The present study was designed to make certain whether there exists adrenomedullin (ADM) in the rat central nervous system and evaluated the hemodynamic actions of intracerebroventricular administration (ICVA) of hum...The present study was designed to make certain whether there exists adrenomedullin (ADM) in the rat central nervous system and evaluated the hemodynamic actions of intracerebroventricular administration (ICVA) of human ADM[13-52]. By immunohistochemistry (ABC method),We found that there was a discrete localization of ADM-positive immunoreactivity in the rat central system including cerebral cortex,paraventricular tissues, hypothalamus, cerebella cortex, mesencephalon and medulla oblongata. By reverse transcription-polymerase chain reaction(RT-PCR) analysis, rat ADM mRNA was found to be expressed in rat brain. These above results of immunohistochemistry and RT-PCR suggest that ADM exists in the rat brain. We also found that centrally administered ADM[13-52]in a dose of 0.4 to 3. 2 nmol/kg provoked marked, prolonged and dosedependent increases in mean arterial blood pressure (MABP) and heart rate (HR). To clarify the mechanisms of the hemodynamic changes induced by centrally administered ADM [13-52]. the effect of centrally administered ADM [13-52] on renal sympathetic nerve activity (RSNA) was studied. The result showed that centrally administered ADM [13-52] ( 1. 6 nmol/kg) provoked a marked increase in RSNA .therefore .the increases in MABP and HR induced by centrally administered ADM [13-52]might be due to the stimulation of central sympathetic mechanism. In addtion,we also compared the relationship of activity and structure among the different fragments of ADM. In conclusion, ADMexists in the rat brain, and it may play an important role in the central control of cardiovascular system.展开更多
Objective:The head-up tilt test(HUTT)is widely used but is time-consuming and not cost-effective to evaluate patients with vasovagal syncope(VVS).The present study aims to verify the hypothesis that ambulatory blood p...Objective:The head-up tilt test(HUTT)is widely used but is time-consuming and not cost-effective to evaluate patients with vasovagal syncope(VVS).The present study aims to verify the hypothesis that ambulatory blood pressure(BP)monitoring(ABPM)and the simplistic tilt test may be potential alternatives to the HUTT.Methods:The study consecutively enrolled 360 patients who underwent the HUTT to evaluate VVS.BP),heart rate(HR),and BP/HR ratios derived from ABPM and the simplistic tilt test were evaluated to predict the presence,pattern,and stage of syncope during the HUTT.Results:Mixed response was the commonest pattern,and syncope occurred frequently with infusion of isoproterenol at a rate of 3μg/min.During the simplistic tilt test,the cardioinhibitory group had higher tilted BP/HR ratios than the vasodepressor group,while the vasodepressor group had a faster tilted HR and a larger HR difference than the cardioinhibitory group.The higher the BP/HR ratio in the tilted position,the higher the isoproterenol dosage needed to induce a positive response.During ABPM,BP/HR ratios were signifi cantly higher in the cardioinhibitory group than in the vasodepressor group.The higher the ABPM-derived BP,the higher the dosage of isoproterenol needed to induce syncope.There were signifi cant correlations in BP/HR ratios between ABPM and the supine position in the vasodepressor group,while signifi cant correlation was found only for the diastolic BP/HR ratio between ABPM and the tilted position in the cardioinhibitory group.The mixed pattern shared correlative features of the other two patterns.Conclusion:ABPM and the simplistic tilt test might be used as promising alternatives to the HUTT in VVS evaluation in clinical settings.展开更多
Objective: To introduce a method to calculate cardiovascular age, a new, accurate and much simpler index for assessing cardiovascular autonomic regulatory function, based on statistical analysis of heart rate and bloo...Objective: To introduce a method to calculate cardiovascular age, a new, accurate and much simpler index for assessing cardiovascular autonomic regulatory function, based on statistical analysis of heart rate and blood pressure variability (HRV and BPV) and baroreflex sensitivity (BRS) data. Methods: Firstly, HRV and BPV of 89 healthy aviation personnel were analyzed by the conventional autoregressive (AR) spectral analysis and their spontaneous BRS was obtained by the sequence method. Secondly, principal component analysis was conducted over original and derived indices of HRV, BPV and BRS data and the relevant principal components, PCi orig and PCi deri (i=1, 2, 3,...) were obtained. Finally, the equation for calculating cardiovascular age was obtained by multiple regression with the chronological age being assigned as the dependent variable and the principal components significantly related to age as the regressors. Results: The first four principal components of original indices accounted for over 90% of total variance of the indices, so did the first three principal components of derived indices. So, these