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            【福建成人高考】2019年專升本醫學綜合之反射

            福建成人高考信息網www.laiwobuy.com 發布時間: 2018年11月08日

            第一節 神經纖維傳導興奮的特征

              一、結構和功能的完整性

              神經傳導是依靠局部電流來完成的。因此它要求神經纖維在結構和功能上都是完整的;如果神經纖維被切斷或因局部受麻醉藥作用而喪失了完整性,則因局部電流不能很好通過斷口或麻醉區而發生傳導阻滯。

              二、絕緣性

              在一束神經干包含有許多神經纖維。各條纖維上傳導的興奮互不干擾。

              三、雙向性

              刺激神經纖維上的任何一點,沖動可沿神經纖維向兩端同時傳導。表現為動作電位以局部電流的形式擴散。但在機體整個神經系統中,總是胞體興奮后,沿神經纖維傳向末梢。

              四、相對不疲勞性

              神經纖維傳導沖動所消耗的能量遠遠小于突觸所消耗的能量,故傳導興奮是不易疲勞的,即能較持久地保持傳導興奮的功能。

              第二節 神經元活動的一般規律

              一、經典突觸的概念和分類

              神經元之間在結構上并沒有原生質相連,每一神經元的軸突末梢僅與其他神經元的胞體或突起相接觸,此接觸的部位稱為突觸。主要的突觸組成可分為三類:

              (1)一個神經元的軸突與另一個神經元的胞體相接觸,稱為軸—胞型突觸;

              (2)一個神經元的軸突與另一個神經元的樹突相接觸,稱為軸—樹型突觸;

              (3)一個神經元的軸突與另一個神經元的軸突相接觸,稱為軸—軸型突觸。

              二、周圍神經遞質

              有乙酰膽堿、去甲腎上腺素及嘌呤類和肽類化學物質。

              (一)乙酰膽堿

              神經纖維末梢釋放乙酰膽堿為遞質的,稱為膽堿能纖維。包括:全部交感、副交感節前纖維;大多數副交感節后纖維(少數為肽能纖維);少數交感神經節后纖維,如支配汗腺分泌、骨骼肌血管舒張的交感神經節后纖維;軀體運動神經纖維。

              (二)去甲腎上腺素

              神經纖維末梢釋放去甲腎上腺素為遞質的,稱為腎上腺素能纖維。大多數交感神經節后節維,為腎上腺索能纖維。

              三、受體

              受體是指細胞膜或細胞內能與某些化學物質(如遞質、激素等)發生特性結合并誘發生物效應的特殊生物分子。

              (一)膽堿能受體

              1.毒蕈堿受體(M受體) M受體既能與Ach結合,也能與毒蕈堿結合。廣泛地分布于絕大多數副交感神經節后纖維支配的效應器,以及部分交感神經節后纖維支配的汗腺、骨骼肌的血管壁上。Ach與M受體結合后,可產生一系列自主神經節后膽堿能纖維興奮的效應,包括心臟活動的抑制、支氣管與胃腸道平滑肌的收縮、膀胱逼尿肌和瞳孔括約肌的收縮、消化腺與汗腺的分泌、以及骨骼肌血管的舒張等,這種效應稱為毒蕈堿樣作用(M樣作用)。阿托品是M受體的阻斷劑。

              2.煙堿受體(N受體) N受體既能與Ach結合,也能與煙堿結合。N受體又分為N1受體與 N2受體兩種亞型。N1受體稱為神經元型N受體,它分布于中樞神經系統內和自主神經節的突觸后膜上,Ach與之結合可引起節后神經元興奮;N2受體稱為肌肉型N受體,其分布在神經一肌肉接頭的終板膜上,Ach與之結合可使骨骼肌興奮。Ach與這兩種受體結合所產生的效應稱為煙堿樣作用(N樣作用),六烴季銨可阻斷N1受體;十烴委銨可阻斷N2受體;氯筒箭毒堿能同時阻斷這兩種受體。

              (二)腎上腺素能受體

              腎上腺素能受體是指能與兒茶酚胺(腎上腺素和去甲腎上腺素)發生特異性結合而產生生理效應的受體。大多數交感神經節后纖維支配的效應器細胞上存在腎上腺素能受體(交感神經支配的汗腺例外,汗腺細胞上為M型受體)。

              腎上腺素能受體可分為兩型:

