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1 Department of Internal Medicine, University of California, Irvine, CA, USA; Department of Cardiovascular Physiology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Okayama, Japan
2 Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine and Dentistry, Okayama, Okayama, Japan
3 Department of Cardiovascular Physiology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Okayama, Japan; National Cardiovascular Center Research Institute, Suita, Osaka, Japan
* To whom correspondence should be addressed. E-mail: wzhou2{at}uci.edu.
Neiguan (PC-6) is a traditional acupoint in each forearm and overlies the trunk of the median nerve. Previous studies show that electroacupuncture (EA) at Neiguan acupoint could improve not only myocardial ischemic dysfunction by inducing a depressor response but also recover hemorrhagic hypotension by inducing a pressor response. However, their physiological mechanisms are not yet elucidated. We investigated the pressor effect of Neiguan EA and its mechanism by focusing on left ventricular (LV) performance in a canine hemorrhagic hypotension model. We hemorrhaged 36 anesthetized and thoracotomized mongrel dogs and decreased LV end-systolic pressure (ESP) to approximately 70 mmHg (35% decrease). We obtained LV pressure-volume (P-V) data with a micromanometer catheter and a conductance catheter. One-hour Neiguan EA significantly recovered the decreased ESP, end-diastolic volume, and stroke volume by 32±13%, 27±13%, and 39±17%, respectively (P < 0.05), without changing heart rate and the slope (Ees) of the end-systolic P-V relation. Neiguan EA inhibited a hemorrhage-induced increase in plasma catecholamines. However, vecuronium (neuromuscular blocking agent) administration abolished the anti-hypotension effect of Neiguan EA. Furthermore, Neiguan EA was much more effective than a non-acupoint thigh EA. We conclude that Neiguan EA achieved the anti-hypotension effect by improving LV filling of the hemorrhage-depressed LV performance despite the inhibition of the hemorrhage-increased plasma catecholamines. This pressor effect seemed to accompany an increased venous return by Neiguan EA-increased vasomotor tone and muscle pump. This study demonstrated a scientific basis for the therapeutic efficacy of acupuncture in the treatment of hemorrhagic hypotension and shock.
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