评Frank-Starling心脏定律——Frank-Starling定律并非定律  

A Comment on the Frank-Starling Law of the Heart──The Frank-Starling Law is not a Law

作　　者：何川[1] 何培芳[2] 

机构地区：[1]四川大学华西医院,成都610041 [2]四川省三台县人民医院,621100

出　　处：《前沿科学》2009年第1期29-39,共11页Frontier Science

摘　　要：心脏收缩释放的能量(作功)是心肌纤维长度(心室舒张末期容积,EDV)的函数,即Frank-Starling(FS)心脏作功定律,被誉为心脏生理学中的"经典"理论,对此,笔者从各种不同角度进行了探讨:首先分析了Frank伸展离体心肌和Starling心肺制备实验与动物生理学实际的差异、以及人们在实验中观测到的增加心肌前负荷引起其收缩力增强的现象(FS现象),认为⑴在正常生理条件下的动物体内,来自心脏以外的、如同Starling心肺制备实验中那样人工控制心室充盈压力升高、引起EDV增加的那种血液的重力动力是不存在的;⑵另一方面,人为地增加前负荷,那是改变了心肌收缩时的外环境条件;⑶由此而激发出的FS现象,是心脏适应其外环境条件变化所作出的反应;⑷此种心肌收缩力增强的反应,需通过心肌细胞内部与收缩过程发生有关的心肌兴奋收缩和化学力学偶联等一系列生化机制(不恒定因素)方能得以实现;因此⑸根据他们实验中观测到的FS现象,在逻辑上不能得出前负荷这一心肌收缩时的外环境条件变化调控其作功的推论,换言之,所有的在实验中被激发出来的FS现象,都不足以成为支持FS心脏定律的证据。然后,引用国内外公认的计算心脏每搏射血作功(W)的生物物理学公式"W=P×(EDV-ESV)",证明了W和EDV之间没有函数关系。根据心脏作功的生物物理学基本原理,笔者认为Frank-Starling心脏定律表达的不是心脏作功的规律。The theory that the energy of cardiac contraction(cardiac work) is a function of the length of the muscle fiber(the end-diastolic volume,EDV) has been known as the Frank-Starling law of the heart(FSLH),which is reputed as the 'classic mechanism' in physiology of the heart.The FSLH is discussed from various perspectives in this paper.First of all,the authors of this paper analyze the difference between Frank's experiments of the stretch of isolated cardiac muscle and Starling's heart-lung preparation and the animal physiological practice,and focus on their experimental results which the increase in the preloads of the cardiac muscle enhances its contractility,the Frank-Starling phenomenon(FSP).The authors conclude that:(1) under normal physiological condition,from the outside of the heart there is no such power that the potential energy of the venous blood was controlled in the heart-lung preparation,in which the artificial increase in the filling pressure caused the increase in the EDV;(2) the artificial increase of the load in the experiments,as far as the work of cardiac muscle contraction is concerned,can certainly change the external environmental condition during contraction;(3) the FSP shown/provoked in the experiments is a response to adapt to the changes in the external environmental condition during contraction;(4) the response of the increase in the contractility to the increase of the preload has to undergo a train of mechanisms of excitation-contraction and chemical-mechanic coupling(changing factors) within myocardial cells;(5) therefore on the basis of the FSP in the experiments,people have concluded that the preload(one of the external environmental condition during contraction) may regulate and determine cardiac work,which does not logically agree with the basics of scientific epistemology,viz.all the FSPs observed in the experiments do not provide enough evidence to support the FSLH.Then,the authors cite the biophysical formula of cardiac work 'Stroke work = P ×(EDV-ESV)' which has been universa

关 键 词：心脏作功(W) 舒张末期容积(EDV) 收缩末期容积(ESV) Frank-Starling现象 Frank-Starling心脏定律 认识论 

分 类 号：R337.2[医药卫生—人体生理学] R331.3+1[医药卫生—基础医学] R312[理学—一般力学与力学基础] O332[理学—力学]