脊髓刺激对心力衰竭患者自主神经系统功能的急性影响。
Acute effect of spinal cord stimulation on autonomic nervous system function in patients with heart failure.
作者信息
Naar Jan, Jaye Deborah, Neuzil Petr, Doskar Petr, Malek Filip, Linderoth Bengt, Lind Goran, Stahlberg Marcus
机构信息
Na Homolce Hospital, Department of Cardiology, Prague, Czech Republic.
Medtronic Plc, Cardiac Rhythm and Heart Failure, Minneapolis, USA.
出版信息
J Appl Biomed. 2021 Sep;19(3):133-141. doi: 10.32725/jab.2021.012. Epub 2021 May 18.
AIMS
To test the hypothesis that spinal cord stimulation (SCS) acutely improves heart rate variability (HRV) and baroreceptor sensitivity (BRS) in patients with heart failure (HF).
METHODS
SCS (15 minutes) was delivered in four different settings: 90% of maximal tolerated stimulation amplitude (MTA) targeting the T1-T4 spinal cord segments (SCS90T1-4), 60% of MTA (SCS60T1-4), 90% of MTA with cranial (SCS90CR) and caudal (SCS90CA) electrode configuration. HRV and BRS were recorded continuously and stimulation was compared to device off.
RESULTS
Fifteen HF patients were included. SCS90T1-4 did not change the standard deviation of intervals between normal beats (SDNN, p = 0.90), BRS (p = 0.55) or other HRV parameters. In patients with baseline SDNN <50 ms, SCS90T1-4 significantly increased SDNN (p = 0.004).
CONCLUSIONS
Acute SCS at 60-90% of MTA targeting upper thoracic spinal cord segments does not improve autonomic balance or baroreceptor sensitivity in unselected patients with heart failure but may improve HRV in patients with low SDNN.
目的
验证脊髓刺激（SCS）能急性改善心力衰竭（HF）患者心率变异性（HRV）和压力感受器敏感性（BRS）这一假说。
方法
在四种不同情况下进行SCS（15分钟）：以90%的最大耐受刺激幅度（MTA）刺激T1 - T4脊髓节段（SCS90T1 - 4）、60%的MTA（SCS60T1 - 4）、90%的MTA采用头端（SCS90CR）和尾端（SCS90CA）电极配置。连续记录HRV和BRS，并将刺激时与设备关闭时进行比较。
结果
纳入15例HF患者。SCS90T1 - 4未改变正常心搏间期标准差（SDNN，p = 0.90）、BRS（p = 0.55）或其他HRV参数。在基线SDNN <50 ms的患者中，SCS90T1 - 4显著增加了SDNN（p = 0.004）。
结论
针对上胸段脊髓节段，以60% - 90%的MTA进行急性SCS，在未选择的心力衰竭患者中并不能改善自主神经平衡或压力感受器敏感性，但可能改善SDNN较低患者的HRV。
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