急性缺氧对肺血管疾病患者心率变异性的影响。

Effects of Acute Hypoxia on Heart Rate Variability in Patients with Pulmonary Vascular Disease.

作者信息

Meszaros Martina, Schneider Simon R, Mayer Laura C, Lichtblau Mona, Pengo Martino F, Berlier Charlotte, Saxer Stéphanie, Furian Michael, Bloch Konrad E, Ulrich Silvia, Schwarz Esther I

机构信息

Department of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.

Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland.

出版信息

J Clin Med. 2023 Feb 23;12(5):1782. doi: 10.3390/jcm12051782.

DOI:10.3390/jcm12051782

PMID:36902567

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10003175/

Abstract

Pulmonary vascular diseases (PVDs), defined as arterial or chronic thromboembolic pulmonary hypertension, are associated with autonomic cardiovascular dysregulation. Resting heart rate variability (HRV) is commonly used to assess autonomic function. Hypoxia is associated with sympathetic overactivation and patients with PVD might be particularly vulnerable to hypoxia-induced autonomic dysregulation. In a randomised crossover trial, 17 stable patients with PVD (resting PaO ≥ 7.3 kPa) were exposed to ambient air (FiO = 21%) and normobaric hypoxia (FiO = 15%) in random order. Indices of resting HRV were derived from two nonoverlapping 5-10-min three-lead electrocardiography segments. We found a significant increase in all time- and frequency-domain HRV measures in response to normobaric hypoxia. There was a significant increase in root mean squared sum difference of RR intervals (RMSSD; 33.49 (27.14) vs. 20.76 (25.19) ms; < 0.01) and RR50 count divided by the total number of all RR intervals (pRR50; 2.75 (7.81) vs. 2.24 (3.39) ms; = 0.03) values in normobaric hypoxia compared to ambient air. Both high-frequency (HF; 431.40 (661.56) vs. 183.70 (251.25) ms; < 0.01) and low-frequency (LF; 558.60 (746.10) vs. 203.90 (425.63) ms; = 0.02) values were significantly higher in normobaric hypoxia compared to normoxia. These results suggest a parasympathetic dominance during acute exposure to normobaric hypoxia in PVD.

摘要

肺血管疾病（PVDs）定义为动脉性或慢性血栓栓塞性肺动脉高压，与自主心血管调节异常有关。静息心率变异性（HRV）常用于评估自主神经功能。缺氧与交感神经过度激活有关，PVD患者可能特别容易受到缺氧诱导的自主神经调节异常的影响。在一项随机交叉试验中，17例稳定的PVD患者（静息动脉血氧分压≥7.3kPa）被随机依次暴露于室内空气（吸入氧分数=21%）和常压性缺氧（吸入氧分数=15%）环境中。静息HRV指标来自两个不重叠的5-10分钟三导联心电图片段。我们发现，对常压性缺氧的反应中，所有时域和频域HRV测量值均显著增加。与室内空气相比，常压性缺氧时RR间期的均方根和差（RMSSD；33.49（27.14）对20.76（25.19）ms；P<0.01）以及RR50计数除以所有RR间期总数（pRR50；2.75（7.81）对2.24（3.39）ms；P=0.03）的值均显著增加。与常氧相比，常压性缺氧时高频（HF；431.40（661.56）对183.70（251.25）ms；P<0.01）和低频（LF；558.60（746.10）对203.90（425.63）ms；P=0.02）值均显著升高。这些结果表明，PVD患者在急性暴露于常压性缺氧时以副交感神经占优势。