Frequency Analysis Unveils Cardiac Autonomic Dysfunction after Mild Traumatic Brain Injury
Frequency Analysis Unveils Cardiac Autonomic Dysfunction after Mild Traumatic Brain Injury
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DOI：
10.1089/neu.2010.1497
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发表时间：
2011-09-01
影响因子：
4.2
通讯作者：
Marthol, Harald
中科院分区：
文献类型：
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作者：
Hilz, Max J.;DeFina, Philip A.;Marthol, Harald
轻度创伤性脑损伤（mTBI）后的长期死亡率增加。由轻微的创伤引起的脑损伤引起的中枢心血管自主神经失调可能导致心血管事件和死亡。我们研究了mTBI后是否存在心血管自主神经失调。在20例mTBI患者（37 +/- 13岁，伤后5-43个月）和20例健康人（26 +/- 9岁）中，我们监测了仰卧和站立时的呼吸、RR间期（RRI）、血压（BP）。我们计算了反映心迷走神经调节的均方根连续RRI差异（RMSSD），以及站立时第30和15次RRI附近的最大和最小RRI的比值（30：15比率）反射压力反射敏感性（BRS），副交感神经高频频谱功率（HF：0.15-0.5 Hz）RRI振荡，主要为交感神经低频（LF：0.04-0.15 Hz）RRI振荡、交感LF-BP振荡、反映交感迷走神经平衡的RRI-LF/HF比值以及BP和RRI振荡之间的增益作为额外的BRS指数（BRSgain）。我们比较了患者和对照组的仰卧位和站立位参数（重复测量方差分析;显著性：p < 0.05）。仰卧时，患者的RRI较低（874.2 +/- 157.8 vs. 1024.3 +/- 165.4 ms），RMSSD（30.1 +/- 23.6 vs. 56.3 +/- 31.4 ms），RRI-HF功率（298.1 +/- 309.8 vs. 1507.2 +/- 1591.4 ms（2））和BRSgain（8.1 +/- 4.4 vs. 12.5 +/- 8.1 ms.mmHg（-1）），但RRI-LF/HF比值（3.0 +/- 1.9 vs. 1.2 +/- 0.7）高于对照组。站立时，对照组的RMSSD和RRI-HF功率显著降低，但患者没有;患者的RRI-30：15比值（1.3 +/- 0.3 vs. 1.6 +/- 0.3）和RRI-LF功率（2450.0 +/- 2110.3 vs. 4805.9 +/- 3453.5 ms（2））低于对照组。仰卧时，mTBI患者的心迷走神经调节和BRS减少。站立时，他们的BRS仍然降低，患者没有充分撤回副交感神经或增强交感神经调制。受损的自主神经调节可能有助于mTBI后的心血管不规则。
Long-term mortality is increased after mild traumatic brain injury (mTBI). Central cardiovascular-autonomic dysregulation resulting from subtle, trauma-induced brain lesions might contribute to cardiovascular events and fatalities. We investigated whether there is cardiovascular-autonomic dysregulation after mTBI. In 20 mTBI patients (37 +/- 13 years, 5-43 months post-injury) and 20 healthy persons (26 +/- 9 years), we monitored respiration, RR intervals (RRI), blood pressures (BP), while supine and upon standing. We calculated the root mean square successive RRI differences (RMSSD) reflecting cardiovagal modulation, the ratio of maximal and minimal RRIs around the 30th and 15th RRI upon standing (30:15 ratio) reflecting baroreflex sensitivity (BRS), spectral powers of parasympathetic high-frequency (HF: 0.15-0.5 Hz) RRI oscillations, of mainly sympathetic low-frequency (LF: 0.04-0.15 Hz) RRI oscillations, of sympathetic LF-BP oscillations, RRI-LF/HF-ratios reflecting sympathovagal balance, and the gain between BP and RRI oscillations as additional BRS index (BRSgain). We compared supine and standing parameters of patients and controls (repeated measures analysis of variance; significance: p < 0.05). While supine, patients had lower RRIs (874.2 +/- 157.8 vs. 1024.3 +/- 165.4 ms), RMSSDs (30.1 +/- 23.6 vs. 56.3 +/- 31.4 ms), RRI-HF powers (298.1 +/- 309.8 vs. 1507.2 +/- 1591.4 ms(2)), and BRSgain (8.1 +/- 4.4 vs. 12.5 +/- 8.1 ms.mmHg(-1)), but higher RRI-LF/HF-ratios (3.0 +/- 1.9 vs. 1.2 +/- 0.7) than controls. Upon standing, RMSSDs and RRI-HF-powers decreased significantly in controls, but not in patients; patients had lower RRI-30:15-ratios (1.3 +/- 0.3 vs. 1.6 +/- 0.3) and RRI-LF-powers (2450.0 +/- 2110.3 vs. 4805.9 +/- 3453.5 ms(2)) than controls. While supine, mTBI patients had reduced cardiovagal modulation and BRS. Upon standing, their BRS was still reduced, and patients did not withdraw parasympathetic or augment sympathetic modulation adequately. Impaired autonomic modulation probably contributes to cardiovascular irregularities post-mTBI.