Abstract
全身麻醉药在临床上常引起剂量依赖性血压下降,直接扩血管作用是其诱发低血压的重要原因之一.血管平滑肌(VSM)收缩反应由细胞内钙离子浓度([Ca2+]i)升高激发,也受钙离子敏感化机制包括蛋白激酶C(PKC)、Rho激酶、p44/42丝裂素激活蛋白激酶(p44/42MAPK)等传导通路的调节.血管张力也受内膜衍生的松弛因子(EDRFs)如一氧化氮(NO)、前列腺素I2(PGI2)、内膜衍生的超极化因子(EDHF)以及ATP敏感性钾(KATP)通道调节.吸入性麻醉药如氟烷、异氟醚、七氟醚等被证明通过抑制平滑肌[Ca2+]i升高和PKC、Rho激酶、p44/42 MAPK的活性、同时也通过抑制EDRFs的释放和增加KATP通道的开放来扩张血管.所以,全身麻醉药的扩血管作用是其同时抑制VSM的收缩作用和血管内膜介导的舒血管作用的综合结果。
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