フォンタン手術後,心臓の自律神経活動がひどく低下した
H Ohuchi1, S Hasegawa, K Yasuda
1Department of Pediatrics, National Cardiovascular Center, Osaka, Japan. hohuchi@hsp.ncvc.go.jp
Circulation
|September 26, 2001
まとめ
フォンタン手術後,心臓の自律神経活動 (CANA) が低下し,パラシンパティック神経活動 (PSNA) と交感性マーカーが低下しています. この自律的機能障害は,フォンタン循環そのものに起因し,ACE阻害剤によって改善されない可能性があります.
科学分野:
- 心臓病学 心臓病学
- 自律神経科学とは
- 小児心臓外科手術について
背景:
- フォントン手術後の患者は,神経幽モラル活動の上昇と異常な運動心肺応答を示します.
- フォントン後の患者の心臓自律神経活動 (CANA) は,まだ十分に研究されていない.
研究 の 目的:
- フォンタン手術を受けた患者の心臓自律神経活動 (CANA) を評価する.
- フォントン後期患者のCANA,運動能力,および臨床的特徴の関係を調査する.
主な方法:
- 心拍数変動,バロレフレクスの感度,および[123I]メタイオデブンジルグアニジン画像 (H/M比) を用いてCANAを評価した.
- イソプロテレノール (β) と運動能力 (ピークVO2) の後にHR増加経由で心交感神経活動の測定.
- フォントン後の63人の患者と44人の対照群を比較し,臨床パラメータとの相関を分析した.
主要な成果:
- フォントン後の患者は,対照群と比較して,心臓のパラシンパティック神経活動 (PSNA) とH/M比が著しく低下した.
- ベータ感受性とPSNAは運動中の心拍数上昇 (DeltaHR) と相関していたが,DeltaHRはピークVO2と相関していなかった.
- CANAマーカー (PSNA,H/M) と臨床的特徴,または外科歴との関連は見つかりませんでした.
結論:
- ポストシナプスベータ感受性とPSNAは維持され,フォントン後の運動誘発性心拍数変化に寄与しますが,運動能力を決定しません.
- 手術因子とは関係なく,フォンタン循環自体がCANAを損なう可能性があります.
- アンジオテンシン変換酵素阻害剤の治療は,観察された自律機能不全を改善しませんでした.
さらに関連する動画
関連する概念動画
Cardiac Catheterization IV: Nursing Management
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Cardiomyopathy II: Dilated Cardiomyopathy
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
Cardiomyopathy V: Interprofessional Care
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
Cardiomyopathy VII: Pre and Post Operative Nursing Management
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...