seven principal components could reflect the information of cardiovascular autonomic regulation which was embodied in the 17 indices of HRV, BPV and BRS exactly with a minimal loss of information. Of the seven principal components, PC2 orig , PC4 orig and PC2 deri were negatively correlated with the chronological age ( P <0 05), whereas the PC3 orig was positively correlated with the chronological age ( P <0 01). The cardiovascular age thus calculated from the regression equation was significantly correlated with the chronological age among the 89 aviation personnel ( r =0.73, P <0 01). Conclusion: The cardiovascular age calculated based on a multi variate analysis of HRV, BPV and BRS could be regarded as a comprehensive indicator reflecting the age dependency of autonomic regulation of cardiovascular system in healthy aviation personnel.展开更多
To investigate the effects of impaired glucose metabolism （IGM） on cardiovascular autonomic nervous systems in essential hypertensive （EH） patients by comparing heart rate variability （HRV） and blood pressure va...To investigate the effects of impaired glucose metabolism （IGM） on cardiovascular autonomic nervous systems in essential hypertensive （EH） patients by comparing heart rate variability （HRV） and blood pressure variability （BPV） in EH patients with or without type 2 diabetes mellitus （T2DM）. Simultaneous 24-h recordings of ambulatory ECG and blood pressure monitoring were performed in 36 male old patients with simple EH and 33 male old patients with EH combined with T2DM. HRV analysis included time domain parameters such as SDNN, SDANN, SDNNi, rMSSD and pNN50, and total spectral power （TP） of HRV, which mainly consists of VLF, LF and HF component along with LF/HF ratio, was also obtained. The value of ambulatory blood pressure was represented as the mean blood pressure （mean systolic/mSBP, diastolic/mDBP and pulse pressure/mPP） during different periods （24 h/24 h, day time/d and night time/n）. Standard deviation （SD） as well as coefficient of variance （CV） of blood pressure during each above-mentioned period were obtained to reflect the long-term BPV. Our result showed that SDNN, SDNNi, SDANN, rMSSD, PNN50, TP and HF of HRV in cases of EH with T2DM were all significantly lower than those in simple EH subjects （P〈0.05）. No significant differences in VLF or LF was found between the two groups （P〉0.05）, while LF/HF ratio was significantly higher in EH with T2DM patients than in simple EH subjects （P〈0.01）. Moreover, dmSBP, 24 h-mPP and dmPP were all significantly higher in EH with T2DM patients than in simple EH subjects （P〈0.05）, while nmSBP, 24 h-mSBP, 24 h-mDBP, dmDBP, nmDBP or nmPP showed no significant difference between this two groups of patients （P〉0.05）. And dSBPSD, dSBPCV and 24 h-SBPSD were all significantly higher in EH with T2DM patients than in simple EH subjects （P〈0.05）, while the other BPV indexes showed no significant difference between this two groups （P〉0.05）. It is concluded that the cardiovascular autonomic nervous systems in EH patients was further impaired by T2DM, displaying lowering of HRV and enlargement of BPV, which in turn induced abnormal structural and functional changes of cardiovascular systems. Therefore, improving cardiovascular autonomic nervous systems might reduce the occurrence of cardiovascular complications in the EH patients with IGM.展开更多
In this study,single-channel photoplethysmography(PPG)signals were used to estimate the heart rate(HR),diastolic blood pressure(DBP),and systolic blood pressure(SBP).A deep learning model was proposed using a long-ter...In this study,single-channel photoplethysmography(PPG)signals were used to estimate the heart rate(HR),diastolic blood pressure(DBP),and systolic blood pressure(SBP).A deep learning model was proposed using a long-term recurrent convolutional network(LRCN)modified from a deep learning algorithm,the convolutional neural network model of the modified inception deep learning module,and a long short-term memory network(LSTM)to improve the model’s accuracy of BP and HR measurements.The PPG data of 1,551 patients were obtained from the University of California Irvine Machine Learning Repository.How to design a filter of PPG signals and how to choose the loss functions for deep learning model were also discussed in the study.Finally,the stability of the proposed model was tested using a 10-fold cross-validation,with an MAE±SD of 2.942±5.076 mmHg for SBP,1.747±3.042 mmHg for DBP,and 1.137±2.463 bpm for the HR.Compared with its existing counterparts,the model entailed less computational load and was more accurate in estimating SBP,DBP,and HR.These results established the validity of the model.展开更多
