妊娠中期心血管自主神经调节和压力反射控制：一项横断面研究。
Cardiovascular autonomic modulation and baroreflex control in the second trimester of pregnancy: A cross sectional study.
机构信息
Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
出版信息
PLoS One. 2019 May 14;14(5):e0216063. doi: 10.1371/journal.pone.0216063. eCollection 2019.
PURPOSE
The aim is to evaluate and characterize cardiovascular autonomic control and baroreflex function and their response to an orthostatic stressor in the second trimester of pregnancy via time, frequency, information and symbolic analyses.
METHODS
We evaluated 22 women at 18 weeks of pregnancy, labeled as pregnant group (PG) (30.8±4.4 years), and 22 non-pregnant women (29.8±5.4 years), labeled as control group (CG). Electrocardiogram, non-invasive photoplethysmographic arterial pressure (AP) and respiratory signals were recorded at rest at left lateral decubitus (REST) and during active standing (STAND) for 10 minutes. The heart period (HP) variability and systolic AP (SAP) variability were assessed in the frequency domain. High frequency (HF) and low frequency (LF) spectral indexes were computed. Nonlinear indexes such as symbolic markers (0V%, 1V%, 2LV% and 2UV% indexes), Shannon entropy (SE) and normalized complexity index (NCI) were calculated as well. Baroreflex control was assessed by cross-spectral HP-SAP analysis. We computed baroreflex sensitivity (BRS), HP-SAP squared coherence (K2) and phase in LF and HF bands.
RESULTS
At REST, the PG had lower mean, variance and HF power of HP series and lower K2(LF), BRS(LF) and BRS(HF) than the CG. During STAND, CG and PG decreased the mean, CI, NCI and 2UV% and increased 0V% of the HP series and augmented the SAP variance. LFabs of SAP series increased during STAND solely in CG. BRS(HF) was reduced during in both PG and CG, while HFabs of HP series did not diminish during STAND either in PG or CG. Complexity of the autonomic control was similar in PG and CG regardless of the experimental condition.
CONCLUSION
We conclude that the second trimester of pregnancy was characterized by a lower parasympathetic modulation and reduced BRS at REST, preserved complexity of cardiac and vascular controls, limited sympathetic response to STAND and general conservation of the baroreflex responses to posture changes.
TRIAL REGISTRATION
Begistro Brasileiro de Ensaios clínicos, Number: RBR-9s8t88.
目的
通过时间、频率、信息和符号分析，评估和描述妊娠中期心血管自主控制和压力反射功能，并研究其对直立应激的反应。
方法
我们评估了 22 名 18 周妊娠的女性（妊娠组，PG）（30.8±4.4 岁）和 22 名非妊娠女性（对照组，CG）（29.8±5.4 岁）。在左侧卧位（REST）和主动站立（STAND）10 分钟期间，记录心电图、无创光电容积脉搏波动脉压（AP）和呼吸信号。在频域评估心率（HP）变异性和收缩压（SAP）变异性。计算高频（HF）和低频（LF）谱指数。还计算了非线性指数，如符号标记（0V%、1V%、2LV%和 2UV%指数）、香农熵（SE）和归一化复杂度指数（NCI）。通过 HP-SAP 交叉谱分析评估压力反射控制。我们计算了压力反射敏感性（BRS）、HP-SAP 平方相干（K2）和 LF 和 HF 带的相位。
结果
在 REST 时，PG 的 HP 系列平均、方差和 HF 功率较低，LF 时 K2（LF）、BRS（LF）和 BRS（HF）较低。在 STAND 期间，CG 和 PG 降低了 HP 系列的平均、CI、NCI 和 2UV%，增加了 HP 系列的 0V%，并增加了 SAP 方差的 LFabs。仅在 CG 中，SAP 系列的 LFabs 在 STAND 期间增加。PG 和 CG 的 BRS（HF）均降低，而 PG 或 CG 的 HP 系列的 HFabs 在 STAND 期间并未降低。无论实验条件如何，PG 和 CG 的自主控制复杂性相似。
结论
我们的结论是，妊娠中期的特点是 REST 时副交感神经调节降低和 BRS 降低，心脏和血管控制的复杂性保持不变，对 STAND 的交感神经反应有限，以及体位变化时的压力反射反应总体保持不变。
试验注册
巴西临床试验注册处，注册号：RBR-9s8t88。
Zotero 插件