Inappropriate sympathetic activation at onset of septic shock - A spectral analysis approach
Inappropriate sympathetic activation at onset of septic shock - A spectral analysis approach
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DOI：
10.1164/ajrccm.160.2.9810073
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发表时间：
1999-08-01
影响因子：
24.7
通讯作者：
Gajdos, P
中科院分区：
文献类型：
--
作者：
Annane, D;Trabold, F;Gajdos, P
研究了10例感染性休克患者、10例脓毒症综合征患者和6例倾斜的健康受试者的自主心血管控制。从5分钟记录中获得心率（HR）、收缩压（SBP）和舒张压（DBP）频谱的总体变异性、高频和低频分量（AUC、HF和LF，beats/min（2）/Hz或mmHg-2/Hz）。LFHR/HFHR和LFSBP/LFHR（α）的平方根分别用作心脏交感迷走神经相互作用和压力反射控制的指标。与倾斜对照受试者和脓毒症综合征患者相比，脓毒症休克的特征在于以下方面的降低：（1）HR变异性，即，AUC（HR）（p = 0.007）、LFHR（p = 0.002）和LFHR/HFHR（p = 0.0002）降低;（2）DBP变异性，即，AUC（DBP）（p = 0.003）和LFDBP（p = 0.001）降低，（3）或（p = 0.003）。在感染性休克中，LFHR/HFHR、α和LFDBP与平均血压相关（分别为r = 0.67，p = 0.04，r = 0.64，p = 0.03和r = 0.88，p = 0.0008），并与血浆去甲肾上腺素水平（分别为r =-0.65，p = 0.03，r =-0.79，p = 0.006和r =-0.69，p = 0.03）。总之，感染性休克的发病特点是高浓度的循环中的儿茶酚胺，但受损的交感神经对心脏和血管的调节，这表明中枢自主调节功能障碍有助于循环衰竭。
The autonomic cardiovascular control was investigated in 10 patients with septic shock, 10 patients with sepsis syndrome, and six tilted healthy subjects. Overall variability, high- and low-frequency components (AUC, HF, and LF, beats/min(2)/Hz or mm Hg-2/Hz) from heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressures spectra were obtained from 5-min recordings. LFHR/HFHR and the square root of LFSBP/LFHR (alpha) were used as indices of sympathovagal interaction and baroreflex control of the heart, respectively. Compared with tilted control subjects and patients with sepsis syndrome, septic shock is characterized by reduction in: (1) HR variability, i.e., decreased AUC(HR) (p = 0.007), LFHR (p = 0.002), and LFHR/HFHR (p = 0.0002); (2) DBP variability, i.e., decreased AUC(DBP) (p = 0.003) and LFDBP (p = 0.001), (3) or (p = 0.003). In septic shock, LFHR/HFHR, alpha, and LFDBP correlated with mean blood pressure (r = 0.67, p = 0.04, r = 0.64, p = 0.03, and r = 0.88, p = 0.0008, respectively), and with plasma norepinephrine levels (r = -0.65, p = 0.03, r = -0.79, p = 0.006, and r = -0.69, p = 0.03, respectively). In conclusion, onset of septic shock is characterized by high concentrations of circulating catecholamines but impaired sympathetic modulation on heart and vessels, suggesting that central autonomic regulatory impairment contributes to circulatory failure.