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入住重症监护病房的新冠肺炎患者的自主神经功能和压力反射控制

Autonomic Function and Baroreflex Control in COVID-19 Patients Admitted to the Intensive Care Unit.

作者信息

Gelpi Francesca, Wu Maddalena Alessandra, Bari Vlasta, Cairo Beatrice, De Maria Beatrice, Fossali Tommaso, Colombo Riccardo, Porta Alberto

机构信息

Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy.

Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy.

出版信息

J Clin Med. 2024 Apr 12;13(8):2228. doi: 10.3390/jcm13082228.

Abstract

: Autonomic function and baroreflex control might influence the survival rate of coronavirus disease 2019 (COVID-19) patients admitted to the intensive care unit (ICU) compared to respiratory failure patients without COVID-19 (non-COVID-19). This study describes physiological control mechanisms in critically ill COVID-19 patients admitted to the ICU in comparison to non-COVID-19 individuals with the aim of improving stratification of mortality risk. : We evaluated autonomic and baroreflex control markers extracted from heart period (HP) and systolic arterial pressure (SAP) variability acquired at rest in the supine position (REST) and during a modified head-up tilt (MHUT) in 17 COVID-19 patients (age: 63 ± 10 years, 14 men) and 33 non-COVID-19 patients (age: 60 ± 12 years, 23 men) during their ICU stays. Patients were categorized as survivors (SURVs) or non-survivors (non-SURVs). : We found that COVID-19 and non-COVID-19 populations exhibited similar vagal and sympathetic control markers; however, non-COVID-19 individuals featured a smaller baroreflex sensitivity and an unexpected reduction in the HP-SAP association during the MHUT compared to the COVID-19 group. Nevertheless, none of the markers of the autonomic and baroreflex functions could distinguish SURVs from non-SURVs in either population. : We concluded that COVID-19 patients exhibited a more preserved baroreflex control compared to non-COVID-19 individuals, even though this information is ineffective in stratifying mortality risk.

摘要

与没有2019冠状病毒病(COVID-19)的呼吸衰竭患者(非COVID-19)相比,自主神经功能和压力反射控制可能会影响入住重症监护病房(ICU)的COVID-19患者的存活率。本研究描述了入住ICU的重症COVID-19患者与非COVID-19个体相比的生理控制机制,目的是改善死亡风险分层。我们评估了17例COVID-19患者(年龄:63±10岁,14名男性)和33例非COVID-19患者(年龄:60±12岁,23名男性)在ICU住院期间,从仰卧位静息状态(REST)和改良头高位倾斜(MHUT)期间获取的心动周期(HP)和收缩期动脉压(SAP)变异性中提取的自主神经和压力反射控制指标。患者被分为幸存者(SURVs)或非幸存者(non-SURVs)。我们发现,COVID-19和非COVID-19人群表现出相似的迷走神经和交感神经控制指标;然而,与COVID-19组相比,非COVID-19个体在MHUT期间的压力反射敏感性较小,且HP-SAP关联意外降低。尽管如此,自主神经和压力反射功能的指标均无法区分这两个人群中的幸存者和非幸存者。我们得出结论,与非COVID-19个体相比,COVID-19患者表现出更保留的压力反射控制,尽管这些信息在分层死亡风险方面无效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd9f/11050480/b7f397a13da6/jcm-13-02228-g001.jpg

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