Vykoupil Karel, Galuszka Jan, Drac Petr, Taborsky Milos
Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic.
Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018 Mar;162(1):36-39. doi: 10.5507/bp.2017.045. Epub 2017 Oct 27.
Internal carotid artery stenosis (ICAS) is associated with significantly higher risk of stroke. Autonomic function can be impaired in the presence of atheroma in the carotid sinus region. Two parameters of autonomic nervous system (ANS) function e.g. heart rate variability (HRV) and baroreflex sensitivity (BRS) are respected predictors of cardiovascular prognosis. We assessed the effect of elective unilateral carotid endarterectomy (CEA) on cardiovascular autonomic functions as a major prognostic factor for cardiovascular health.
Nineteen patients indicated for CEA underwent formal autonomic assessment in the laboratory. Hemodynamic profiles, HRV and BRS were evaluated with the dedicated high-tech device Task Force Monitor before surgery (day-1) and postoperatively (day 3±1). Data were obtained during 5 min orthostatic challenge and subsequent 5 min in a supine position.
There were no significant early postoperative changes in evaluated parameters after CEA. There was a mild decrease of blood pressure and therefore only a slight increase in BRS. It was also possible to observe a rise in the value of total power and high frequency power.
In the early postoperative period, healing processes are occurring and the sympatho-vagal interaction is probably still unbalanced. Given the considerable clinical potential of BRS and HRV measurement, further short-term and, more importantly, long-term investigations are needed.
颈内动脉狭窄（ICAS）与中风风险显著升高相关。颈动脉窦区域存在动脉粥样硬化时，自主神经功能可能受损。自主神经系统（ANS）功能的两个参数，即心率变异性（HRV）和压力反射敏感性（BRS），是心血管预后的重要预测指标。我们评估了择期单侧颈动脉内膜切除术（CEA）对心血管自主神经功能的影响，将其作为心血管健康的主要预后因素。
19例拟行CEA的患者在实验室接受了正式的自主神经评估。术前（第1天）和术后（第3±1天）使用专用高科技设备任务 Force 监测仪评估血流动力学特征、HRV和BRS。在5分钟直立挑战及随后5分钟仰卧位期间获取数据。
CEA术后评估参数无明显早期变化。血压有轻度下降，因此BRS仅略有升高。还可观察到总功率和高频功率值上升。
在术后早期，愈合过程正在进行，交感-迷走神经相互作用可能仍不平衡。鉴于BRS和HRV测量具有相当大的临床潜力，需要进一步进行短期研究，更重要的是长期研究。
