Matchett Gerald, Wood Philip
Department of Anesthesiology & Pain Management, University of Texas-Southwestern Medical Center, 5323 Harry Hines Blvd., M.C. 9068, Dallas, Texas 75390-9068, USA.
Department of Mathematics, University of Wisconsin-Madison, 480 Lincoln Dr., Madison, Wisconsin 53706-1325, USA.
Chaos. 2014 Jun;24(2):023129. doi: 10.1063/1.4882395.
The human heart normally exhibits robust beat-to-beat heart rate variability (HRV). The loss of this variability is associated with pathology, including disease states such as congestive heart failure (CHF). The effect of general anesthesia on intrinsic HRV is unknown. In this prospective, observational study we enrolled 100 human subjects having elective major surgical procedures under general anesthesia. We recorded continuous heart rate data via continuous electrocardiogram before, during, and after anesthesia, and we assessed HRV of the R-R intervals. We assessed HRV using several common metrics including Detrended Fluctuation Analysis (DFA), Multifractal Analysis, and Multiscale Entropy Analysis. Each of these analyses was done in each of the four clinical phases for each study subject over the course of 24 h: Before anesthesia, during anesthesia, early recovery, and late recovery. On average, we observed a loss of variability on the aforementioned metrics that appeared to correspond to the state of general anesthesia. Following the conclusion of anesthesia, most study subjects appeared to regain their normal HRV, although this did not occur immediately. The resumption of normal HRV was especially delayed on DFA. Qualitatively, the reduction in HRV under anesthesia appears similar to the reduction in HRV observed in CHF. These observations will need to be validated in future studies, and the broader clinical implications of these observations, if any, are unknown.
人的心脏通常表现出较强的逐搏心率变异性（HRV）。这种变异性的丧失与包括充血性心力衰竭（CHF）等疾病状态在内的病理情况相关。全身麻醉对固有HRV的影响尚不清楚。在这项前瞻性观察研究中，我们招募了100名接受全身麻醉下择期大手术的受试者。我们在麻醉前、麻醉期间和麻醉后通过连续心电图记录连续心率数据，并评估R-R间期的HRV。我们使用几种常见指标评估HRV，包括去趋势波动分析（DFA）、多重分形分析和多尺度熵分析。在24小时的过程中，对每个研究对象的四个临床阶段（麻醉前、麻醉期间、早期恢复和晚期恢复）分别进行这些分析。平均而言，我们观察到上述指标的变异性丧失，这似乎与全身麻醉状态相对应。麻醉结束后，大多数研究对象似乎恢复了正常的HRV，尽管并非立即恢复。DFA显示正常HRV的恢复尤其延迟。定性地说，麻醉下HRV的降低似乎与CHF中观察到的HRV降低相似。这些观察结果需要在未来的研究中得到验证，而且这些观察结果更广泛的临床意义（如果有的话）尚不清楚。
