Tang Collin H H, Chan Gregory S H, Middleton Paul M, Cave Grant, Harvey Martyn, Savkin Andrey V, Lovell Nigel H
School of Electrical Engineering and Telecommunications, University of New South Wales, Sydney, NSW 2052, Australia.
Annu Int Conf IEEE Eng Med Biol Soc. 2009;2009:1848-51. doi: 10.1109/IEMBS.2009.5332626.
Sepsis is characterized by profound cardiovascular abnormalities which may result from the derangements in the arterial baroreflex system and other autonomic regulatory functions. In this study, a mechanically ventilated and anesthetized rabbit model of endotoxic shock was utilized to mimic the behaviors of the cardiovascular system in a sepsis patient. 13 adult New Zealand white rabbits were studied, with 8 of them injected with endotoxin and the remaining given saline solution as sham fluid. Measurements of heart period (RRi) and systolic blood pressure (SBP) were obtained pre-and post-intervention after a 90 minute period, which allowed spectral and cross-spectral analysis of heart rate and blood pressure variabilities to be performed. A significant increase of blood lactate level (p < 0.01) in post-intervention stage signified the onset of distributive shock. Based on this model, the novel findings were that in the low frequency (LF) and mid frequency (MF) bands, there was a decrease in coherence (p < 0.01 and p < 0.05 respectively) and loss of phase delay (p < 0.05) between SBP and RRi, along with a depression in transfer function gain in the LF band (p < 0.05), which might indicate an impairment of baroreflex control of heart rate following the administration of endotoxin. None of the above variables changed significantly in the control group. Moreover, endotoxin also led to a decrease in RRi variability in the ventilatory frequency (VF) band, suggesting a suppression of cardiac vagal modulation. These results highlight the potential value of frequency spectrum analysis combined with transfer function analysis of cardiovascular variability in the assessment of autonomic and baroreflex-related changes associated with endotoxic shock.
脓毒症的特征是严重的心血管异常,这可能是由动脉压力反射系统和其他自主调节功能紊乱引起的。在本研究中,采用机械通气和麻醉的内毒素休克兔模型来模拟脓毒症患者的心血管系统行为。研究了13只成年新西兰白兔,其中8只注射内毒素,其余注射生理盐水作为假处理液。在干预前后90分钟测量心动周期(RRi)和收缩压(SBP),从而对心率和血压变异性进行频谱和交叉频谱分析。干预后阶段血乳酸水平显著升高(p < 0.01)表明分布性休克的发生。基于该模型,新发现是在低频(LF)和中频(MF)频段,SBP与RRi之间的相干性降低(分别为p < 0.01和p < 0.05)且相位延迟丧失(p < 0.05),同时LF频段的传递函数增益降低(p < 0.05),这可能表明内毒素给药后压力反射对心率的控制受损。对照组中上述变量均无显著变化。此外,内毒素还导致通气频率(VF)频段的RRi变异性降低,提示心脏迷走神经调制受到抑制。这些结果突出了频谱分析结合心血管变异性传递函数分析在评估与内毒素休克相关的自主神经和压力反射相关变化方面的潜在价值。