              (1)α受體:兒茶酚胺與α受體結合后產生的平滑肌效應主要是興奮性的,如皮膚和內臟血管收縮、子宮和擴瞳肌收縮,但胃腸平滑肌舒張。酚妥拉明是α受體的阻斷劑。

              (2)β受體:又分為β1和β2兩種。β1受體與兒茶酚胺結合后使心跳加快、加強、房室傳導加快;β2受體與兒茶酚胺結合后,使骨骼肌血管、支氣管和胃腸平滑肌舒張。β受體的阻斷劑是心得安。

              第三節 突觸傳遞

              一、突觸傳遞的過程和原理

              神經沖動傳到神經末梢時,突觸前膜產生動作電位,使突觸前膜對Ca2+通透性增加,Ca2+便由膜外進入突觸小體內。突觸小體內Ca2+的增加可促使小體內的囊泡向突觸前膜靠近,并將囊泡內的神經遞質以出胞的方式釋放到突觸間隙內。遞質擴散到后膜與其上的相應受體結合,使突觸后膜對離子的通透性發生變化,引起離子跨膜流動,產生突觸后電位,改變了突觸后神經元的興奮性,完成了信息的跨突觸傳遞。

              二、興奮性突觸后電位(EPSP)

              興奮性突觸后電位及其產生原理:如果是興奮性突觸,則突觸小體囊泡釋放的遞質為興奮性遞質,它與突觸后膜特異性受體結合后,可提高后膜對Na+、K+、Cl-,尤其是Na+的通透性促使Na+內流,使后膜內電位上升,形成局部去極化。其結果使突觸后神經元的興奮性增高,經過總和而產生動作電位,使后膜興奮。這種發生的突觸后膜上的局部去極化電位稱為興奮性突觸后電位。

              三、抑制性突觸后電位(EPSP)

              突觸小體囊泡釋放的遞質與突觸后膜受體結合后,主要提高后膜對Cl-的通透性,引起Cl-內流,使原有的膜電位增大,發生局部超極化,結果使突觸后神經元的興奮性降低。這種發生在突觸后膜上的局部超極化電位稱為抑制性突觸后電位。

              四、突觸傳遞的特點

              (一)單向傳布

              在人為刺激神經時,興奮可由刺激點爆發后沿神經纖維向兩個方向傳導(雙向性);但在中樞內大量存在的化學性突觸處,興奮傳布只能由傳入神經元向傳出神經元方向傳布,也即興奮只能由一個神經元的軸突向另一個神經元的胞體或突起傳遞。

              (二)中樞延擱(突觸延擱)

              興奮通過突觸部分比較緩慢,稱為突觸延擱。這是因為興奮越過突觸要耗費較長的時間,其中包括突觸前膜釋放遞質、遞質擴散到突觸后膜發揮作用等環節。興奮通過一個突觸所需的時間約為0.3~0.5ms。

              (三)總和

              單根神經纖維的一次沖動引起的突觸前膜釋放的遞質數量以及所引起的興奮性突觸后電位并不能使突觸后神經元產生動作電位。如果同一突觸前膜連續多次興奮或許多突觸前軸突末梢同時將沖動傳至同一突觸后神經元,則突觸后神經元產生的興奮性突觸后電位經過時間性或空間性總和而達到閾電位,從而產生動作電位,這一過程稱為興奮的總和。抑制也可以總和,其結果是使突觸后神經元更不易產生動作電位。

              (四)興奮節律的改變

              在一反射活動中,如同時分別記錄傳入與傳出的沖動頻率,則可測得兩者的頻率不同。因為傳出神經的興奮節律來自傳出神經元,而傳出神經元的興奮節律除取決于傳人沖動的節律外,還取決于中問神經元和傳出神經元的功能狀態。

              (五)后放(后發放、后放電)

              一個感覺神經元接受一次強刺激時,可以引起突觸后神經元接連發放若干個神經沖動,并可出現予刺激停止以后,這種現象稱為后發放。后發放是沖動通過若干個中間神經元形成回路聯系造成的。

              (六)對內環境變化的敏感性和易疲勞性

              在反射活動中,突觸部位是反射弧中最易疲勞的環節。同時,突觸部位也最易受內環境變化的影響,缺氧、二氧化碳和麻醉劑等因素均可作用于中樞而改變其興奮性,亦即改變突觸部位的傳遞活動。



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