Effect of Pharmacological preconditioning on heart rate variability, hemodynamics and renal function after aortic cross clamping in patients undergoing aortic surgery.

药理学预处理对主动脉手术患者主动脉阻断后心率变异性、血流动力学和肾功能的影响。

• 批准号: 11470321
• 负责人: KOMATSU Toru
• 金额: $ 5.82万
• 依托单位: AICHI MEDICAL UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1999
• 资助国家: 日本
• 起止时间: 1999 至 2001
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-11470321/
• 关键词: aortic surgery; aortic cross clamping; heqrt rate variability; hemodynamics; openers of mitochondrial ATP-sensitive potassium; ischemic preconditioning; preconditioning; 大動脈遮断; カオス; 循環能調節; アデノシン; KATP開口薬; 1; f傾き

Pharmacological openers of mitochondrial ATP-sensitive potassium (mitoKATP) channels have been shown to mimic ischemic preconditioning (IPC) in both the brain and myocardium. Power spectrum of heart rate variability (HRV) decreased after abdominal aortic surgery (AAS). We hypothesized that nicorandil, a mitoKATP opener, and adenosine could improve HRV and hemodynamics and reduce renal dysfunction after aortic cross-clamping in patients undergoing aortic surgery.With informed consent and institutional approval, patients undergoing elective AAS were studied. Nicorandil was given continiously during surgery. RR intervals were measured for 24 hourx on the preoperative day (C) and on 1 (POD1), 3 (POD3), and 7 (POD7) postoperative day. An instantaneous heart rate (IHR) time series was constructed from RR intervals. Phase-space attractors were created by using a time delay technique to produce a n-dimensional vector from a one-dimensional time series..A point in n-dimensional phase space , n= … More 2 to 20, was formed by n successive time-delayed values of the IHR. Correlation dimensions and embedding dimensions of attractors were determined by means of the method of Grassberger and Procaccia. Spectral analysis of an instantaneous heart rate time series was performed on 512-s segments of RR intervals. The areas of the spectral peaks within-each measurement were calculated as follows : low (LF, 0.04-0.15 Hz), and high-frequency area (HF, 0.15-0.5 Hz), and total power (TP, 0.04-0.5Hz).LF, HF, and TP were decreased until 7th postoperative day as compared to C. The embedding dimension decreased on the first and the third postoperative days after AAS, returning to Control level on the 7th postoperative day. The correlation dimension decreased on the first postoperative day after AAS, returning to Control level on the 3rd postoperative day, The renal function did not changed as compared with those before surgery.Simultaneous analysis of nonlinear and linear measures of HRV revealed different patterns of alterations in status of dynamic cardiovascular homeostasis and autonomic nervous system after AAS. Using dimensional analysis, we have shown that significant reduction occurred both the embedding and correlation of dimensions in HRV only during immediate postoperative period in patients without nicorandil. Patients recieved with nicorandil improved HRV, hemodynamics after aortic cross clamping as compared patients without nicorandil after aortic cross clamping. Less

线粒体ATP敏感性钾通道（mitoKATP）的药理学开放剂已被证明可以模拟脑和心肌中的缺血预处理（IPC）。腹主动脉手术（AAS）后心率变异性（HRV）功率谱降低。我们假设尼可地尔（mitoKATP开放剂）和腺苷可以改善接受主动脉手术的患者在主动脉阻断后的心率变异性和血流动力学，并减少肾功能不全。手术期间持续给予尼可地尔。在术前第1天（C）和术后第1天（POD 1）、第3天（POD 3）和第7天（POD 7）测量24小时的RR间期。瞬时心率（IHR）时间序列由RR间期构建。通过使用时间延迟技术从一维时间序列产生n维向量来创建相空间吸引子。n维相空间中的一点，n= ...更多信息 2至20，由n个连续的时间延迟值的IHR。利用Grassberger和Procaccia的方法确定了吸引子的关联维数和嵌入维数。对RR间期的512-s片段进行瞬时心率时间序列的频谱分析。计算低频（LF，0.04-0.15 Hz）、高频（HF，0.15-0.5 Hz）和总功率（TP，0.04- 0.5 Hz）的频谱峰面积，LF、HF和TP在术后第7天开始下降。AAS术后第1天和第3天埋植直径减小，术后第7天恢复到对照水平。AAS术后第1天相关维数下降，术后第3天恢复到对照水平，肾功能与术前相比无明显变化，同时分析HRV的非线性和线性指标，发现AAS术后心血管动态平衡和自主神经系统的变化具有不同的模式。使用维度分析，我们已经表明，在未使用尼可地尔的患者中，仅在术后即刻，HRV中维度的嵌入和相关性均显著降低。与未使用尼可地尔的患者相比，使用尼可地尔的患者在主动脉阻断后改善了HRV和血流动力学。少

项目成果

小松 徹: "心拍変動の定量的エントロピー評価法"日本集中治療医学会誌. 6. D304 (1999)

小松彻：“心率变异性的定量熵评估方法”日本重症监护医学会杂志6.D304（1999）。

小松 徹, 木村智政, 堀場 清: "心拍変動の基礎と麻酔科領域での臨床応用"臨床麻酔. 24. 1771-1786 (2000)

Toru Komatsu、Tomomasa Kimura、Kiyoshi Horiba：“心率变异性基础知识和麻醉学领域的临床应用”《临床麻醉》24。1771-1786 (2000)。

Komatus T: "Chronomedicine and perioeprative period"Masui. 50(11). 1185-1186 (2001)

Komatus T：“时间医学和围手术期”Masui。

小松 徹, 瀬見井明子, 若尾政弘, 他: "腹部大血管手術後の心拍変動1/fslope日内変動"日本集中治療医学会雑誌. 8. D-289 (2001)

Toru Komatsu、Akiko Semii、Masahiro Wakao 等人：“腹部大血管手术后心率变异性 1/fslope 昼夜变化”日本重症监护医学会杂志 8. D-289 (2001)。

Komatsu T, Horiba K, Kimura T.: "Monitoring of autonomic nervous system (heart rate variability)"Iyaku no Mon. 41(1). 70-79 (2001)

Komatsu T、Horiba K、Kimura T.：“自主神经系统的监测（心率变异性）”Iyaku no Mon。