Kaltman Jonathan R, Hanna Brian D, Gallagher Paul R, Gaynor J William, Godinez Rodolfo I, Tanel Ronn E, Shah Maully J, Vetter Victoria L, Rhodes Larry A
Division of Cardiology, University of Pennsylvania School of Medicine, and The Cardiac Center at The Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Pacing Clin Electrophysiol. 2006 May;29(5):471-8. doi: 10.1111/j.1540-8159.2006.00378.x.
Altered cardiac autonomic control may play a role in the morbidity and mortality suffered by neonates who undergo surgery for complex congenital heart disease (CHD). The purpose of this study was to evaluate cardiac autonomic activity, as measured by spectral indices of heart rate variability (HRV), prior to and early after infant surgery for CHD and attempt to correlate HRV indices with clinical outcome. In addition, we assessed the hypothesis that single-ventricle physiology and surgical interruption of the great arteries negatively affects HRV.
Sixty neonates prospectively wore 24-hour Holter monitors at three time points: before and early after CHD surgery, and at 3- to 6-month follow-up. Standard spectral indices of HRV were measured.
In the early postoperative time point, patients with single-ventricle physiology had lower low-frequency power (LF) compared to patients with two ventricles (P=0.040). Surgical interruption of the great arteries did not affect HRV in this cohort. For the entire cohort, LF (P=0.004) and high-frequency power (HF) (P<0.001) increased over the three time points, while LF/HF (P=0.119) did not significantly change. In the multivariable linear regression model, significant predictors of longer postoperative hospital stay included longer total support time (P=or<0.001), longer duration of inotrope support (P=0.012), elevated mean heart rate at postoperative time point (P=0.002), and lower LF/HF ratio at the postoperative time point (P=0.014).
Patients with single-ventricle physiology have a significant physiologic reduction in LF in the early postoperative period compared to patients with two ventricles. Diminished cardiac autonomic control is associated with longer hospitalization following neonatal cardiac surgery.
心脏自主神经控制改变可能在患有复杂先天性心脏病（CHD）并接受手术的新生儿的发病和死亡中起作用。本研究的目的是评估CHD婴儿手术前和术后早期通过心率变异性（HRV）频谱指标测量的心脏自主神经活动，并尝试将HRV指标与临床结果相关联。此外，我们评估了单心室生理和大动脉手术中断对HRV产生负面影响的假设。
60名新生儿在三个时间点前瞻性佩戴24小时动态心电图监测仪：CHD手术前、术后早期以及3至6个月随访时。测量HRV的标准频谱指标。
在术后早期，单心室生理的患者与双心室患者相比，低频功率（LF）较低（P = 0.040）。在该队列中，大动脉手术中断并未影响HRV。对于整个队列，LF（P = 0.004）和高频功率（HF）（P < 0.001）在三个时间点有所增加，而LF/HF（P = 0.119）没有显著变化。在多变量线性回归模型中，术后住院时间较长的显著预测因素包括总支持时间较长（P ≤ 0.001）、血管活性药物支持持续时间较长（P = 0.012）、术后时间点平均心率升高（P = 0.002）以及术后时间点LF/HF比值较低（P = 0.014）。
与双心室患者相比，单心室生理的患者在术后早期LF有显著的生理性降低。心脏自主神经控制减弱与新生儿心脏手术后住院时间延长有关。