To evaluate vital signs and body indices in Helicobacter pylori (H. pylori) positive and negative persons. A total of 22 centres entered the study. They were spread over the whole country, corresponding well to the ge...To evaluate vital signs and body indices in Helicobacter pylori (H. pylori) positive and negative persons. A total of 22 centres entered the study. They were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1818 subjects (aged 5-98 years) took part in the study, randomly selected out of 38147 subjects. H. pylori infection was investigated by means of a 13C-urea breath test. Data on height, weight, systolic and diastolic blood pressure and heart rate were collected at the clinics of general practitioners. The overall prevalence of H. pylori infection was 30.4% (402/1321) in adults (≥ 18 year-old) and 5.2% (26/497) in children and adolescents (≤ 17 year-old). Once adjusted for age and gender, only a difference in body mass index remained statistically significant with H. pylori positive adults showing an increase of 0.6 kg/m<sup>2</sup> in body mass index. Once adjusted for age and gender, we found a difference in height between H. pylori positive and H. pylori negative children and adolescents. On further adjustment for place of residence, this difference became statistically significant, with H. pylori positive children and adolescents being on average 3.5 cm shorter. H. pylori positive adults were significantly older compared to H. pylori negative subjects. Once adjusted for age and gender, H. pylori infection had no impact on body weight, body mass index and vital signs either in adults or children and adolescents. Chronic H. pylori infection appeared to be associated with short stature in children. H. pylori infection did not influence blood pressure, body weight and body mass index either in adults or children and adolescents.展开更多
This investigation was to evaluate the driving fatigue based on power spectral analysis of heart rate variability (HRV) under vertical vibration. Forty healthy male subjects (29.7±3.5 years) were randomly divided...This investigation was to evaluate the driving fatigue based on power spectral analysis of heart rate variability (HRV) under vertical vibration. Forty healthy male subjects (29.7±3.5 years) were randomly divided into two groups, Group A (28.8±4.3 years) and Group B (30.6±2.7 years). Group A (experiment group) was required to perform the simulated driving and Group B (control group) kept calm for 90 min. The frequency domain indices of HRV such as low frequency (0.04 0.15 Hz, LF), high frequency (0.150.4 Hz, HF), LF/HF together with the indices of hemodynamics such as blood pressure (BP) and heart rate (HR) of the subjects between both groups were calculated and analyzed after the simulated driving. There were significances of the former indices between both groups (P<0.05). All the data collected after experiment of Group A was observed the remarkable linear correlation (P<0.05) and parameters and errors of their linear regression equation were stated (α=0.05, P<0.001) in this paper, respectively. The present study investigated that sympathetic activity of the subjects enhanced after the simulated driving while parasympathetic activities decreased. The sympathovagal balance was also improved. As autonomic function indictors of HRV reflected fatigue level, quantitative evaluation of driving mental fatigue from physiological reaction could be possible.展开更多
Objective: The aim of this study was to assess the relationship of blood pressure variability (BPV) and heart rate variability (HRV) to investigate the effect of baroreflex function on blood pressure variability. Meth...Objective: The aim of this study was to assess the relationship of blood pressure variability (BPV) and heart rate variability (HRV) to investigate the effect of baroreflex function on blood pressure variability. Methods: This study consisted of 111 subjects, including 32 normotensives and 79 hypertensives. All the subjects were given two concurrent tests: 24-hour Holter ECG and ambulatory blood pressure monitoring. According to standard deviation of normal-to-normal sinus RR intervals (SDNN) derived from the Holter ECG, the hypertensives were divided into two groups: an HRV normal group with SDNN > 100 ms and an HRV abnormal group with展开更多
BACKGROUND During surgery for gastric cancer,peritoneal lavage using warm distilled water can cause temporary hemodynamic changes.AIM To examine the associations between changes in heart rate and single nucleotide pol...BACKGROUND During surgery for gastric cancer,peritoneal lavage using warm distilled water can cause temporary hemodynamic changes.AIM To examine the associations between changes in heart rate and single nucleotide polymorphisms(SNPs).METHODS This was a prospective observational study of patients with gastric cancer who underwent gastrectomy and peritoneal hypotonic lavage at the Third Afliated Hospital of Soochow University from March 2018 to March 2019.Related SNPs were selected,and the verified exons were analyzed.Heart rate and blood pressure(BP)were measured before and after lavage.The patients were grouped as heart rate change≥30%vs<30%.Comparison and regression analyses of the selected SNPs were performed between the two groups.RESULTS According to the inclusion/exclusion criteria,194 patients were included in the analysis.Of these patients,138 were male,with a mean age of 65.9±0.8 years,and 56 were female,with a mean age of 65.0±1.3 years.Heart rate dropped by 0%-10%in 65 participants,by 10%-15%in 29,by 15%-20%in 23,by 20%-50%in 39,by 50%-100%in four,six had a cardiac arrest,and 28 had an increase in heart rate.Considering the possible impact of exonic SNPs on the phenotypes,TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)were analyzed.The haplotype analysis suggested that the haplotypes CTT[odds ratio(OR)=2.018,95%confidence interval(CI):1.012-4.025,P=0.0430]and GCC(OR=2.293,95%CI:1.174-4.477,P=0.0131)of TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)increased the risk of a drop in heart rate>30%.CONCLUSION The TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)SNPs were associated with changes in heart rate≥30%during intraperitoneal lavage using distilled water after gastrectomy for gastric cancer.展开更多
