Central Nervous System and Cardiac Arrhythmias

中樞神經系統與心律不整

陳幸一(H. I. Chen) ； 蔡作雍(C. Y. Chai)

《Journal of Medical Sciences》 2卷3期 (1978/01) Pp. 681-693

摘要

某些心律不整的發生可能與神經系統有關，本論著收集相關文獻，以檢討中樞神經系統（包括大腦皮質、間腦、中腦、橋腦及延腦等）產生心律不整之部位及可能機轉。對於以下兩個題目之分析較為詳細：（甲）腦血管猝發症產生之心律變化特性與機轉，（乙）交感及迷走（副交感）神經系統兩者產生心律變化之交互作用。中樞神經系統產生心律不整之機構具有解剖上之特殊性。一般言之，刺激腦皮質或視丘不易發生心律不整，刺激大視丘、中腦及橋延腦部位則經常引發心律變化。即使刺激這些部位，有時甲乙兩個刺激點僅隔0.5至1毫米，兩者均引起相同之升壓反應，而甲點刺激可併發嚴重之心律不整，乙點則僅為輕度或甚至不產生心律不整。神經性心律不整亦具有功能上之特殊性，由於夾閉頸動脈引起感壓反射而併發升壓，心律加速以及心律不整之反應，心律不整經常可因去大腦或破壞中腦部位而消除，然而升壓及心速反應則不受影響。可見負責升壓及心速之交感機構不同於產生心律不整之機構。至於中樞神經系統在產生心律不整之解剖及功能間之關連與交互作用，則有待進一步研究。

並列摘要

This paper briefly reviews some studies on the cardiac arrhythmias of nervous origin. The characteristics and the mechanism of ECG changes in case of cerebrovascular accidents and the interaction of vagal and sympathetic systems on the production of centrogenic arrhythmias are discussed more in detail.Some mechanisms in the CNS which are responsible for the genesis of cardiac arrhythmias are anatomically specific. In general, cardiac arrhythmias were not frequently observed in stimulation of the cortex and the thalamus, but could be easily induced by stimulation of the hypothalamic, mesencephalic and bulbar areas. In the latter locations, stimulation of two points within 0.5 - 1 mm, one might produce marked cardiac arrhytyhmias, while the other might produce only a minimum or not at all, although both elicited pressor response of the same magnitude. There is also evidence of functional specificity. Baroreceptor reflex by carotid occlusion in vagotomized animals evoked pressor response, sinus tachycardia and cardiac arrhythmias. Decerebration or mesencephalic lesions eliminated the cardiac arrhythmias, but did not affect the pressor response and the sinus tachycardia. This would indicate that the pressor and the positive chronotropic effects during barorecptor reflex might be mediated through the sympathetic mechanism different from that for the genesis of cardiac arrhythmias. However, the anatomical and functional relations of the CNS on cardiac arrhythmias are open to further study.