Dynamic assessment of baroreflex control of heart rate during induction of propofol anesthesia using a point process method.
Dynamic assessment of baroreflex control of heart rate during induction of propofol anesthesia using a point process method.
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DOI：
10.1007/s10439-010-0179-z
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发表时间：
2011-01
影响因子：
3.8
通讯作者：
Barbieri, Riccardo
中科院分区：
文献类型：
--
作者：
Chen, Zhe;Purdon, Patrick L.;Harrell, Grace;Pierce, Eric T.;Walsh, John;Brown, Emery N.;Barbieri, Riccardo
关键词：
在本文中，我们提出了一个点过程的方法来评估动态压力反射敏感性，通过估计压力反射增益作为一个简化的心血管系统的闭环模型的焦点分量。具体而言，逆高斯概率分布用于对心跳间隔进行建模，而瞬时平均值通过对先前的R-R间隔（RR）和血压（BP）逐搏测量的线性和双线性双变量回归来识别。瞬时压力反射增益被估计为具有点过程滤波器的环路的反馈分支，而代表心脏收缩力和血管效应的RR→BP前馈传递函数被同时估计为递归最小二乘（RLS）滤波器。这两个闭环增益提供了对心率的压力反射控制的直接评估。此外，还可以估计动态相干性、互双谱及其功率比。所有的统计指标提供了一个有价值的定量评估之间的相互作用的心跳动力学和血流动力学。为了说明的应用程序，我们已经应用了建议的点过程模型的实验记录从11个健康受试者，以监测心血管调节异丙酚麻醉。我们提出了在短暂的时间内的定量结果，以及对丙泊酚给药前后的稳态时期的统计分析。我们的研究结果验证了该算法提供可靠和快速跟踪评估压力反射敏感性（BRS）的能力，并显示从基线期到丙泊酚麻醉开始的压力反射增益明显总体减少，证实了动脉压力反射控制心率的即时评估可能在临床实践中产生重要影响，特别是在麻醉期间和术后护理中。
In this paper, we present a point process method to assess dynamic baroreflex sensitivity by estimating the baroreflex gain as focal component of a simplified closed-loop model of the cardiovascular system. Specifically, an inverse Gaussian probability distribution is used to model the heartbeat interval, whereas the instantaneous mean is identified by linear and bilinear bivariate regressions on both the previous R-R intervals (RR) and blood pressure (BP) beat-to-beat measures. The instantaneous baroreflex gain is estimated as the feedback branch of the loop with a point-process filter, while the RR→BP feedforward transfer function representing heart contractility and vasculature effects is simultaneously estimated by a recursive least-squares (RLS) filter. These two closed-loop gains provide a direct assessment of baroreflex control of heart rate. In addition, the dynamic coherence, cross-bispectrum, and their power ratio can also be estimated. All statistical indices provide a valuable quantitative assessment of the interaction between heartbeat dynamics and hemodynamics. To illustrate the application, we have applied the proposed point process model to experimental recordings from eleven healthy subjects in order to monitor cardiovascular regulation under propofol anesthesia. We present quantitative results during transient periods, as well as statistical analyses on steady state epochs before and after propofol administration. Our findings validate the ability of the algorithm to provide a reliable and fast-tracking assessment of baroreflex sensitivity (BRS), and show a clear overall reduction in baroreflex gain from the baseline period to the start of propofol anesthesia, confirming that instantaneous evaluation of arterial baroreflex control of heart rate may yield important implications in clinical practice, particularly during anesthesia and in postoperative care.
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