Heart rate control and mechanical cardiopulmonary coupling to assess central volume: a systems analysis
Heart rate control and mechanical cardiopulmonary coupling to assess central volume: a systems analysis
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DOI：
10.1152/ajpregu.00127.2002
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发表时间：
2002-11-01
影响因子：
2.8
通讯作者：
Saul, JP
中科院分区：
文献类型：
--
作者：
Barbieri, R;Triedman, JK;Saul, JP
中枢容量的微小负性变化减少了心输出量，而动脉血压(ABP)没有明显变化，这表明有足够的调节反应。此外，有证据支持人类存在班布里奇反射(心动过速伴高容量血症)。为了研究这些现象，采用多元自回归技术在中心容量减少和增加的六个水平上评估呼吸、R-R间期和ABP之间的相互作用。随着中枢容量的降低，压力反射和呼吸性窦性心律失常的增益降低，而随着容量的增加，前两个水平的增益增加，但在最高容量水平再次下降，这表明健康受试者存在班布里奇反射。呼吸对中心静脉压(CVP)的机械影响在轻度中枢性高血容量点出现意外的位相变化，在低容量时与预期的负相关(吸气量降低CVP)，而在高容量时正相关(吸气量升高CVP)。我们的结论是，多变量技术可以量化各种呼吸和血流动力学参数之间的关系，允许在体内评估中央容量操作过程中复杂的心肺相互作用。这一结果证实了人类存在班布里奇反射，并表明在轻度高容量血症时，短期心血管控制是最佳的。
Small negative changes of central volume reduce cardiac output without significant alterations of arterial blood pressure (ABP), suggesting an adequate regulatory response. Furthermore, evidence has arisen supporting a Bainbridge reflex (tachycardia with hypervolemia) in humans. To investigate these phenomena, multivariate autoregressive techniques were used to evaluate the beat-to-beat interactions between respiration, R-R interval, and ABP at six levels of decreased and increased central volume. With reductions of central volume below control, baroreflex and respiratory sinus arrhythmia gains were reduced, while with increases of volume above control, gains increased for the first two levels but decreased again at the highest volume level, suggesting the presence of a Bainbridge reflex in healthy human subjects. The mechanical influence of respiration on central venous pressure (CVP) had an unexpected shift in phase at the point of mild central hypervolemia, with the expected negative relation at lower volumes (inspiration lowers CVP) but a positive relation at higher volumes (inspiration raises CVP). We conclude that multivariate techniques can quantify the relations between a variety of respiratory and hemodynamic parameters, allowing for the in vivo assessment of complex cardiorespiratory interactions during manipulations of central volume. The results identify the presence of a Bainbridge reflex in humans and suggest that short-term cardiovascular control is optimized at mild hypervolemia.