Impact of lower body negative pressure induced hypovolemia on peripheral venous pressure waveform parameters in healthy volunteers
Impact of lower body negative pressure induced hypovolemia on peripheral venous pressure waveform parameters in healthy volunteers
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DOI：
10.1088/0967-3334/35/7/1509
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发表时间：
2014-07-01
影响因子：
3.2
通讯作者：
Shelley, Kirk H.
中科院分区：
文献类型：
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作者：
Alian, Aymen A.;Galante, Nicholas J.;Shelley, Kirk H.
下体负压(LBNP)通过隔离下肢的血容量而造成可逆性的低血容量。本研究旨在研究中枢低血容量对自主呼吸受试者外周静脉压(PVP)波形的影响。在IRB批准的情况下，11名健康受试者接受进行性下体负压(基线、-30、-75和-90毫米汞柱或直到受试者出现症状)。分别监测心率(HR)、手指动脉压(BP)、胸腔呼吸带和上肢静脉转导部位产生的PVP波形。由于收集静脉压波形的技术错误，第一个受试者被排除在PVP分析之外。分析PVP波形以确定静脉脉压、平均静脉压、脉宽、最大斜率和最小斜率(时域分析)以及心脏和呼吸调节(频域分析)。在-30 mm HgLBNP时，动脉血压无明显变化，而PVP波形的时间域参数(呼吸诱发调制的50%宽度除外)显著降低，同时PVP波形在心脏频率处有调制，但在呼吸频率处无明显变化。随着下体负压的进展，动脉收缩压、平均血压和脉压、PVP参数和PVP心脏调制显著降低，而舒张压和心率显著升高。血流动力学和PVP波形参数的变化在症状期达到最大。恢复期HR显著降低，HR变异性、平均PVP和PVP心脏调制显著增加。因此，对于下体负压引起的轻度低血容量血症，心脏调制和其他PVP波形参数的变化在可检测到血流动力学变化之前确定为低血容量血症。
Lower body negative pressure (LBNP) creates a reversible hypovolemia by sequestrating blood volume in the lower extremities. This study sought to examine the impact of central hypovolemia on peripheral venous pressure (PVP) waveforms in spontaneously breathing subjects. With IRB approval, 11 healthy subjects underwent progressive LBNP (baseline, -30, -75, and -90 mmHg or until the subject became symptomatic). Each was monitored for heart rate (HR), finger arterial blood pressure (BP), a chest respiratory band and PVP waveforms which are generated from a transduced upper extremity intravenous site. The first subject was excluded from PVP analysis because of technical errors in collecting the venous pressure waveform. PVP waveforms were analyzed to determine venous pulse pressure, mean venous pressure, pulse width, maximum and minimum slope (time domain analysis) together with cardiac and respiratory modulations (frequency domain analysis). No changes of significance were found in the arterial BP values at -30 mmHg LBNP, while there were significant reductions in the PVP waveforms time domain parameters (except for 50% width of the respiration induced modulations) together with modulation of the PVP waveform at the cardiac frequency but not at the respiratory frequency. As the LBNP progressed, arterial systolic BP, mean BP and pulse pressure, PVP parameters and PVP cardiac modulation decreased significantly, while diastolic BP and HR increased significantly. Changes in hemodynamic and PVP waveform parameters reached a maximum during the symptomatic phase. During the recovery phase, there was a significant reduction in HR together with a significant increase in HR variability, mean PVP and PVP cardiac modulation. Thus, in response to mild hypovolemia induced by LBNP, changes in cardiac modulation and other PVP waveform parameters identified hypovolemia before detectable hemodynamic changes.