Colombo Joseph, Shoemaker William C, Belzberg Howard, Hatzakis George, Fathizadeh Payman, Demetriades Demetrios
Ansar Inc, Philadelphia, Pennsylvania, USA.
J Trauma. 2008 Dec;65(6):1364-73. doi: 10.1097/TA.0b013e31818cc307.
To describe early effects of sympathetic (SNS) and parasympathetic nervous system (PSNS) activities measured by heart rate (HR) and respiratory rate variabilities simultaneously with noninvasive hemodynamic patterns in patients with blunt and penetrating trauma.
Descriptive study of 168 monitored trauma patients in a level I university-run trauma service. We studied HR and respiratory rate variability by spectral analysis as a measure of autonomic nervous system (ANS) activity in severe blunt and penetrating injuries beginning shortly after their admission to the emergency department. The low frequency area is the area under the HR spectral analysis curve within the frequency range of 0.04 Hz to 0.10 Hz. This area primarily reflects the tone of the SNS as mediated by the vagus nerve. The respiratory frequency area, sometimes referred to as the high frequency area, is a 0.12 Hz-wide frequency range centered around the fundamental respiratory frequency defined by the peak mode of the respiratory activity power spectrum. It is indicative of vagal outflow reflecting PSNS activity. The low frequency area/respiratory frequency area, or L/R ratio, reflects the balance of the SNS and the PSNS. ANS was studied simultaneously with noninvasive hemodynamic patterns after blunt and penetrating thoracic or abdominal injury beginning shortly after admission. We measured cardiac index by bioimpedance, HR, and mean arterial pressure (MAP) to evaluate cardiac function, pulse oximetry (SapO2) to reflect changes in respiratory function, and transcutaneous oxygen indexed to fractional inspired oxygen (PtcO2/FIO2) to reflect tissue perfusion.
ANS activity markedly increased especially in the nonsurvivors at 12 hours to 24 hours after admission. Compared with survivors, the nonsurvivors had lower MAP, CI, and PtcO2/FIO2 values associated with increased ANS activity.
In the nonsurvivors, low flow, low MAP, and reduced tissue perfusion were associated with pronounced increases in PSNS and lesser increases in SNS activity. In the survivors, higher CI, MAP, and PtcO2/FIO2 values were associated with lesser increases in both PSNS and SNS activities.
描述在钝性和穿透性创伤患者中，通过心率（HR）和呼吸频率变异性同时测量交感神经系统（SNS）和副交感神经系统（PSNS）活动的早期效应，并与无创血流动力学模式进行对比。
对一所一级大学创伤中心的168例受监测创伤患者进行描述性研究。我们通过频谱分析研究HR和呼吸频率变异性，以此作为自主神经系统（ANS）活动的指标，研究对象为严重钝性和穿透性损伤患者，自其入院急诊科后不久即开始研究。低频区域是HR频谱分析曲线在0.04Hz至0.10Hz频率范围内的面积。该区域主要反映由迷走神经介导的SNS张力。呼吸频率区域，有时也称为高频区域，是一个以呼吸活动功率谱的峰值模式定义的基本呼吸频率为中心、宽度为0.12Hz的频率范围。它指示反映PSNS活动的迷走神经传出。低频区域/呼吸频率区域，即L/R比值，反映SNS和PSNS的平衡。在钝性和穿透性胸腹部损伤患者入院后不久，同时研究ANS与无创血流动力学模式。我们通过生物阻抗测量心脏指数、HR和平均动脉压（MAP）以评估心脏功能，通过脉搏血氧饱和度（SapO2）反映呼吸功能变化，通过经皮氧分压与吸入氧分数的比值（PtcO2/FIO2）反映组织灌注。
ANS活动显著增加，尤其是在入院后12小时至24小时内的非存活者中。与存活者相比，非存活者的MAP、CI和PtcO2/FIO2值较低，且ANS活动增加。
在非存活者中，低流量、低MAP和组织灌注减少与PSNS的显著增加及SNS活动的较小增加相关。在存活者中，较高的CI、MAP和PtcO2/FIO2值与PSNS和SNS活动的较小增加相关。