Introduction: Transcranial Magnetic Stimulation (TMS) is a non-invasive technique for brain stimulation. Repetitive TMS (rTMS) over the medial Prefrontal Cortex (mPFC), Broadman Area 10 (BA10) may stimulate transynapt...Introduction: Transcranial Magnetic Stimulation (TMS) is a non-invasive technique for brain stimulation. Repetitive TMS (rTMS) over the medial Prefrontal Cortex (mPFC), Broadman Area 10 (BA10) may stimulate transynaptically perigenual Anterior Cingulate Cortex (pACC, BA 33), insula, amigdala, hypothalamus and connected branches of the Autonomic Nervous System (ANS) involved in stressorevoked cardiovascular reactivity. Stressors are associated with an increase in sympathetic cardiac control, a decrease in parasympathetic control, or both, and, consequently, an increase in systolic/stroke volume, total vascular impedance/resistance and heart rate, a decrease of baroreflex sensitivity, i.e., an increase in blood pressure/arterial tension. Objectives and Aims: The present work aims, using TMS and accordingly to Gianaros modeling, based on functional neuroimaging studies and previous neuroanatomical data from animal models, to probe the connectivity of brain systems involved in stressor-evoked cardiovascular reactivity and to explore TMS potential as a tool for detection and stratification of individual differences concerning this reactivity and hemorreological risk factors correlated with the development of Coronary Heart Disease (CHD). Methods: Both subjects, a 52 years old male and a 40 years old female with previous increased Low Frequency (LF)/High Frequency (HF) Heart Rate Variability (HRV) ratios (respectively, 4.209/3.028) without decompensated cardiorespiratory symptoms, gave informed consent, and ethico-legal issues have been observed. Electroencephalographic (EEG) monitoring has been performed for safety purposes. Immediately after administration, over the mPFC, of 15 pulses of rTMS, during 60 second, with an inductive electrical current, at the stimulating coil, of 85.9 Ampère per μsecond and 66 Ampère per μsecond, respectively, for male and female subjects (a “figure-of-eight” coil and magnetic stimulator MagLite, Dantec/Medtronic, have been used), HRV spectrum analysis (cStress software) has been performed (during 5 minutes, in supine position). Results: In both subjects, LF power, HF power and LF/HF ratio results, before and after rTMS administration, pointed towards sympathetic attenuation and parasympathetic augmentation (respectively, in male/female subject: decreased LF power—65.1 nu/69.3 nu, before rTMS;56.1 nu/41.6 nu, after rTMS;increased HF power—15.5 nu/22.9 nu, before rTMS;30.9 nu/45.5 nu, after rTMS). Conclusions: In this preliminary investigation, the existence of a link between “mind” and heart’s function has been put in evidence, through a reversible “virtual” lesion, of brain systems involved in cardiovascular control, caused by TMS. Repetitive TMS over mPFC decreased brain function involved in stressorevoked cardiovascular reactivity, suggesting the importance of TMS in the management of stress-related cardiovascular disorders.展开更多
Objective To evaluate the acute toxicity of 2-deoxy-D-glucose （2DG） by oral （p.o.） and intravenous （i.v.） routes, and also the cardio-respiratory effects following high doses of 2DG in animal models. Methods The...Objective To evaluate the acute toxicity of 2-deoxy-D-glucose （2DG） by oral （p.o.） and intravenous （i.v.） routes, and also the cardio-respiratory effects following high doses of 2DG in animal models. Methods The LD50 of 2DG （in water） was determined in rats and mice by p.o. route and in mice by i.v. route. The effect of 2-DG （250 mg/kg, 500 mg/kg, and 1000 mg/kg, i.v.） was studied on various cardio-respiratory parameters viz., mean arterial blood pressure, heart rate and respiratory rate in anaesthetised rats. The effect of 2DG （500 mg/kg, 1000 mg/kg, and 2000 mg/kg, p.o.） was also studied on various respiratory parameters viz., respiratory rate and tidal volume in conscious rats and mice using a computer program. Results The p.o. LD50 of 2DG was found to be 〉8000 mg/kg in mice and rats, and at this dose no death was observed. The LD50 in mice by i.v. route was found to be 8000 mg/kg. At this dose 2 out of 4 mice died and the death occurred within 6 h. A significant increase in the body weight was observed after p.o. administration of 2DG in rats at 500 mg/kg, 1000 