Beuchée Alain, Nsegbe Elise, St Hilaire Marie, Carrault Guy, Branger Bernard, Pladys Patrick, Praud Jean-Paul
Neonatal Intensive Care Unit, CHU Pontchaillou, Rennes, France.
Neonatology. 2007;91(2):83-91. doi: 10.1159/000097124. Epub 2006 Nov 17.
Exaggerated laryngeal chemoreflexes (LCR) have been implicated in the occurrence and prolongation of apnea in premature and term neonates.
To test the hypothesis that the cardiovascular component of the LCR can occur and be prolonged in the absence of apnea.
Bolus injections of 0.5 ml of citric acid (CitAc) and serum saline were administered onto the larynx in seven non-sedated lambs, aged 4-5 days, during quiet sleep. Blood pressure (BP) and heart rate (HR) variability measurements were taken and compared with results obtained prior to stimulation and with saline.
Apneas were rare and occurred consistently in the 32-beat period (10 s) following stimulation. The increase in BP and decrease in HR were consistent after CitAc and saline. All the studied components of HR variability significantly increased after CitAc, but not after saline. The low frequency estimates were significantly increased during a 480-beat period (133 +/- 6.6 s) following CitAc stimulation. Analysis of gains and respiration showed that bradycardia and HR variability changes were neither related to an apnea nor a vagal arterial baroreflex.
This long-lasting increase in HR variability indicates a prolonged disturbance of the cardiovascular regulatory systems, consisting in increased sympathetic and parasympathetic tones following CitAc stimulation.
夸张的喉化学反射(LCR)与早产儿和足月儿呼吸暂停的发生及延长有关。
检验在无呼吸暂停情况下LCR的心血管成分是否会出现并延长的假设。
在7只4 - 5日龄非镇静的羔羊安静睡眠期间,向其喉部推注0.5 ml柠檬酸(CitAc)和生理盐水。测量血压(BP)和心率(HR)变异性,并与刺激前及生理盐水注射后的结果进行比较。
呼吸暂停很少见,且在刺激后的32次心跳周期(10秒)内持续出现。柠檬酸和生理盐水注射后,血压升高和心率降低的情况一致。柠檬酸注射后,所有研究的心率变异性成分均显著增加,而生理盐水注射后则无此现象。柠檬酸刺激后的480次心跳周期(133±6.6秒)内,低频估计值显著增加。增益和呼吸分析表明,心动过缓和心率变异性变化既与呼吸暂停无关,也与迷走动脉压力反射无关。
心率变异性的这种长期增加表明心血管调节系统受到长期干扰,表现为柠檬酸刺激后交感神经和副交感神经张力增加。