Artificial baroreflex - Clinical application of a bionic baroreflex system
Artificial baroreflex - Clinical application of a bionic baroreflex system
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DOI：
10.1161/circulationaha.105.587915
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发表时间：
2006-02-07
期刊：
影响因子：
37.8
通讯作者：
Sato, T
中科院分区：
文献类型：
--
作者：
Yamasaki, F;Ushida, T;Sato, T
背景-我们提出了一种新的治疗中枢压力反射衰竭的策略：实现了一种自动调节交感血管紧张性人工压力反射系统，即仿生压力反射系统（BBS），方法和结果-BBS由一个计算机控制的负反馈电路组成，它可以感知动脉压（AP），并自动计算通过置于下胸脊髓水平的硬膜外导管刺激交感神经所需的脉冲串的频率（STM）。随后的操作规则设计的BBS使用比例和积分增益因子的反馈校正。通过白色噪声系统辨识方法对12例七氟醚麻醉下颈椎骨科手术患者的STM到AP的传递函数进行辨识，并通过数值模拟确定反馈校正因子，使BBS能够快速稳定地衰减AP上的外部干扰。然后在膝关节手术期间的直立性低血压模型中检查设计的BBS的性能（n = 21）。在没有实施BBS的情况下，大腿止血带突然放气导致AP在10秒内降低17 +/- 3 mm Hg，在50秒内降低25 +/- 2 mm Hg。相比之下，在实时执行的BBS，AP的减少是9 +/- 2毫米汞柱在10秒和1 +/- 2毫米汞柱在50秒后deflation.Conclusions -这些结果表明，BBS的方法为中央压力反射失败的可行性。
Background - We proposed a novel therapeutic strategy against central baroreflex failure: implementation of an artificial baroreflex system to automatically regulate sympathetic vasomotor tone, ie, a bionic baroreflex system (BBS), and we tested its efficacy in a model of sudden hypotension during surgery.Methods and Results - The BBS consisted of a computer-controlled negative-feedback circuit that sensed arterial pressure (AP) and automatically computed the frequency (STM) of a pulse train required to stimulate sympathetic nerves via an epidural catheter placed at the level of the lower thoracic spinal cord. An operation rule was subsequently designed for the BBS using a feedback correction with proportional and integral gain factors. The transfer function from STM to AP was identified by a white noise system identification method in 12 sevoflurane-anesthetized patients undergoing orthopedic surgery involving the cervical vertebrae, and the feedback correction factors were determined with a numerical simulation to enable the BBS to quickly and stably attenuate an external disturbance on AP. The performance of the designed BBS was then examined in a model of orthostatic hypotension during knee joint surgery (n = 21). Without the implementation of the BBS, a sudden deflation of a thigh tourniquet resulted in a 17 +/- 3 mm Hg decrease in AP within 10 seconds and a 25 +/- 2 mm Hg decrease in AP within 50 seconds. By contrast, during real-time execution of the BBS, the decrease in AP was 9 +/- 2 mm Hg at 10 seconds and 1 +/- 2 mm Hg at 50 seconds after the deflation.Conclusions - These results suggest the feasibility of a BBS approach for central baroreflex failure.