Changes in nonlinear dynamic complexity measures of blood pressure during anesthesia for cardiac surgeries using cardio pulmonary bypass.
Changes in nonlinear dynamic complexity measures of blood pressure during anesthesia for cardiac surgeries using cardio pulmonary bypass.
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使用心肺旁路进行心脏手术麻醉期间血压的非线性动态复杂性测量的变化。
DOI：
10.1007/s10877-019-00370-4
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发表时间：
2020
影响因子：
2.2
通讯作者：
Subramaniam,Balachundhar
中科院分区：
文献类型：
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作者：
Rangasamy,Valluvan;Henriques,TeresaS;Mathur,PoojaA;Davis,RogerB;Mittleman,MurrayA;Subramaniam,Balachundhar
从心跳到心跳动脉血压动态计算的非线性复杂性测量显示与标准心脏手术风险指数相关。它们反映了系统的生理适应性，并已被提议作为整体健康状况的动态生物标志物。我们试图确定麻醉诱导和体外循环（CPB）对围手术期BP时间序列计算的复杂性指标的影响。在这项前瞻性、观察性研究中，纳入了300例接受心脏手术的成人患者。围手术期分为：（1）术前（PreOp）;（2）ORIS诱导至胸骨切开术;（3）ORSB-胸骨切开术至CPB;（4）ORposB-CPB后和离开OR前30分钟内;（5）术后阶段（PostOp）-在心脏外科重症监护室的最初30分钟。记录收缩压（SAP）、舒张压（DAP）、平均动脉压（MAP）和脉压（PP）的血压波形，计算其复杂性指数（MSE∑）。对于所有BP时间序列，观察到从术前到术后阶段MSE∑显著降低。在麻醉诱导后（ORIS）阶段观察到最大下降。在后续阶段观察到轻度恢复，但从未达到基线值。在探索性分析中，术前MSE∑与术后ICU住院时间显著相关。血压复杂性在不同的时间点变化，并且对于给定的个体是不固定的。术前BP复杂度在麻醉诱导后显著降低，直到手术后30分钟才恢复到基线水平。预防这种显著下降可以在整个手术期间提供MSE Σ的恢复。此外，术前BP复杂性本身或与当前风险指数一起作为主要术后不良事件的预测因子需要进行探讨。
Nonlinear complexity measures computed from beat-to-beat arterial BP dynamics have shown associations with standard cardiac surgical risk indices. They reflect the physiological adaptability of a system and has been proposed as dynamical biomarkers of overall health status. We sought to determine the impact of anesthetic induction and cardiopulmonary bypass (CPB) upon the complexity measures computed from perioperative BP time series. In this prospective, observational study, 300 adult patients undergoing cardiac surgery were included. Perioperative period was divided as: (1) Preoperative (PreOp); (2) ORIS—induction to sternotomy; (3) ORSB- sternotomy to CPB; (4) ORposB—post CPB and within 30 min before leaving OR and (5) postoperative phase (PostOp)—initial 30 min in the cardiac surgical intensive care unit. BP waveforms for systolic (SAP), diastolic (DAP), mean arterial pressure (MAP) and pulse pressure (PP) were recorded, and their corresponding complexity index (MSE∑) was calculated. Significant decrease in MSE∑from Preop to PostOp phases was observed for all BP time series. Maximum fall was seen during post anesthetic induction (ORIS) phase. Mild recovery during the subsequent phases was observed but they never reached the baseline values. In an exploratory analysis, preoperative MSE∑showed a significant correlation with postoperative length of ICU stay. Blood pressure complexity varies at different time points and is not fixed for a given individual. Preoperative BP Complexity decreased significantly following anesthetic induction and did not recover to baseline until 30 min after surgery. Prevention of this significant fall may offer restoration of MSE∑throughout surgery. Furthermore, preoperative BP complexity needs to be explored as a predictor of major postoperative adverse events by itself or in addition with the current risk indices.