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截瘫和四肢瘫患者的心血管自主控制

Cardiovascular autonomic control in paraplegic and quadriplegic.

作者信息

de Carvalho Abreu Elizângela Márcia, Dias Lucas Pinto Salles, Lima Fernanda Pupio Silva, de Paula Júnior Alderico Rodrigues, Lima Mário Oliveira

机构信息

Sensory Motor Rehabilitation Engineering Laboratory, Universidade do Vale do Paraíba (UNIVAP), Avenida: Shishima Hifumi, 2911, Urbanova, São José dos Campos, SP, 12244-000, Brazil.

Instituto Nacional de Pesquisa Espacial (INPE), São José dos Campos, Brazil.

出版信息

Clin Auton Res. 2016 Apr;26(2):117-26. doi: 10.1007/s10286-015-0339-1. Epub 2016 Mar 7.

Abstract

INTRODUCTION

Spinal cord injury (SCI) is commonly associated with devastating paralysis. This condition also results in cardiovascular autonomic dysfunction associated with increased mortality from cardiovascular disease. The purpose of this study was to explore the differences in cardiovascular autonomic modulation in individuals with and without SCI.

METHODS

The study included 60 individuals: 30 individuals without SCI, who formed the control group-CG and 30 individuals with SCI, who formed the SCI group-SCIG. The latter group was divided into two, one group of subjects with SCI above the spinal segment T6-SCIG (above T6) and a group of individuals with SCI below T6-SCIG (below T6). The subjects were evaluated by linear and nonlinear analysis of heart rate variability (HRV).

RESULTS

The SCIG showed significantly lower square root of the mean squares differences of successive NN intervals (rMSSD), number of pairs of adjacent NN intervals differing by more than 50 ms (pNN50), standard deviation of short-term HRV (SD1), and high frequency power (HF). Their low frequency power (LF) in absolute units (ms(2)) was significantly lower and their normalized units (n.u.) were significantly higher. Their LF/HF ratio was significantly higher, and sample entropy (SampEn), which indicates the complexity and irregularity of the NN intervals time series, was significantly lower compared to the CG. The differences between the SCIG and CG were derived mainly from the SCIG (above T6). The correlation test revealed very low values between each of the parameters evaluated for CG and SCIG.

CONCLUSIONS

The SCIG (above T6) showed greater cardiovascular autonomic impairment compared to SCIG (below T6) and CG. The SCIG (below T6) also presented some degree of autonomic dysfunction. All parameters, linear or nonlinear, are suitable to demonstrate the differences between the SCIG and CG.

摘要

引言

脊髓损伤(SCI)通常会导致严重的瘫痪。这种情况还会导致心血管自主神经功能障碍,增加心血管疾病的死亡率。本研究的目的是探讨脊髓损伤患者与非脊髓损伤患者在心血管自主神经调节方面的差异。

方法

该研究纳入了60名个体:30名无脊髓损伤的个体组成对照组(CG),30名脊髓损伤患者组成脊髓损伤组(SCIG)。后者又分为两组,一组是脊髓损伤位于脊髓节段T6以上的受试者(SCIG(T6以上)),另一组是脊髓损伤位于T6以下的个体(SCIG(T6以下))。通过心率变异性(HRV)的线性和非线性分析对受试者进行评估。

结果

SCIG组的连续NN间期均方根(rMSSD)、相邻NN间期差值超过50毫秒的对数(pNN50)、短期HRV标准差(SD1)和高频功率(HF)显著降低。其绝对单位(ms²)的低频功率(LF)显著降低,标准化单位(n.u.)显著升高。其LF/HF比值显著升高,与CG组相比,样本熵(SampEn)显著降低,样本熵表明NN间期时间序列的复杂性和不规则性。SCIG组与CG组之间的差异主要源于SCIG(T6以上)。相关性检验显示,CG组和SCIG组评估的各参数之间的值非常低。

结论

与SCIG(T6以下)和CG组相比,SCIG(T6以上)表现出更大的心血管自主神经损伤。SCIG(T6以下)也存在一定程度的自主神经功能障碍。所有参数,无论是线性还是非线性的,都适合用于证明SCIG组和CG组之间的差异。

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