右心室外流出管の再建後の異常な心臓自律神経活動
H Ohuchi1, H Suzuki, K Toyohara
1Department of Pediatrics, National Cardiovascular Center, Osaka, Japan.
Circulation
|November 30, 2000
まとめ
心臓の自律神経活動 (CANA) は,先天性心疾患の患者に手術後の変化がある. 副交感機能が改善する一方で,右心室外流管の再建後に交感性デナーヴェーションは一般的であり,運動能力に影響を与えます.
科学分野:
- 心臓病学 心臓病学
- 自律神経系の研究
- 小児心臓外科手術について
背景:
- 生まれながらの心臓病 (CHD) は,心血管機能に重大な影響を及ぼします.
- 心臓病患者の心臓自律神経活動 (CANA) に関する研究は限られている.
- 自律的機能を理解することは,CHDのアウトカムを管理するために不可欠です.
研究 の 目的:
- 異なるタイプの先天性心不全を有する患者の心臓自律神経活動 (CANA) を手術後の評価するために.
- 外科介入後のパラシンパティックおよびシンパティック神経系の機能の回復を評価する.
- 自律機能と運動能力,および臨床パラメータを相関させる.
主な方法:
- 4つのグループでCANAを評価した:心房/心室隔膜欠陥閉塞後の (n=54),成功後のRVOTR (n=54),残留狭窄のRVOTR後の (n=35),および対照群 (n=47).
- 胆管阻害後の心拍数 (HR) の変化,HRの変動性,動脈バロレフレクスの感受性 (BRS) を通して,心臓のパラシンパティック神経活動 (PSNA) を測定した.
- (123) I-メタイオデベンジルグアニジン吸収比率 (H/M) を用いて推定された心交感神経活動 (CSNA) と,イソプロテレノール (ss) の後のHR増加. 運動テストではHR応答 (DeltaHR) とピーク酸素摂取量 (VO(2) を測定した.
主要な成果:
- 交感応答 (ss) の有意な差異は,グループ間で観察されませんでした.
- グループA (septal defect closure) は軽度かつ一時的なPSNA障害を示した.
- グループB1とB2 (RVOTR) は,対照群 (P<0.001) と比較して,PSNAの障害とH/Mの低下を示し,PSNAはRVOTRを繰り返した後に回復する傾向を示した.
- グループB1では,PSNAとssはDeltaHRと相関し,BRSはRVOTRでの外科歴と年齢と逆相関し,DeltaHRはピークVOと相関した.
結論:
- 後シナプスベータアドレナージ感は,RVOTR後に維持され,運動誘発の心拍数変化には,PSNAと共に不可欠です.
- Ventricular sympathetic denervationはRVOTR後によく見られるが,PSNAは改善され,エアロビック能力が向上する.
- 静脈の交感性再神経化の長期的な回復は,依然として不確実です.
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