mg/kg, and 2000 mg/kg doses. There was no significant change in the body weight at 4000 mg/kg and 8000 mg/kg by the p.o. route in rats and up to 8000 mg/kg by p.o. as well as i.v. routes in mice. Intravenous administration of 2DG （250 mg/kg, 500 mg/kg, and 1000 mg/kg） in anaesthetised rats showed a time-dependent decrease in the mean arterial blood pressure. There was no change in the heart rate in any of the treatment groups. The tidal volume was not changed significantly by p.o administration in conscious rats, but a significant decrease in the respiratory frequency at 500 mg/kg and 1000 mg/kg doses was observed. In the mice also there was no change in the tidal volume after p.o, administration, but the respiratory frequency decreased significantly at 2000 mg/kg dose. Conclusion 2DG is a safe compound but can cause a fall in the blood pressure and a decrease in respiratory frequency at high doses.展开更多
Microinjection of 0.5μg guanabenz(GB)into the nucleus tractus solitarii(NTS)orintravenous(i.v.)injection of 10μg/kg of GB significantly lowered plasma renin activity(PRA).blood pressure(BP)and heart rate(HR)in rats ...Microinjection of 0.5μg guanabenz(GB)into the nucleus tractus solitarii(NTS)orintravenous(i.v.)injection of 10μg/kg of GB significantly lowered plasma renin activity(PRA).blood pressure(BP)and heart rate(HR)in rats i.v.10 μg/kg GB,after the bilateral NIS were de-stroyed by electric current(1 mA 20s),did not decrease PRA,BP and HR.These findings suggestthat the inhibitory action of GB on PRA,BP and HR is related to the activation of alpha-2adrenoceptors in the NTS.展开更多
This aim of the present study was to analyze the hemodynamic responses during resistance exercise performed at different intensities and with different recovery intervals. This study was conducted on twenty-four appar...This aim of the present study was to analyze the hemodynamic responses during resistance exercise performed at different intensities and with different recovery intervals. This study was conducted on twenty-four apparently healthy male individuals (25.50 ± 3.72 years and 76.50 ± 4.50 kg) experienced in strength training. The volunteers performed a 1RM test to determine the training load for the study. Blood pressure and Rate Pressure Product were measured before and at the end of the exercise training. The only significant difference observed was in SBP during strength training at 70% intensity (121.7 ± 8.68, p = 0.039), which was lower than SBP at the remaining intensities of 80% (126.3 ± 7.11) and 90% (127.1 ± 7.51). It was concluded that strength training performed at different intensities and recovery intervals did not significantly alter most variables, changing only the SBP due to the intensity employed.展开更多
The purpose of this work is to identify in the anthropometrical indicators used here in this study the percentage of body fat, the body mass index (BMI) and the waist-hip ratio (WHR), which present a correlation with ...The purpose of this work is to identify in the anthropometrical indicators used here in this study the percentage of body fat, the body mass index (BMI) and the waist-hip ratio (WHR), which present a correlation with the metabolic variables of heart rate, blood pressure (systolic and diastolic) and double product. A population of 69 subjects averaging 41.7 ± 6.6 years old had their data registered by applying the Bruce Protocol modified to calculate metabolic variables;to obtain the percentage of fat, the formula of Petroski was used. The data collected received statistical treatment by the “Statistical 5.0” program with correlation being made by the calculation of the simple coefficient of Pearson “r” by means of a statistical significance test (p < 0.05). In the results, heart rate appeared to be correlated essentially with the intensity of force, associating itself with the percentage of fat and the BMI. Blood pressure presented a good correlation with the BMI, principally in the female group. In the male group, the anthropometrical indicator that had major associations with blood pressure was the WHR, showing an association between the pattern of male body fat distribution (android) and blood pressure. The double-product had a major correlation with the BMI;however, this variable really reflects the work of the myocardium since the BMI is the only indicator used here that includes lean mass in its values. The time spent on the treadmill was correlated in a negative way only with the percentage of fat;in other words, the greater the percentage, the lesser time spent on the treadmill.展开更多
