一种用于评估心力衰竭患者交感神经系统功能的新型无创设备。
A Novel Noninvasive Device to Assess Sympathetic Nervous System Function in Patients With Heart Failure.
作者信息
Parry Monica, Nielson Chantelle A, Muckle Fiona, O'Keefe-McCarthy Sheila, van Lien Rene, Meijer Jan H
机构信息
Monica Parry, NP-Adult, PhD, CCN(C), is Assistant Professor and Director, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and is Nurse Practitioner, Cardiac Program, Kingston General Hospital, Ontario, Canada. Chantelle A. Nielson, MSc, is Undergraduate Nursing Student; and Fiona Muckle, MSc, is Registered Nurse, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada. Sheila O'Keefe-McCarthy, PhD, is Adjunct Scientist, Ross Memorial Hospital, Lindsay, Ontario, Canada. Rene van Lien, PhD, is Product Specialist, Heinen and Lowenstein, Rotterdam, the Netherlands. Jan H. Meijer, PhD, is Biomedical Physicist, Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands.
出版信息
Nurs Res. 2015 Sep-Oct;64(5):351-60. doi: 10.1097/NNR.0000000000000111.
BACKGROUND
Heart failure is a complex syndrome associated with sympathetic nervous system and renin-angiotensin-aldosterone system hyperactivity. Sympathoinhibition and downregulation of sympathetic activity using medications and exercise training improve outcomes in patients with heart failure. Impedance cardiography provides data on hemodynamic and autonomic function that may assist with safe medication, exercise monitoring, and titration.
PURPOSE
The purpose of this pilot study was to evaluate the sensitivity of the Vrije Universiteit Ambulatory Monitoring System (VU-AMS) version 5fs to detect hemodynamic and sympathetic nervous system changes associated with postural shift in persons with heart failure with reduced ejection fraction.
METHODS
In this descriptive study, participants (N = 28) were recruited from an outpatient device clinic at a tertiary care hospital in Ontario, Canada. They completed a sit-to-stand posture protocol wearing an ambulatory blood pressure (ABP) and a noninvasive VU-AMS version 5fs impedance cardiography system.
RESULTS
Most (n = 18, 64%) participants were eliminated from the final analyses in this sample because of difficulty in Q-onset and B-point identification in peculiar electrocardiogram and impedance cardiogram waveforms. The remaining participants (n = 10) had a mean age of 69 years (SD = 10 years) and responses to a sit-to-stand posture protocol that included a 5% increase in heart rate (p = .001), an 18% decrease in stroke volume (p = .01), and an 8% decrease in left ventricular ejection time (p = .01). Participants had an increased preejection period (11%, p = .01), a drop in cardiac output of 13% (p = .02), and a reduced mean arterial pressure of approximately 4% (p = .09) with standing.
DISCUSSION
Although the VU-AMS version 5fs system detected anticipated hemodynamic and sympathetic nervous system changes to postural shift in participants (n = 10), the elimination of 64% (n = 18) of the sample because of scoring difficulties limits the use of this impedance cardiography device using standard scoring algorithms in persons with heart failure with reduced ejection fraction.
背景
心力衰竭是一种与交感神经系统和肾素 - 血管紧张素 - 醛固酮系统亢进相关的复杂综合征。使用药物和运动训练进行交感神经抑制及下调交感神经活动可改善心力衰竭患者的预后。阻抗心动图可提供有关血流动力学和自主神经功能的数据，有助于安全用药、运动监测及滴定。
目的
本初步研究的目的是评估Vrije大学动态监测系统（VU - AMS）5fs版本检测射血分数降低的心力衰竭患者体位改变相关血流动力学和交感神经系统变化的敏感性。
方法
在这项描述性研究中，参与者（N = 28）从加拿大安大略省一家三级护理医院的门诊设备诊所招募。他们穿着动态血压（ABP）和无创VU - AMS 5fs版本阻抗心动图系统完成了从坐到站的体位方案。
结果
在该样本中，由于在特殊心电图和阻抗心动图波形中难以识别Q波起始点和B点，大多数（n = 18，64%）参与者被排除在最终分析之外。其余参与者（n = 10）的平均年龄为69岁（标准差 = 10岁），对从坐到站体位方案的反应包括心率增加5%（p = .001）、每搏输出量减少18%（p = .01）和左心室射血时间减少8%（p = .01）。站立时，参与者的射血前期增加（11%，p = .01）、心输出量下降13%（p = .02），平均动脉压降低约4%（p = .09）。
讨论
尽管VU - AMS 5fs版本系统检测到了参与者（n = 10）体位改变时预期的血流动力学和交感神经系统变化，但由于评分困难而排除样本的64%（n = 18）限制了这种使用标准评分算法的阻抗心动图设备在射血分数降低的心力衰竭患者中的应用。
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