健康足月新生儿的心率变异性与分娩方式有关：一项前瞻性观察研究。
Heart rate variability in healthy term newborns is related to delivery mode: a prospective observational study.
机构信息
Department of Neonatology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Kollarova 2, 03659, Martin, Slovakia.
Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 03601, Martin, Slovakia.
出版信息
BMC Pregnancy Childbirth. 2018 Jun 27;18(1):264. doi: 10.1186/s12884-018-1900-4.
BACKGROUND
Early postnatal period is characterized by dramatic adaptation changes of cardiovascular and respiratory systems in newborns. There is still insufficient data regarding maturation of autonomic regulatory mechanisms in neonates early after delivery. Aim of this study was to analyze cardiac autonomic regulation in newborns within the first few postnatal days in relation to different modes of delivery using time and spectral heart rate variability analysis.
METHODS
Eutrophic healthy term newborns (n = 46) were divided into three groups according to the delivery mode: vaginal delivery (VD group; n = 16), vaginal delivery with epidural analgesia (EDA group; n = 16), and caesarean section under general anesthesia (CS group; n = 14). Heart rate variability (HRV), blood pressure (BP), and blood oxygen saturation (SpO) were measured within the first two hours after birth and on the third to fourth postnatal day. HRV parameters were evaluated in the time domain (RR intervals, mean square of successive differences - MSSD) and frequency domain (total spectral power - TP, absolute and relative low and high frequency powers).
RESULTS
The HRV spectral analysis showed significantly higher relative power of the high-frequency band (HF%) in the VD group compared to the CS group early after delivery (p = 0.002). HRV parameters and BP significantly increased on the third to fourth postnatal day in all groups (p < 0.05). No significant differences in basic characteristics, BP and SpO were identified between groups during both measurements.
CONCLUSIONS
HRV analysis revealed higher cardiovagal modulation in spontaneously born newborns without analgesia compared to neonates born by caesarean section. It could represent a potential pathomechanism that leads to discrete abnormal neurocardiac regulation associated with higher risk for worsened postnatal adaptation of cardiovascular system in surgically delivered neonates.
背景
新生儿在出生后的早期阶段，心血管和呼吸系统会经历剧烈的适应变化。然而，关于新生儿在分娩后早期自主调节机制的成熟程度，目前的数据还不够充分。本研究旨在通过时间和频谱心率变异性分析，探讨分娩方式对新生儿出生后最初几天心脏自主调节的影响。
方法
将 46 例足月健康的新生儿根据分娩方式分为三组：阴道分娩组（VD 组，n=16）、阴道分娩联合硬膜外镇痛组（EDA 组，n=16）和全身麻醉下剖宫产组（CS 组，n=14）。在出生后前 2 小时和第 3-4 天测量心率变异性（HRV）、血压（BP）和血氧饱和度（SpO2）。在时域（RR 间期、均方根差的均方根 - MSSD）和频域（总谱功率 - TP、绝对和相对低频和高频功率）评估 HRV 指标。
结果
HRV 频谱分析显示，VD 组新生儿在分娩后早期的高频带相对功率（HF%）明显高于 CS 组（p=0.002）。所有组的 HRV 参数和 BP 在第 3-4 天均显著增加（p<0.05）。在两次测量中，各组之间的基本特征、BP 和 SpO2 均无显著差异。
结论
HRV 分析显示，未接受镇痛的自然分娩新生儿的心脏迷走神经调节较高，而剖宫产分娩的新生儿则较低。这可能是一种潜在的病理机制，导致与心血管系统适应不良相关的离散异常神经心脏调节，增加了手术分娩新生儿的风险。
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