Purpose: In this study, we investigated physical and psychological effects of the shiatsu (finger pressure) stimulation in a sitting position. Subjects and Methods: A crossover test was conducted on 20 subjects (avera...Purpose: In this study, we investigated physical and psychological effects of the shiatsu (finger pressure) stimulation in a sitting position. Subjects and Methods: A crossover test was conducted on 20 subjects (average 34.5 ± 7.6 years old;male = 10, female = 10). First they were randomly divided into two groups: Group A (shiatsu stimulation/control) and group B (control/shiatsu stimulation). They had shiatsu stimulation (Namikoshi basic methods in the sitting position, five minutes). At the same time, POMS (profile of mood states), SBP (systolic blood pressure, DBP (diastolic blood pressure) and HR (heart rate) were measured. Results: Physical result—Compared to the baseline, the shiatsu stimulation showed statistical decreased SBP and HR while the control (no shiatsu stimulation) did not. Psychological result (POMS)— Compared to the baseline, the stimulation showed significant change in all six mood states (Tension-Anxiety, Depression-Dejection, Fatigue and Confusion decreased while Vigor elevated). Male showed statistical decrease in Tension-Anxiety, Depression-Dejection, Anger, Fatigue and Confusion as well as significant increase in Vigor. Female only showed decrease in Depression-Dejection and Anger. Discussion and Conclusion: The shiatsu stimulation in the sitting position could modulate autonomic nerve system and it could affect human body. Gender differences were found in physiological effect.展开更多
Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses;however,the effects of anesthesia with pentobarbital sodium on these responses are unclear.Pentobarbital sodium was infused...Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses;however,the effects of anesthesia with pentobarbital sodium on these responses are unclear.Pentobarbital sodium was infused intravenously at a nominal rate and the lingual nerve was electrically stimulated at each infusion rate.Increases in systolic blood pressure（SBP） and heart rate（HR） were evoked by lingual nerve stimulation at an infusion rate between 5 and 7 mg？kg 21 ？h 21.This response was associated with an increase in the low-frequency band of SBP variability（SBP-LF）.As the infusion rate increased to 10 mg？kg 21 ？h 21 or more,decreases in SBP and HR were observed.This response was associated with the reduction of SBP-LF.In conclusion,lingual nerve stimulation has both sympathomimetic and sympathoinhibitory effects,depending on the depth of pentobarbital anesthesia.The reaction pattern seems to be closely related to the autonomic balance produced by pentobarbital anesthesia.展开更多
目的 探讨收缩压变异性(SBPV)和心率变异性(HRV)对维持性血液透析(MHD)患者主要不良心血管事件(MACE)发生风险的预测价值。方法 纳入2017年3月—2018年3月在宜昌市中心人民医院肾病内科血液净化中心接受规律治疗的MHD患者120例,根据是...目的 探讨收缩压变异性(SBPV)和心率变异性(HRV)对维持性血液透析(MHD)患者主要不良心血管事件(MACE)发生风险的预测价值。方法 纳入2017年3月—2018年3月在宜昌市中心人民医院肾病内科血液净化中心接受规律治疗的MHD患者120例,根据是否发生MACE分为MACE组(n=59)与无MACE组(n=61)。在患者行血液透析前佩戴Holter,收集24 h心电活动信息,计算均值(MEAN)、RR间期总体标准差(SDNN)、RR间期平均值的标准差(SDANN)和相邻RR间期差值的均方根(r-MSSD)。采用自动血压监测系统记录24 h血压变化,计算白昼收缩压变异性(dSBPV)、夜间收缩压变异性(nSBPV)和24 h收缩压变异性(24 h SBPV)。Logistic回归分析MHD患者MACE发生的危险因素。调整混杂因素后,采用Cox比例风险模型回归分析24 h SBPV和SDNN与MHD患者MACE发生的关系。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)、灵敏度、特异度,分析SDNN和收缩压变异性单独及联合对维持性MHD患者发生MACE的预测价值。根据SDNN和24 h SBPV水平将患者分成3组,绘制Kaplan-Meier生存曲线评价不同SDNN和收缩压变异性的MHD患者MACE发生情况。结果 与无MACE组相比,MACE组年龄较大,24 h SBPV、dSBPV、nSBPV较高,SDNN、SDANN较低,差异具有统计学意义(P<0.05)。Logistic回归分析显示,年龄、Kt/V、24 h SBPV、dSBPV、nSBPV、SDNN、SDANN是MHD患者MACE发生的独立危险因素(P<0.05)。调整混杂因素后,多因素COX比例风险模型回归分析,24 h SBPV为MHD患者发生MACE的危险因素,而SDNN为MHD患者发生MACE的保护性因素(P<0.05)。SDNN与收缩压变异性联合预测MHD患者发生MACE的AUC为0.879,预测效能高于单项检测(P<0.05)。组1随访期间累积MACE发生率显著低于组2和组3(19.15%vs 65.12%vs 73.33%,P<0.001)。结论 MHD不良预后患者中24 h SBPV升高,SDNN降低,24 h SBPV和SDNN单独预测MACE的具体价值尚可,两者联合预测效果更佳,可为临床上及早识别及干预MHD患者MACE发生提供参考依据。展开更多
文摘The present study was designed to make certain whether there exists adrenomedullin (ADM) in the rat central nervous system and evaluated the hemodynamic actions of intracerebroventricular administration (ICVA) of human ADM[13-52]. By immunohistochemistry (ABC method),We found that there was a discrete localization of ADM-positive immunoreactivity in the rat central system including cerebral cortex,paraventricular tissues, hypothalamus, cerebella cortex, mesencephalon and medulla oblongata. By reverse transcription-polymerase chain reaction(RT-PCR) analysis, rat ADM mRNA was found to be expressed in rat brain. These above results of immunohistochemistry and RT-PCR suggest that ADM exists in the rat brain. We also found that centrally administered ADM[13-52]in a dose of 0.4 to 3. 2 nmol/kg provoked marked, prolonged and dosedependent increases in mean arterial blood pressure (MABP) and heart rate (HR). To clarify the mechanisms of the hemodynamic changes induced by centrally administered ADM [13-52]. the effect of centrally administered ADM [13-52] on renal sympathetic nerve activity (RSNA) was studied. The result showed that centrally administered ADM [13-52] ( 1. 6 nmol/kg) provoked a marked increase in RSNA .therefore .the increases in MABP and HR induced by centrally administered ADM [13-52]might be due to the stimulation of central sympathetic mechanism. In addtion,we also compared the relationship of activity and structure among the different fragments of ADM. In conclusion, ADMexists in the rat brain, and it may play an important role in the central control of cardiovascular system.
基金the Guangdong Natural Science Foundation Project(2018A030313531)the Yat-Sen Scholarship for Young Scientists.
