Centre for Digestive Diseases, Blizard Institute of Cell & Molecular Science, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
Neurogastroenterol Motil. 2013 Dec;25(12):950-e772. doi: 10.1111/nmo.12231. Epub 2013 Sep 20.
Esophageal intubation is a widely utilized technique for a diverse array of physiological studies, activating a complex physiological response mediated, in part, by the autonomic nervous system (ANS). In order to determine the optimal time period after intubation when physiological observations should be recorded, it is important to know the duration of, and factors that influence, this ANS response, in both health and disease.
Fifty healthy subjects (27 males, median age 31.9 years, range 20-53 years) and 20 patients with Rome III defined functional chest pain (nine male, median age of 38.7 years, range 28-59 years) had personality traits and anxiety measured. Subjects had heart rate (HR), blood pressure (BP), sympathetic (cardiac sympathetic index, CSI), and parasympathetic nervous system (cardiac vagal tone, CVT) parameters measured at baseline and in response to per nasum intubation with an esophageal catheter. CSI/CVT recovery was measured following esophageal intubation.
In all subjects, esophageal intubation caused an elevation in HR, BP, CSI, and skin conductance response (SCR; all p < 0.0001) but concomitant CVT and cardiac sensitivity to the baroreflex (CSB) withdrawal (all p < 0.04). Multiple linear regression analysis demonstrated that longer CVT recovery times were independently associated with higher neuroticism (p < 0.001). Patients had prolonged CSI and CVT recovery times in comparison to healthy subjects (112.5 s vs 46.5 s, p = 0.0001 and 549 s vs 223.5 s, p = 0.0001, respectively).
CONCLUSIONS & INFERENCES: Esophageal intubation activates a flight/flight ANS response. Future studies should allow for at least 10 min of recovery time. Consideration should be given to psychological traits and disease status as these can influence recovery.
食管插管是一种广泛应用于各种生理研究的技术，它会引起复杂的生理反应，部分是由自主神经系统（ANS）介导的。为了确定插管后记录生理观察的最佳时间段，了解健康和疾病状态下这种 ANS 反应的持续时间和影响因素非常重要。
50 名健康受试者（27 名男性，中位年龄 31.9 岁，范围 20-53 岁）和 20 名罗马 III 定义的功能性胸痛患者（9 名男性，中位年龄 38.7 岁，范围 28-59 岁）进行了人格特质和焦虑测量。受试者在基线和经鼻插入食管导管后，测量心率（HR）、血压（BP）、交感神经（心脏交感神经指数，CSI）和副交感神经系统（心脏迷走神经张力，CVT）参数。测量食管插管后的 CSI/CVT 恢复情况。
在所有受试者中，食管插管引起 HR、BP、CSI 和皮肤电导率反应（SCR；均 p<0.0001）升高，但同时 CVT 和心脏对压力反射的敏感性（CSB）下降（均 p<0.04）。多元线性回归分析表明，CVT 恢复时间较长与神经质水平较高独立相关（p<0.001）。与健康受试者相比，患者的 CSI 和 CVT 恢复时间更长（112.5 秒与 46.5 秒，p=0.0001 和 549 秒与 223.5 秒，p=0.0001）。
食管插管激活了逃避/战斗自主神经系统反应。未来的研究应至少允许 10 分钟的恢复时间。应考虑心理特征和疾病状态，因为它们可能会影响恢复。
