机械通气的早产儿进食时副交感神经反应受损。
Impaired parasympathetic response to feeding in ventilated preterm babies.
作者信息
Smith S L, Doig A K, Dudley W N
机构信息
University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2005 Nov;90(6):F505-8. doi: 10.1136/adc.2004.070334. Epub 2005 Jun 7.
BACKGROUND
Premature very low birthweight (VLBW) infants are born with an underdeveloped parasympathetic nervous system (PNS) which may limit their ability to respond adequately to feeding and may limit their capacities for extrauterine growth and development.
OBJECTIVES
To describe the patterns of autonomic response to feeding and identify relationships between change in heart period variability measures over time with selected infant characteristics.
METHODS
Individual growth curve analysis techniques were used to describe the patterns of change over time in sympathetic and parasympathetic tone as measured by low and high frequency heart period power.
RESULTS
Sixteen mechanically ventilated VLBW infants with a mean corrected gestational age of 30.4 weeks participated in the study. The low frequency (LF) power slope was -17.67 (p = 0.0002) and the high frequency (HF) power slope was -0.92 (0.0003). There was a significant relationship between HF slope and birth gestational age (r = -0.49, p = 0.05).
CONCLUSIONS
HF power, representing primarily parasympathetic activity, did not increase with enteral feeding as anticipated. LF power, an indicator of sympathetic tone, decreased during and after feeding suggesting the anticipated effect of inhibition of the sympathetic nervous system in response to the gut stimulus. Critically ill VLBW infants possess an overriding sympathetic response, but may not have adequate PNS tone development.
背景
早产极低出生体重（VLBW）婴儿出生时副交感神经系统（PNS）发育不全，这可能会限制他们对喂养做出充分反应的能力，并可能限制其宫外生长和发育的能力。
目的
描述对喂养的自主反应模式，并确定随着时间推移心率变异性测量值的变化与选定婴儿特征之间的关系。
方法
采用个体生长曲线分析技术，描述通过低频和高频心率功率测量的交感神经和副交感神经张力随时间的变化模式。
结果
16名平均矫正胎龄为30.4周的机械通气VLBW婴儿参与了该研究。低频（LF）功率斜率为-17.67（p = 0.0002），高频（HF）功率斜率为-0.92（0.0003）。HF斜率与出生胎龄之间存在显著关系（r = -0.49，p = 0.05）。
结论
主要代表副交感神经活动的HF功率并未如预期那样随着肠内喂养而增加。LF功率作为交感神经张力的指标，在喂养期间和之后降低，表明对肠道刺激时交感神经系统受到抑制的预期效果。危重症VLBW婴儿具有占主导地位的交感神经反应，但可能没有足够的PNS张力发育。
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