文摘Objective:The head-up tilt test(HUTT)is widely used but is time-consuming and not cost-effective to evaluate patients with vasovagal syncope(VVS).The present study aims to verify the hypothesis that ambulatory blood pressure(BP)monitoring(ABPM)and the simplistic tilt test may be potential alternatives to the HUTT.Methods:The study consecutively enrolled 360 patients who underwent the HUTT to evaluate VVS.BP),heart rate(HR),and BP/HR ratios derived from ABPM and the simplistic tilt test were evaluated to predict the presence,pattern,and stage of syncope during the HUTT.Results:Mixed response was the commonest pattern,and syncope occurred frequently with infusion of isoproterenol at a rate of 3μg/min.During the simplistic tilt test,the cardioinhibitory group had higher tilted BP/HR ratios than the vasodepressor group,while the vasodepressor group had a faster tilted HR and a larger HR difference than the cardioinhibitory group.The higher the BP/HR ratio in the tilted position,the higher the isoproterenol dosage needed to induce a positive response.During ABPM,BP/HR ratios were signifi cantly higher in the cardioinhibitory group than in the vasodepressor group.The higher the ABPM-derived BP,the higher the dosage of isoproterenol needed to induce syncope.There were signifi cant correlations in BP/HR ratios between ABPM and the supine position in the vasodepressor group,while signifi cant correlation was found only for the diastolic BP/HR ratio between ABPM and the tilted position in the cardioinhibitory group.The mixed pattern shared correlative features of the other two patterns.Conclusion:ABPM and the simplistic tilt test might be used as promising alternatives to the HUTT in VVS evaluation in clinical settings.
文摘Objective: To introduce a method to calculate cardiovascular age, a new, accurate and much simpler index for assessing cardiovascular autonomic regulatory function, based on statistical analysis of heart rate and blood pressure variability (HRV and BPV) and baroreflex sensitivity (BRS) data. Methods: Firstly, HRV and BPV of 89 healthy aviation personnel were analyzed by the conventional autoregressive (AR) spectral analysis and their spontaneous BRS was obtained by the sequence method. Secondly, principal component analysis was conducted over original and derived indices of HRV, BPV and BRS data and the relevant principal components, PCi orig and PCi deri (i=1, 2, 3,...) were obtained. Finally, the equation for calculating cardiovascular age was obtained by multiple regression with the chronological age being assigned as the dependent variable and the principal components significantly related to age as the regressors. Results: The first four principal components of original indices accounted for over 90% of total variance of the indices, so did the first three principal components of derived indices. So, these seven principal components could reflect the information of cardiovascular autonomic regulation which was embodied in the 17 indices of HRV, BPV and BRS exactly with a minimal loss of information. Of the seven principal components, PC2 orig , PC4 orig and PC2 deri were negatively correlated with the chronological age ( P <0 05), whereas the PC3 orig was positively correlated with the chronological age ( P <0 01). The cardiovascular age thus calculated from the regression equation was significantly correlated with the chronological age among the 89 aviation personnel ( r =0.73, P <0 01). Conclusion: The cardiovascular age calculated based on a multi variate analysis of HRV, BPV and BRS could be regarded as a comprehensive indicator reflecting the age dependency of autonomic regulation of cardiovascular system in healthy aviation personnel.
文摘To investigate the effects of impaired glucose metabolism （IGM） on cardiovascular autonomic nervous systems in essential hypertensive （EH） patients by comparing heart rate variability （HRV） and blood pressure variability （BPV） in EH patients with or without type 2 diabetes mellitus （T2DM）. Simultaneous 24-h recordings of ambulatory ECG and blood pressure monitoring were performed in 36 male old patients with simple EH and 33 male old patients with EH combined with T2DM. HRV analysis included time domain parameters such as SDNN, SDANN, SDNNi, rMSSD and pNN50, and total spectral power （TP） of HRV, which mainly consists of VLF, LF and HF component along with LF/HF ratio, was also obtained. The value of ambulatory blood pressure was represented as the mean blood pressure （mean systolic/mSBP, diastolic/mDBP and pulse pressure/mPP） during different periods （24 h/24 h, day time/d and night time/n）. Standard deviation （SD） as well as coefficient of variance （CV） of blood pressure during each above-mentioned period were obtained to reflect the long-term BPV. Our result showed that SDNN, SDNNi, SDANN, rMSSD, PNN50, TP and HF of HRV in cases of EH with T2DM were all significantly lower than those in simple EH subjects （P〈0.05）. No significant differences in VLF or LF was found between the two groups （P〉0.05）, while LF/HF ratio was significantly higher in EH with T2DM patients than in simple EH subjects （P〈0.01）. Moreover, dmSBP, 24 h-mPP and dmPP were all significantly higher in EH with T2DM patients than in simple EH subjects （P〈0.05）, while nmSBP, 24 h-mSBP, 24 h-mDBP, dmDBP, nmDBP or nmPP showed no significant difference between this two groups of patients （P〉0.05）. And dSBPSD, dSBPCV and 24 h-SBPSD were all significantly higher in EH with T2DM patients than in simple EH subjects （P〈0.05）, while the other BPV indexes showed no significant difference between this two groups （P〉0.05）. It is concluded that the cardiovascular autonomic nervous systems in EH patients was further impaired by T2DM, displaying lowering of HRV and enlargement of BPV, which in turn induced abnormal structural and functional changes of cardiovascular systems. Therefore, improving cardiovascular autonomic nervous systems might reduce the occurrence of cardiovascular complications in the EH patients with IGM.
基金This study was supported in part by the Ministry of Science and Technology MOST108-2221-E-150-022-MY3 and Taiwan Ocean University.
