistance Inverse, that is, the greater the resistance CBF less. Some of the factors that will affect CBF now are as follows: