PDF herunterladen
Fortschr Neurol Psychiatr 2000; 68(1): 37-47
DOI: 10.1055/s-2000-11641
ORIGINALARBEIT
Georg Thieme Verlag Stuttgart ·New York

Physiologie und Untersuchungsmethoden des Baroreflexes

Baroreflex Physiology and Examination TechniquesM. J. Hilz, B. Stemper, B. Neundörfer
  • Neurologische Klinik mit Poliklinik(Direktor: Prof. Dr. B. Neundörfer) der Friedrich-Alexander-Universität Erlangen-Nürnberg
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Dezember 2000 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung:

Der Barorezeptorenreflex hat entscheidenden Anteil an der Konstanthaltung der Herz-Kreislauf-Regulation besonders bei akuter orthostatischer Belastung. Die Stimulation der Barorezeptoren vor allem im Karotissinus und Aortenbogen durch Blutdruckanstieg bzw. das abrupte Aussetzen dieser Stimulation bei Blutdruckabfall werden über die Nervi glossopharyngeus und vagus an den Nucleus tractus solitarii vermittelt und über weitere zentrale Schaltstellen wie den Nucleus ambiguus, die rostrale ventrale Medulla oblongata, den dorsalen Vaguskern, parabrachiale und paraventrikuläre Kerne efferent parasympathisch zum Herzen und sympathisch zum Herzen und den peripheren Gefäßen geleitet. Der Regelkreis beantwortet Blutdruckanstieg mit Minderung des peripheren Sympathikotonus und Zunahme kardiovagaler Aktivität. Blutdruckabfall hat die umgekehrte Wirkung. Die Barorezeptoren zeigen ein proportional-differentielles Feuerungsverhalten mit Adaptation und Resetting sowie Hysteresisverhalten, d. h. stärkerer Feuerungsrate bei raschem Blutdruckanstieg als bei seiner Rückkehr zum Ausgangswert. Die Rezeptoren interagieren u. a. mit der Atmung, den Chemorezeptoren, physischer Belastung und untereinander. Das Zusammenwirken mit Chemorezeptoren ist z. B. bei chronischer Herzinsuffizienz, bei Schlafapnoe-Syndromen oder dem Sudden Infant Death Syndrom gestört und kann letale Komplikationen wie ungezügelte Bradykardien verursachen. Die exakte Beurteilung der Barorezeptoren gewinnt daher zunehmende Bedeutung für die Diagnose und das Verständnis pathophysiologischer Zusammenhänge bei zahlreichen neurologischen und kardiologischen Erkrankungen wie der diabetisch autonomen Neuropathie, dem Guillain-Barré-Syndrom, arterieller Hypertonie, Herzinsuffizienz und vermutlich bei allen „Stroke”-Patienten. Neben der pharmakologischen Prüfung stehen die Untersuchung mittels „neck suction”, d. h. Unterdruckstimulation der Halsregion und der Karotisrezeptoren sowie die computerisierte Analyse der Zusammenhänge zwischen spontaner Blutdruck- und Herzfrequenzmodulation zur Verfügung.

The baroreflex is of major importance for the moment-to-moment maintenance of arterial pressure particularly during orthostatic stress. Blood pressure increase stimulates the receptors e. g. in the carotid sinuses and the aortic arch, and rapidly increases the receptor discharge rate. Blood pressure decrease induces arrest of impulse transmission to the nucleus of the solitary tract. The impulses are modulated by the nucleus ambiguus, the rostral ventrolateral medulla, the dorsal nucleus of the vagus nerve, parabrachial and paraventricular nuclei and other central structures. Blood pressure increase induces an increase of cardiovagal activity resulting in cardiodeceleration and a decrease of sympathetic peripheral vasoconstrictor outflow. The receptor firing rates show adaptation and resetting to longer lasting blood pressure changes, hysteresis, i. e. firing rates that are higher with rapid blood pressure increase than during the return to baseline pressure. The receptors interact with respiration, chemoreceptor stimulation, central stimuli, exercise and sleep, etc. Baroreceptor function and interaction e. g. with chemoreceptors is compromised in diseases such as diabetic autonomic neuropathy, Guillain-Barré syndrome, arterial hypertension, heart failure and probably in most stroke patients. Fatal complications may result from baroreceptor malfunction. Subtle analysis of the baroreflex is therefore crucial for a refined pathophysiological understanding of these diseases. Pharmacological testing and „neck chamber” negative pressure stimulation of the receptors are as useful as the non-invasive computerized analysis of the interaction of spontaneous blood pressure and heart rate fluctuations.

Literatur

  • 1 Smit A AJ, Wieling W, Karemaker J M. Clinical approach to cardiovascular reflex testing.  Clin Sci. 1996;  91 108-112
    PubMedGoogle Scholar
  • 2 Wieling W, v Lieshout J J. Maintenance of postural normotension in humans. In: Low PA (Hrsg.) Clinical autonomic disorders. Philadelphia; Lippincott-Raven 1997: 73-82
    Google Scholar
  • 3 Eckberg D L, Sleight P. Human baroreflexes in health and disease, Volume 43. New York; Oxford University Press 1992
  • 4 Parry C H. An inquiry into the symptoms and causes of the syncope anginosa, commonly called angina pectoris. Bath; R Cruttwell 1799
  • 5 Czermak J. Über mechanische Vagus-Reizung beim Menschen. Jenaische Zeitschrift für Medicin und Naturwissenschaft 1866: 384-386
  • 6 Hering H E. Der Sinus caroticus an der Ursprungsstelle der Carotis interna als Ausgangsort eines hemmenden Herzreflexes und eines depressorischen Gefäßreflexes.  Münchener Medizinische Wochenschrift. 1924;  71 701-704
    PubMedGoogle Scholar
  • 7 Hering H E. Die Sinusreflexe vom Sinus caroticus werden durch einen Nerven (Sinusnerv) vermittelt, der ein Ast des Nervus glossopharyngeus ist.  Münchener Medizinische Wochenschrift. 1924;  71 1265-1266
    PubMedGoogle Scholar
  • 8 Koch E. Klinische Beobachtungen zum Karotisdruckversuch.  Münchener Medizinische Wochenschrift. 1923;  43 1316-1318
    PubMedGoogle Scholar
  • 9 Koch E. Die reflektorische Selbststeuerung des Kreislaufes. In: Kisch B (Hrsg.) Ergebnisse der Kreislaufforschung. Dresden; Steinkopff 1931
    Google Scholar
  • 10 Ciriello J, Rohlicek C V, Polosa C. Aortic baroreceptor reflex pathway: a functional mapping using [3H]2-deoxyglucose autoradiography in the rat.  J Auton Nerv Syst. 1983;  8 111-128
    CrossrefPubMedGoogle Scholar
  • 11 Rees P M. Observations on the fine structure and distribution of persumptive baroreceptor nerves at the carotid sinus.  J Comp Neurol. 1967;  131 517-548
    PubMedGoogle Scholar
  • 12 Rees P M. The distribution of biogenic amines in the carotid bifurcation region.  J Physiol (Lond). 1967;  193 245-253
    PubMedGoogle Scholar
  • 13 Reis D J, Fuxe K. Adrenergic innervation of the carotid sinus.  Am J Physiol. 1968;  215 1054-1057
    PubMedGoogle Scholar
  • 14 Stanton P D, Hinrichsen C F. Monoaminergic innervation of the carotid sinus in mammals: a histochemical study.  Acta Anat. 1980;  108 34-44
    PubMedGoogle Scholar
  • 15 Lipski J, Trzebski A. Bulbo-spinal neurons activated by baroreceptor afferents and their possible role in inhibition of preganglionic sympathetic neurons.  Pflugers Arch. 1975;  356 181-192
    PubMedGoogle Scholar
  • 16 Lipski J, McAllen R M, Spyer K M. The sinus nerve and baroreceptor input to the medulla of the cat.  J Physiol (Lond). 1975;  251 61-78
    PubMedGoogle Scholar
  • 17 Miura M, Reis D J. The role of the solitary and paramedian reticular nuclei in mediating cardiovascular reflex responses from carotid baro- and chemoreceptors.  J Physiol (Lond). 1972;  223 525-548
    CrossrefPubMedGoogle Scholar
  • 18 Panneton W M, Loewy A D. Projections of the carotid sinus nerve to the nucleus of the solitary tract in the cat.  Brain Res. 1980;  191 239-244
    CrossrefPubMedGoogle Scholar
  • 19 Bennaroch E E. Central autonomic network: functional organization and clinical correlations. Futura Publishing Company, Inc. Armonk 1997
  • 20 Ciriello J, Rohlicek C V, Poulsen R S, Polosa C. Deoxyglucose uptake in the rat thoracolumbar cord during activation of aortic baroreceptor afferent fibers.  Brain Res. 1982;  231 240-245
    CrossrefPubMedGoogle Scholar
  • 21 Kostreva D R. Functional mapping of cardiovascular reflexes and the heart using 2-[14C]deoxyglucose.  Physiologist. 1983;  26 333-350
    PubMedGoogle Scholar
  • 22 Eckberg D L, Fritsch J M. How should human baroreflexes be tested.  News Physiol Sci. 1993;  8 7-12
    PubMedGoogle Scholar
  • 23 Landgren S. On the excitation mechanism of the carotid baroreceptor.  Acta Physiol Scand. 1952;  26 1-34
    PubMedGoogle Scholar
  • 24 Eckberg D L. Baroreflex inhibition of the human sinus node: importance of stimulus intensity, duration, and rate of pressure change.  J Physiol (Lond). 1977;  269 561-577
    PubMedGoogle Scholar
  • 25 Coleridge H M, Coleridge J C, Poore E R, Roberts A M, Schultz H D. Aortic wall properties and baroreceptor behaviour at normal arterial pressure and in acute hypertensive resetting in dogs.  J Physiol (Lond). 1984;  350 309-326
    PubMedGoogle Scholar
  • 26 Korner P I, West M J, Shaw J, Uther J B. “Steady-state” properties of the baroreceptor-heart rate reflex in essential hypertension in man.  Clin Exp Pharmacol Physiol. 1974;  1 65-76
    PubMedGoogle Scholar
  • 27 Bronk D W, Stella G. Afferent impulses in the carotid sinus nerve. I. The relation of the discharge from single end organs to arterial blood pressure.  Journal of Cellular and Comparative Physiology. 1932;  1 113-130
    CrossrefPubMedGoogle Scholar
  • 28 Bronk D W, Stella G. The response to steady pressures of single end organs in the isolated carotid sinus.  Am J Physiol. 1935;  110 708-714
    PubMedGoogle Scholar
  • 29 Somers V K, Abboud F M. Baroreflexes in health and disease. In: Levy MN, PJ Schwartz (Hrsg.) Vagal control of the heart: experimental basis and clinical implications. Armonk, NY: Futura Publishing Company, Inc 1994: 381-402
    Google Scholar
  • 30 Thames M D, Dibner-Dunlap M E, Smith M L. Mechanisms of arterial baroreflex control. In: Levy MN, PJ Schwartz (Hrsg.) Vagal control of the heart: experimental basis and clinical implications. Armonk, NY: Futura Publishing Company, Inc 1994: 369-380
    Google Scholar
  • 31 Eckberg D L, Kifle Y T, Roberts V L. Phase relationship between normal human respiration and baroreflex responsiveness.  J Physiol (Lond). 1980;  304 489-502
    PubMedGoogle Scholar
  • 32 Trzebski A, Raczkowska M, Kubin L. Carotid baroreceptor reflex in man, its modulation over the respiratory cycle.  Acta Neurobiol Exp. 1980;  40 807-820
    PubMedGoogle Scholar
  • 33 Heistad D D, Abboud F M, Dickinson W. Richards Lecture: Circulatory adjustments to hypoxia.  Circulation. 1980;  61 463-470
    CrossrefPubMedGoogle Scholar
  • 34 Somers V K, Abboud F M. Chemoreflex control of cardiac vagal activity. In: Levy MN, PJ Schwartz (Hrsg.) Vagal control of the heart: experimental basis and clinical implications. Armonk, NY: Futura Publishing Company, Inc 1994: 403-416
    Google Scholar
  • 35 Somers V K, Dyken M E, Mark A L, Abboud F M. Parasympathetic hyperresponsiveness and bradyarrhythmias during apnoea in hypertension.  Clin Auton Res. 1992;  2 171-176
    CrossrefPubMedGoogle Scholar
  • 36 Bristow J D, Brown Jr E B, Cunningham D J, Goode R C, Howson M G, Pickering T G, Sleight P. Changes in baroreflex sensitivity at the transitions between rest and exercise.  J Physiol (Lond). 1969;  202 84-85P
    PubMedGoogle Scholar
  • 37 Bristow J D, Brown E B, Cunningham D J, Goode R C, Howson M G, Pickerings T G, Sleight P. Changes in the baroreceptor-cardiac reflex in exercise.  J Physiol (Lond). 1969;  201 106-107P
    PubMedGoogle Scholar
  • 38 Ferguson D W, Abboud F M, Mark A L. Relative contribution of aortic and carotid baroreflexes to heart rate control in man during steady state and dynamic increases in arterial pressure.  J Clin Invest. 1985;  76 2265-2274
    PubMedGoogle Scholar
  • 39 Mancia G, Ferrari A, Gregorini L, Valentini R, Ludbrook J, Zanchetti A. Circulatory reflexes from carotid and extracarotid baroreceptor areas in man.  Circ Res. 1977;  41 309-315
    PubMedGoogle Scholar
  • 40 Guo G B, Thames M D, Abboud F M. Differential baroreflex control of heart rate and vascular resistance in rabbits. Relative role of carotid, aortic, and cardiopulmonary baroreceptors.  Circ Res. 1982;  50 554-565
    CrossrefPubMedGoogle Scholar
  • 41 Smyth H S, Sleight P, Pickering G W. Reflex regulation of arterial pressure during sleep in man. A quantitative method of assessing baroreflex sensitivity.  Circ Res. 1969;  24 109-121
    PubMedGoogle Scholar
  • 42 Eckberg D L. Nonlinearities of the human carotid baroreceptor-cardiac reflex.  Circ Res. 1980;  47 208-216
    PubMedGoogle Scholar
  • 43 Rea R F, Eckberg D L. Carotid baroreceptor-muscle sympathetic relation in humans.  Am J Physiol. 1987;  253 R929-R934
    PubMedGoogle Scholar
  • 44 Imaizumi T, Brunk S D, Gupta B N, Thames M D. Central effect of intravenous phenylephrine on baroreflex control of renal nerves.  Hypertension. 1984;  6 906-914
    PubMedGoogle Scholar
  • 45 Hjemdahl P, Daleskog M, Kahan T. Determination of plasma catecholamines by high performance liquid chromatography with electrochemical detection: comparison with a radioenzymatic method.  Life Sci. 1979;  25 131-138
    CrossrefPubMedGoogle Scholar
  • 46 Peveler R C, Bergel D H, Robinson J L, Sleight P. The effect of phenylephrine upon arterial pressure, carotid sinus radius and baroreflex sensitivity in the conscious greyhound.  Clin Sci. 1983;  64 455-461
    PubMedGoogle Scholar
  • 47 White C W, Eckberg D L, Inasaka T. Direct effects of methoxamine and phenylephrine on sinus node function.  Am J Cardiol. 1973;  31 164
    PubMedGoogle Scholar
  • 48 Eckberg D L, Eckberg M J. Human sinus node responses to repetitive, ramped carotid baroreceptor stimuli.  Am J Physiol. 1982;  242 H638-644
    PubMedGoogle Scholar
  • 49 Ferrari A U, Cavallazzi A, Gregorini L, Perondi R, Daffonchio A, Mancia G. Effects of altering the interval between the stimulus and the reflex response in the analysis of the baroreceptor control of the sinus and atrioventricular nodes in man.  Cardiovasc Res. 1987;  21 385-390
    PubMedGoogle Scholar
  • 50 Pickering T G, Davies J. Estimation of the conduction time of the baroreceptor-cardiac reflex in man.  Cardiovasc Res. 1973;  7 213-219
    PubMedGoogle Scholar
  • 51 Ernsting J, Parry D J. Some observations on the effects of stimulating the stretch receptors in the carotid artery of man.  J Physiol. 1957;  136 45-46
    PubMedGoogle Scholar
  • 52 Bernardi L, Leuzzi S, Radaelli A, Passino C, Johnston J A, Sleight P. Low-frequency spontaneous fluctuations of R-R interval and blood pressure in conscious humans: a baroreceptor or central phenomenon.  Clin Sci (Colch). 1994;  87 649-654
    PubMedGoogle Scholar
  • 53 Bernardi L, Passino C, Robergs R, Appenzeller O. Acute and persistent effects of a 46-kilometre wilderness trail run at altitude: cardiovascular autonomic modulation and baroreflexes.  Cardiovasc Res. 1997;  34 273-280
    CrossrefPubMedGoogle Scholar
  • 54 Bernardi L, Bianchini B, Spadacini G, Leuzzi S, Valle F, Marchesi E, Passino C, Calciati A, Vigano M, Rinaldi M, Martinelli L, Finardi G, Sleight P. Demonstrable cardiac reinnervation after human heart transplantation by carotid baroreflex modulation of RR interval.  Circulation. 1995;  92 2895-2903
    CrossrefPubMedGoogle Scholar
  • 55 Sopher S M, Smith M L, Eckberg D L, Fritsch J M, Dibner-Dunlap M E. Autonomic pathophysiology in heart failure: carotid baroreceptor-cardiac reflexes.  Am J Physiol. 1990;  259 H689-696
    PubMedGoogle Scholar
  • 56 Bernardi L, Hayoz D, Wenzel R, Passino C, Calciati A, Weber R, Noll G. Synchronous and baroreceptor-sensitive oscillations in skin microcirculation: evidence for central autonomic control.  Am J Physiol. 1997;  273 H1867-1878
    PubMedGoogle Scholar
  • 57 Saul J P, Berger R D, Albrecht P, Stein S P, Chen M H, Cohen R J. Transfer function analysis of the circulation: unique insights into cardiovascular regulation.  Am J Physiol. 1991;  261 H1231-1245
    PubMedGoogle Scholar
  • 58 Sleight P, La Rovere M T, Mortara A, Pinna G, Maestri R, Leuzzi S, Bianchini B, Tavazzi L, Bernardi L. Physiology and pathophysiology of heart rate and blood pressure variability in humans: is power spectral analysis largely an index of baroreflex gain.  Clin Sci (Colch). 1995;  88 103-109
    PubMedGoogle Scholar
  • 59 Ludbrook J, Mancia G, Ferrari A, Zanchetti A. The variable-pressure neck-chamber method for studying the carotid baroreflex in man.  Clin Sci Mol Med. 1977;  53 165-171
    PubMedGoogle Scholar
  • 60 Shubrooks Jr S J. Carotid sinus counterpressure as a baroreceptor stimulus in the intact dog.  J Appl Physiol. 1972;  32 12-19
