WTARLING心脏定律质疑(英文)

DOUBTS ABOUT WTARLING'S LAW OF THE HEART

本文分析了游离心肌和心肺制备试验结果，并从Starling心脏定律的主要作用、显微结构基础和心脏做功等几个方面进行了讨论。作者认为：①游离心肌条所具有的Frank-Starling效应不能用以表征完整心脏的生理特性，如同一台机器的零件离开整机时所具有的性质不能视为是那台机器的主要性质一样;②在心肺制备试验中增加心脏负荷所引起的心脏收缩活动增强，是心脏具有丰富储备力的表现，它需要通过心肌细胞内的生化机制方能得以实现，因此，根据试验中增加心室充盈压引起心脏收缩活动增强的事实，在逻辑上不应得出心室充盈压力（心肌纤维长度）决定心脏收缩强度的推论;③公式“每搏功＝P×（EDV-ESV）”的数学关系表明，心脏每搏做功和心室舒张末期容积（EDV，心肌纤维初长度）不成正比例或正相关;④Starling心脏定律是一个错误的概念，它不是心脏的一种生理特性。

This paper analyses the experimental results obtained in the isolated heart rnuscle strips by Frank and in the heart-lung preparation by Starling and his colleagues. And then Starling's law of the heart is further explored as to aspects of its major role, microstructural basis and the cardiac working. The author believes the following ideas: ①Frank-Starling effect observed in the isolated heart muscle preparation cannot be used to indicate the physiological character of intact heart, just as the nature of the parts of a machine cann0t characterize the machine itself when they are separated from it. ②The experiment by increasing the load on heart to enhance the contractile strength of the heart manifests that the heart has a remarkeble reserve power, which is revealed by the increased load on the heart. This response must undergo a series of biochemical mechanisms within myocardial cells, and so based on the results of the experiment in which increasing the ventricular filling pressure increases the strength of the contraction of the heart, one ought not logically to get the deduction that the contractile strength of the heart depends upon the ventricular filling pressure (the muscle fiber length). ③As to the mathematical relationship, the formula 'Stroke work=P × (EDV-ESV)' illustrates that the stroke work is not directly proportional or positively correlated to the end-diastolic volume (EDV, the initial length of the muscle fibers). ④Starling's law of the heart is a mistaken conception, and it is not a physiological character of the heart.