Uberfuhr P, Frey A W, Fuchs A, Paniara C, Roskamm H, Schwaiger M, Reichart B
Department of Cardiac Surgery, University of Munich, Klinikum Grosshadern, Germany.
Eur J Cardiothorac Surg. 1997 Dec;12(6):907-12. doi: 10.1016/s1010-7940(97)00271-6.
Several investigators have shown signs of possible sympathetic but not parasympathetic reinnervation in heart transplanted patients. Spectral analysis of heart rate and blood pressure variability is a noninvasive tool appropriate to detect a functional autonomous reinnervation to the heart. In a follow-up study, 13 patients after heart transplantation (HTx) were investigated, mean age 50.6+/-8.5 years, 18 healthy volunteers were selected as control group. For each patient two recordings were performed which took part 14+/-5 months respectively 42+/-8 months after HTx. ECG and systolic blood pressure (SBP) have been recorded simultaneously for 5 min in supine position during controlled respiratory rate of 12 or 15 cycles/min. No graft rejection has been detected in the endomyocardial biopsy performed right after the recordings. Power spectral densities (PSD) were calculated for the beat-to-beat time series of RR-intervals (distance of two following QRS complexes) and SBPs. The area of PSD in the range of 0.05-0.17 Hz was defined as low frequency (LF) and that of 0.18-0.35 Hz as high frequency (HF). LF and HF are indicative of efferent sympathetic respectively parasympathetic activity at the sinus node. A significant increase of LF (226%) and HF (213%) during a mean period of 28 months could be found. No differences were to be shown for systolic blood pressure variability. Previous findings confirm that LF band increases 4 years after transplantation, suggesting a possible sympathetic reinnervation of the heart. On the other hand an increase of the HF band also suggests a parasympathetic reinnervation.
几位研究者已表明，心脏移植患者可能存在交感神经而非副交感神经的再支配迹象。心率和血压变异性的频谱分析是一种适用于检测心脏功能性自主再支配的非侵入性工具。在一项随访研究中，对13例心脏移植（HTx）后的患者进行了调查，平均年龄50.6±8.5岁，选取18名健康志愿者作为对照组。对每位患者进行了两次记录，分别在HTx后14±5个月和42±8个月进行。在仰卧位、呼吸频率控制为12或15次/分钟的情况下，同时记录心电图和收缩压（SBP）5分钟。记录后立即进行的心内膜活检未检测到移植排斥反应。计算RR间期（两个连续QRS波群的距离）和SBP的逐搏时间序列的功率谱密度（PSD）。PSD在0.05 - 0.17Hz范围内的区域定义为低频（LF），0.18 - 0.35Hz范围内的区域定义为高频（HF）。LF和HF分别指示窦房结处传出交感神经和副交感神经的活动。在平均28个月的时间里，可发现LF（226%）和HF（213%）显著增加。收缩压变异性未显示出差异。先前的研究结果证实，移植后4年LF波段增加，提示心脏可能存在交感神经再支配。另一方面，HF波段的增加也提示副交感神经再支配。