    PubMedGoogle Scholar
  • 61 Thron H L, Brechmann W, Wagner J, Keller K. [Quantitative studies on the importance of vasodilator receptors in the skin during circulatory homeostasis in waking humans. I. Character of the arterial blood pressure and heart rate with respect to gradual transmural blood pressure change in the carotid sinus region].  Pflugers Arch Gesamte Physiol Menschen Tiere. 1967;  293 68-99
    PubMedGoogle Scholar
  • 62 Robbe H W, Mulder L J, Ruddel H, Langewitz W A, Veldman J B, Mulder G. Assessment of baroreceptor reflex sensitivity by means of spectral analysis.  Hypertension. 1987;  10 538-543
    CrossrefPubMedGoogle Scholar
  • 63 Weise F, Laude D, Girard A, Zitoun P, Siche J P, Elghozi J L. Effects of the cold pressor test on short-term fluctuations of finger arterial blood pressure and heart rate in normal subjects.  Clin Auton Res. 1993;  3 303-310
    CrossrefPubMedGoogle Scholar
  • 64 Fritsch J M, Eckberg D L, Graves L D, Wallin B G. Arterial pressure ramps provoke linear increases of heart period in humans.  Am J Physiol. 1986;  251 R1086-1090
    PubMedGoogle Scholar
  • 65 Bertinieri G, Di Rienzo M, Cavallazzi A, Ferrari A U, Pedotti A, Mancia G. Evaluation of baroreceptor reflex by blood pressure monitoring in unanesthetized cats.  Am J Physiol. 1988;  254 H377-383
    PubMedGoogle Scholar
  • 66 Parati G, Di Rienzo M, Bertinieri G, Pomidossi G, Casadei R, Groppelli A, Pedotti A, Zanchetti A, Mancia G. Evaluation of the baroreceptor-heart rate reflex by 24-hour intra-aterial blood pressure monitoring in humans.  Hypertension. 1988;  12 214-222
    CrossrefPubMedGoogle Scholar
  • 67 Ponikowski P, Chua T P, Piepoli M, Ondusova D, Webb-Peploe K, Harrington D, Anker S D, Volterrani M, Colombo R, Mazzuero G, Giordano A, Coats A JS. Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure.  Circulation. 1997;  96 2586-2594
    PubMedGoogle Scholar
  • 68 Tuck R R, McLeod J G. Autonomic dysfunction in Guillain-Barré syndrome.  J Neurol Neurosurg Psychiatry. 1981;  44 983-990
    CrossrefPubMedGoogle Scholar
  • 69 Lown B, Levine S A. The carotid sinus: Clinical value of its stimulation.  Circulation. 1961;  23 766-789
    CrossrefPubMedGoogle Scholar
  • 70 Huang S K, Ezri M D, Hauser R G, Denes P. Carotid sinus hypersensitivity in patients with unexplained syncope: clinical, electrophysiologic, and long-term follow-up observations.  Am Heart J. 1988;  116 989-996
    CrossrefPubMedGoogle Scholar
  • 71 Madigan N P, Flaker G C, Curtis J J, Reid J, Mueller K J, Murphy T J. Carotid sinus hypersensitivity: beneficial effects of dual-chamber pacing.  Am J Cardiol. 1984;  53 1034-1040
    CrossrefPubMedGoogle Scholar
  • 72 Trout H H d, Brown L L, Thompson J E. Carotid sinus syndrome: treatment by carotid sinus denervation.  Ann Surg. 1979;  189 575-580
    PubMedGoogle Scholar

Prof. Dr. med. Max J. Hilz

Neurologische Klinik mit Poliklinik der Friedrich-Alexander-

Universität Erlangen-Nürnberg

Schwabachanlage 6

D-91054 Erlangen

eMail: max.hilz@neuro.med. uni-erlangen.de