Physiologie und Untersuchungsmethoden des Baroreflexes

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.

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