冠循環に關する神經反射機構の研究(第1報) : 膽嚢擴張刺激の冠循環に及ぼす實驗的研究

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Since Babcock has called attention to the frequent association of gallstone disease and cardiac disease in 1909,many workers have studied the relationship between these diseases. It has been known that the patients with gall-bladder disease often exhibit cardiac symptoms, particularly "anginal pain" and that those symptoms disappear after removal of the affected gall-bladder. Furthermore, it was found that abnormal electrocardiogram of patients with gall-bladder disease occasionally returned to normal after such an operation. Gilbert and his associates published experimental data which suggested a decrease in coronary blood flow upon distention of the gall-bladder, which disappeared by cutting the vagi. He explained these facts by a viscerocardiac reflex in which reflexes arising from the gall-bladder might at times cause decrease of cronary blood flow, resulting in symptoms of angina pectoris. Several investigators noted that pre-existent abnormalities of the coronary system appeared to facilitate the viscerocardiac reflexes. The present investigation was conducted in order to see the effect of distention of the gall-bladder on coronary blood flow and other vasomotor system in normal and coronary constricted dogs. The urinary bladder was also distended in normal dogs to compare its effect with that of the gall-bladder distention.Open-chest dogs weighing 10-15 kg were anesthetized with sodium thiopental (0.03-0.05 g/kg) intravenously. Coronary inflow of the left coronary artery was measured by rotameter. Blood pressure was recorded from the left femoral artery by a mercury manometer. The dogs were divided into two groups. Group I represented 25 normal dogs. Group II represented 8 dogs which underwent the operation of coronary artery constrictions 10 days prior to the gall-bladder stimulation. Below the bifurcation of the first ventricular branch the ramus descendens of the left coronary artery was constricted with U-shaped silver clamp. A toy balloon attached to a vinyl tube was placed in the gall-bladder through an incision in its dome. The tube was connected with a mercury manometer for recording its pressure. The balloon was distended for 15-20 seconds with air or water injected through a syringe. (Fig. 1) Distention of the urinary bladder was carried out similarly.Following results were obtained.(1) No uniform changes of the blood pressure were observed following the distention of the gallbladder. Of total 33 cases, elevation was observed in 6,and depression in 14. In 13 cases no change of blood pressure was found. (Table I.) The results were similar even in cases with coronary artery constriction.(2) The responses of the coronary blood flow were variable, but they were always in the same direction as the blood pressure. In no instance the blood pressure and the coronary flow changed in the opposite direction.(3) Changes of the heart rate were not observed. However, in 11 experiments on 9 dogs ventricular premature systoles were recognized after distention of the gall-bladder.(4) It was found that appearance of ventricular fibrillation was more common in the experiment of distention of the gall-bladder than in any other experiment of the coronary circulation.(5) The effects of distention of gall-bladder on coronary blood flow, blood pressure and heart rhythm were not essentially different between the normal dogs and the dogs with coronary artery constriction.(6) Changes of the blood pressure on distention of the urinary bladder were also variable, but it was noted that in several cases the common response was an initial rise in blood pressure followed by depression. Changes of the coronary blood flow were parallel with the blood pressure. The effects of distention of the urinary bladder on the circulatory system, therefore, were essentially identical with that of the gall-bladder except appearance of the arrythmia.
社団法人日本循環器学会の論文
1959-09-20

冠循環に關する神經反射機構の研究(第1報) : 膽嚢擴張刺激の冠循環に及ぼす實驗的研究

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