在右心室外流通道重建后心脏自主神经活动异常
H Ohuchi1, H Suzuki, K Toyohara
1Department of Pediatrics, National Cardiovascular Center, Osaka, Japan.
Circulation
|November 30, 2000
概括
心脏自主神经活动 (CANA) 在先天性心脏病患者手术后发生变化. 虽然副交感功能有所改善,但在右心室外流通道重建后,交感缺血是常见的,这会影响运动能力.
科学领域:
- 心脏病学 心脏病学
- 自主神经系统研究 自主神经系统研究
- 儿科心脏手术 儿科心脏手术
背景情况:
- 先天性心脏病 (CHD) 显著影响心血管功能.
- 关于心脏自主神经活动 (CANA) 在心脏病患者中的研究有限.
- 了解自主功能对于管理CHD结果至关重要.
研究的目的:
- 在手术后评估不同类型先天性心脏缺陷患者的心脏自主神经活动 (CANA).
- 为了评估手术干预后的副交感和交感神经系统功能的恢复.
- 为了将自主功能与运动能力和临床参数相关联.
主要方法:
- 在4组中评估CANA:心房/心室隔膜缺陷闭合后 (n=54),成功后的RVOTR (n=54),残留狭窄后的RVOTR (n=35) 和对照组 (n=47).
- 通过胆固醇阻塞后的心率 (HR) 变化测量心脏副交感神经活动 (PSNA),心率变化,HR变化和动脉巴罗反射灵敏度 (BRS).
- 使用 (123) I-metaiodobenzylguanidine吸收比率 (H/M) 估计的心脏交感神经活动 (CSNA) 和在异二醇 (ss) 后的HR增加. 运动测试测量了HR响应 (DeltaHR) 和氧气吸收峰值 (VO(2)).
主要成果:
- 两组之间没有观察到同情反应 (ss) 的显著差异.
- 组A (septal缺陷关闭) 显示轻度,暂时的PSNA损伤.
- 与对照组相比 (P<0.001),B1和B2组 (RVOTR) 呈现出受损PSNA和低H/M,PSNA在重新RVOTR后倾向于恢复.
- 在B1组中,PSNA和ss与DeltaHR相关;BRS与RVOTR手术史和年龄相反相关,而DeltaHR与峰值VO相关.
结论:
- 在RVOTR后保持了后交互性β-上腺素敏感性,并且与PSNA一起对运动诱导的心率变化至关重要.
- 室腔交感性缩是RVOTR后常见的,尽管PSNA有所改善,导致有氧能力更好.
- 对于心室交感性再内核的长期恢复仍然不确定.
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