治疗性低温对心率变异性的影响
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The effect of therapeutic hypothermia on heart rate variability
背景与目的
心率变异性反映了自主神经系统的完整性。然而，尚无研究探讨治疗性低体温症(TH)对新生儿缺氧缺血性脑病(HIE) HRV测量的影响。
方 法
患有中度-严重HIE的足月婴儿接受标准TH治疗和前瞻性脑电图(EEG)和心电图(ECG)记录。结果良好的婴儿(无癫痫发作，96小时正常/轻度脑电图评分，18 - 24个月无磁共振脑损伤和正常神经发育评分)在胎龄、性别和最严重脑病评分方面与一组结果不佳的婴儿相匹配。在三个时间点（24小时（低体温），48小时（低温）和96小时（正常体温）获得的60分钟ECG数据计算时域和频域HRV值。时间和温度的影响使用重复测量方差分析来评估。
结 果
纳入了16名婴儿（8名有利，8名不利）。 对于这两组婴儿，HR，RR和高频段功率HF的增加都与温度升高有关，但与任何其他HRV测量无关。 相反，随着时间的推移，HRV随着脑病的减少而增加，对于结果良好的婴儿（反映皮层 - 自主神经整合的增加），但对于不良结局的患儿则无效。
结 论
一般来说，体温过低对HRV测量的影响仅限于心率（心动过缓）和呼吸频率的变化，而不是真实变异性的变化。 这支持这样的假设：HRV的持续性变化是由潜在的脑损伤驱动的，而不是TH的过程。
原始文献摘要
Vesoulis Z A, Rao R, Trivedi S B, et al. The Effect of Therapeutic Hypothermia On Heart Rate Variability[J]. Journal of Perinatology Official Journal of the California Perinatal Association, 2017, 37(6).
OBJECTIVE: Heart rate variability (HRV) reflects integrity of the autonomic nervous system. However, no study has investigated the impact of therapeutic hypothermia (TH) on HRV measures in infants with hypoxic–ischemic encephalopathy (HIE). In this study, weevaluate the influence of temperature on measures of HRV for a group of infants with favorable outcomes, as compared with a control group of infants with unfavorable outcomes.
STUDY DESIGN: Term-born infants with moderate-severe HIE underwent standard TH treatment and prospective electroencephalography (EEG) and electrocardiogram (ECG) recording. Infants with favorable outcome (no seizures, normal/mild EEG scores at 96 h, no magnetic resonance imaging brain injury and normal neurodevelopmental scores at 18 to 24 months) were
matched on gestational age, sex and worst encephalopathy score to a group of infants with unfavorable outcomes. Time- and frequency-domain HRV measures were calculated from 60 min of ECG data obtained at three time points: 24 h (hypothermia), 48 h (hypothermia) and 96 h (normothermia). The effect of time and temperature were evaluated using repeated-measures analysis of variance.
RESULTS: Sixteen infants were included (8 favorable, 8 unfavorable). For both groups of infants, an increase in the HR, RR and HF power was associated with an increase in temperature, but was not associated with any other HRV measure. In contrast, measures of HRV increased over time, as encephalopathy decreased, for infants with favorable outcomes (reflecting increased cortical-autonomic integration), but not for those with unfavorable outcomes.
CONCLUSIONS: In general, the effect of hypothermia on measures of HRV is limited to changes in heart rate (bradycardia) and respiratory rate, as opposed to changes in true variability. This supports the hypothesis that persistent changes in HRV are driven by the underlying brain injury and not by the process of TH.
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