Vural Cagdas, Dinleyici Ener Cagri, Kosger Pelin, Bolluk Ozge, Kilic Zubeyir, Ucar Birsen
1Department of Pediatrics, Faculty of Medicine,Eskisehir Osmangazi University,Eskisehir,Turkey.
2Department of Pediatric Intensive Care, Faculty of Medicine,Eskisehir Osmangazi University,Eskisehir,Turkey.
Cardiol Young. 2017 Nov;27(9):1662-1669. doi: 10.1017/S1047951117000944. Epub 2017 Aug 1.
Introduction Carbon monoxide poisoning may cause myocardial toxicity and cardiac autonomic dysfunction, which may contribute to the development of life-threatening arrhythmias. We investigated the potential association between acute carbon monoxide exposure and cardiac autonomic function measured by heart rate variability.
The present study included 40 children aged 1-17 years who were admitted to the Pediatric Intensive Care Unit with acute carbon monoxide poisoning and 40 healthy age- and sex-matched controls. Carboxyhaemoglobin and cardiac enzymes were measured at admission. Electrocardiography was performed on admission and discharge, and 24-hour Holter electrocardiography was digitally recorded. Heart rate variability was analysed at both time points - 24-hour recordings - and frequency domains - from the first 5 minutes of intensive care unit admission.
Time domain and frequency indices such as high-frequency spectral power and low-frequency spectral power were similar between patient and control groups (p>0.05). The ratio of low-frequency spectral power to high-frequency spectral power was significantly lower in the carbon monoxide poisoning group (p<0.001) and was negatively correlated with carboxyhaemoglobin levels (r=-0.351, p<0.05). The mean heart rate, QT dispersion, corrected QT dispersion, and P dispersion values were higher in the carbon monoxide poisoning group (p<0.05) on admission. The QT dispersion and corrected QT dispersion remained longer in the carbon monoxide poisoning group compared with controls on discharge (p<0.05).
The frequency domain indices, especially the ratio of low-frequency spectral power to high-frequency spectral power, are useful for the evaluation of the cardiac autonomic function. The decreased low-frequency spectral power-to-high-frequency spectral power ratio reflects a balance of the autonomic nervous system, which shifted to parasympathetic components.
引言 一氧化碳中毒可能导致心肌毒性和心脏自主神经功能障碍，这可能促成危及生命的心律失常的发生。我们研究了急性一氧化碳暴露与通过心率变异性测量的心脏自主神经功能之间的潜在关联。
本研究纳入了40名年龄在1至17岁之间因急性一氧化碳中毒入住儿科重症监护病房的儿童以及40名年龄和性别匹配的健康对照者。入院时测量碳氧血红蛋白和心肌酶。入院时和出院时进行心电图检查，并对24小时动态心电图进行数字记录。在两个时间点——24小时记录——以及频域——从重症监护病房入院的前5分钟——分析心率变异性。
患者组和对照组之间的时域和频域指标，如高频谱功率和低频谱功率相似（p>0.05）。一氧化碳中毒组的低频谱功率与高频谱功率之比显著较低（p<0.001），且与碳氧血红蛋白水平呈负相关（r=-0.351，p<0.05）。入院时，一氧化碳中毒组的平均心率、QT离散度、校正QT离散度和P离散度值较高（p<0.05）。出院时，一氧化碳中毒组的QT离散度和校正QT离散度仍比对照组更长（p<0.05）。
频域指标，尤其是低频谱功率与高频谱功率之比，有助于评估心脏自主神经功能。低频谱功率与高频谱功率之比降低反映了自主神经系统的平衡，这种平衡向副交感神经成分偏移。
