Autonomic predictors of recovery following surgery: a comparative study.
Autonomic predictors of recovery following surgery: a comparative study.
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DOI：
10.1016/j.autneu.2010.03.009
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发表时间：
2010-08-25
期刊：
影响因子：
--
通讯作者：
Porges SW
中科院分区：
文献类型：
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作者：
Williamson JB;Lewis G;Grippo AJ;Lamb D;Harden E;Handleman M;Lebow J;Carter CS;Porges SW
尽管在手术后的恢复过程中持续监测患者的心率和体温，但从逐次心率中提取自主神经回路神经调节的直接表现的措施可能对结果更敏感。我们探索了草原田鼠的自主调节特征与生存之间的关系，草原田鼠是一种小型哺乳动物，其心脏的迷走神经调节特征与人类相似。心脏迷走神经调节表现为逐次心跳心率变异性 (HRV) 模式，并且可以通过提取与自主呼吸相关的周期性振荡的振幅测量值来量化。因此，监测草原田鼠手术后的逐次心率模式可能为动态评估恢复期间的自主调节提供机会。我们的实验室经常进行植入遥测设备的手术，以监测草原田鼠的体温和连续心电图。其中 10 只植入的草原田鼠在术后 48 小时内死亡。为了将手术后自主轨迹与典型存活的草原田鼠进行比较，随机选择了 17 只存活的草原田鼠的术后数据。 27 只草原田鼠在手术后 6 至 14 小时（第一名受试者死亡前 1 小时）内每小时报告一次数据。每小时计算每个变量的受试者工作曲线，以评估区分生存的敏感性。数据表明 HRV 测量是最敏感的指标。这些发现为进一步研究心血管功能的神经机制奠定了基础。
Although heart rate and temperature are continuously monitored in patients during recovery following surgery, measures that extract direct manifestations of neural regulation of autonomic circuits from the beat-to-beat heart rate may be more sensitive to outcome. We explore the relationship between features of autonomic regulation and survival in the prairie vole, a small mammal, with features of vagal regulation of the heart similar to humans. Cardiac vagal regulation is manifested in the beat-to-beat heart rate variability (HRV) pattern and can be quantified by extracting measures of the amplitude of periodic oscillations associated with spontaneous breathing. Thus, monitoring beat-to-beat heart rate patterns post-surgery in the prairie vole may provide an opportunity to dynamically assess autonomic adjustments during recovery. Surgeries to implant telemetry devices to monitor body temperature and continuous ECG in prairie voles are routinely performed in our laboratory. Ten of these implanted prairie voles died within 48 h post-surgery. To compare the post-surgery autonomic trajectories with typical surviving prairie voles, the post-surgery data from 17 surviving prairie voles were randomly selected. The data are reported hourly for 27 prairie voles between 6 and 14 h (1 h before the demise of the first subject) post-surgery. Receiver operator curves were calculated hourly for each variable to evaluate sensitivity in discriminating survival. The data illustrate that measures of HRV are the most sensitive indicators. These findings provide a foundation for investigating further neural mechanisms of cardiovascular function.