Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
J Cardiothorac Vasc Anesth. 2013 Jun;27(3):485-93. doi: 10.1053/j.jvca.2012.07.016. Epub 2012 Oct 1.
Autonomic nervous system dysfunction is a well-recognized but rarely evaluated risk factor for patients undergoing cardiac surgery. By measuring autonomic reserves in patients scheduled for cardiac surgery, the authors aimed to identify those with autonomic dysfunction and to evaluate their risk of perioperative complications.
This was a prospective, observational study.
The study was conducted in a single academic center.
Sixty-seven patients completed the study.
Autonomic reserves were evaluated using analysis of heart rate variability (HRV) and blood pressure variability (BPV) after a Valsalva maneuver.
The patients were divided into 2 groups depending on their response to the autonomic challenge, a group with autonomic reserves (AR, n = 38) and a group with negligible autonomic reserves (NAR, n = 29). The groups were compared for baseline psychologic distress, demographic and medical profiles, autonomic response to morphine premedication and the induction of anesthesia, hemodynamic instability, the occurrence of decreases in cerebral oxygen saturation, and postoperative complications. Patients in the NAR group had significantly higher psychologic distress scores (p < 0.001), a higher baseline parasympathetic tone (p = 0.003), were unable to increase parasympathetic tone with morphine premedication, had more severe hypotension at the induction of anesthesia (p < 0.001), more episodes of decreases in cerebral saturation (p = 0.0485), and a higher overall complication rate (p = 0.0388) independent of other variables studied.
Patients with diminished autonomic reserves can be identified before cardiac surgery using analysis of HRV and BPV of the response to the Valsalva maneuver, and some evidence suggests that they may be at increased risk of perioperative complications.
自主神经系统功能障碍是心脏手术患者公认但很少评估的风险因素。通过测量拟行心脏手术患者的自主神经储备，作者旨在识别自主神经功能障碍患者，并评估其围手术期并发症的风险。
这是一项前瞻性观察研究。
该研究在一家学术中心进行。
67 名患者完成了研究。
使用瓦尔萨尔瓦动作后的心率变异性（HRV）和血压变异性（BPV）分析评估自主神经储备。
根据自主神经挑战的反应，将患者分为两组，一组具有自主神经储备（AR，n=38），一组自主神经储备可忽略不计（NAR，n=29）。比较两组患者的基线心理困扰、人口统计学和医学特征、吗啡预处理和麻醉诱导时的自主神经反应、血流动力学不稳定、脑氧饱和度降低的发生情况以及术后并发症。NAR 组患者的心理困扰评分显著升高（p<0.001），基础副交感神经张力较高（p=0.003），无法通过吗啡预处理增加副交感神经张力，麻醉诱导时低血压更严重（p<0.001），脑饱和度降低的发作次数更多（p=0.0485），总体并发症发生率更高（p=0.0388），与其他研究变量无关。
可以使用对瓦尔萨尔瓦动作的反应的 HRV 和 BPV 分析在心脏手术前识别自主神经储备减少的患者，并且有一些证据表明他们可能面临围手术期并发症的风险增加。