文摘In this study,single-channel photoplethysmography(PPG)signals were used to estimate the heart rate(HR),diastolic blood pressure(DBP),and systolic blood pressure(SBP).A deep learning model was proposed using a long-term recurrent convolutional network(LRCN)modified from a deep learning algorithm,the convolutional neural network model of the modified inception deep learning module,and a long short-term memory network(LSTM)to improve the model’s accuracy of BP and HR measurements.The PPG data of 1,551 patients were obtained from the University of California Irvine Machine Learning Repository.How to design a filter of PPG signals and how to choose the loss functions for deep learning model were also discussed in the study.Finally,the stability of the proposed model was tested using a 10-fold cross-validation,with an MAE±SD of 2.942±5.076 mmHg for SBP,1.747±3.042 mmHg for DBP,and 1.137±2.463 bpm for the HR.Compared with its existing counterparts,the model entailed less computational load and was more accurate in estimating SBP,DBP,and HR.These results established the validity of the model.
基金Supported by Research project PRVOUK P37-08(from Charles University in Praha,Faculty of Medicine at Hradec Kralove,Czech Republic)
文摘To evaluate vital signs and body indices in Helicobacter pylori (H. pylori) positive and negative persons. A total of 22 centres entered the study. They were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1818 subjects (aged 5-98 years) took part in the study, randomly selected out of 38147 subjects. H. pylori infection was investigated by means of a 13C-urea breath test. Data on height, weight, systolic and diastolic blood pressure and heart rate were collected at the clinics of general practitioners. The overall prevalence of H. pylori infection was 30.4% (402/1321) in adults (≥ 18 year-old) and 5.2% (26/497) in children and adolescents (≤ 17 year-old). Once adjusted for age and gender, only a difference in body mass index remained statistically significant with H. pylori positive adults showing an increase of 0.6 kg/m<sup>2</sup> in body mass index. Once adjusted for age and gender, we found a difference in height between H. pylori positive and H. pylori negative children and adolescents. On further adjustment for place of residence, this difference became statistically significant, with H. pylori positive children and adolescents being on average 3.5 cm shorter. H. pylori positive adults were significantly older compared to H. pylori negative subjects. Once adjusted for age and gender, H. pylori infection had no impact on body weight, body mass index and vital signs either in adults or children and adolescents. Chronic H. pylori infection appeared to be associated with short stature in children. H. pylori infection did not influence blood pressure, body weight and body mass index either in adults or children and adolescents.
文摘This investigation was to evaluate the driving fatigue based on power spectral analysis of heart rate variability (HRV) under vertical vibration. Forty healthy male subjects (29.7±3.5 years) were randomly divided into two groups, Group A (28.8±4.3 years) and Group B (30.6±2.7 years). Group A (experiment group) was required to perform the simulated driving and Group B (control group) kept calm for 90 min. The frequency domain indices of HRV such as low frequency (0.04 0.15 Hz, LF), high frequency (0.150.4 Hz, HF), LF/HF together with the indices of hemodynamics such as blood pressure (BP) and heart rate (HR) of the subjects between both groups were calculated and analyzed after the simulated driving. There were significances of the former indices between both groups (P<0.05). All the data collected after experiment of Group A was observed the remarkable linear correlation (P<0.05) and parameters and errors of their linear regression equation were stated (α=0.05, P<0.001) in this paper, respectively. The present study investigated that sympathetic activity of the subjects enhanced after the simulated driving while parasympathetic activities decreased. The sympathovagal balance was also improved. As autonomic function indictors of HRV reflected fatigue level, quantitative evaluation of driving mental fatigue from physiological reaction could be possible.
文摘Objective: The aim of this study was to assess the relationship of blood pressure variability (BPV) and heart rate variability (HRV) to investigate the effect of baroreflex function on blood pressure variability. Methods: This study consisted of 111 subjects, including 32 normotensives and 79 hypertensives. All the subjects were given two concurrent tests: 24-hour Holter ECG and ambulatory blood pressure monitoring. According to standard deviation of normal-to-normal sinus RR intervals (SDNN) derived from the Holter ECG, the hypertensives were divided into two groups: an HRV normal group with SDNN > 100 ms and an HRV abnormal group with
文摘BACKGROUND During surgery for gastric cancer,peritoneal lavage using warm distilled water can cause temporary hemodynamic changes.AIM To examine the associations between changes in heart rate and single nucleotide polymorphisms(SNPs).METHODS This was a prospective observational study of patients with gastric cancer who underwent gastrectomy and peritoneal hypotonic lavage at the Third Afliated Hospital of Soochow University from March 2018 to March 2019.Related SNPs were selected,and the verified exons were analyzed.Heart rate and blood pressure(BP)were measured before and after lavage.The patients were grouped as heart rate change≥30%vs<30%.Comparison and regression analyses of the selected SNPs were performed between the two groups.RESULTS According to the inclusion/exclusion criteria,194 patients were included in the analysis.Of these patients,138 were male,with a mean age of 65.9±0.8 years,and 56 were female,with a mean age of 65.0±1.3 years.Heart rate dropped by 0%-10%in 65 participants,by 10%-15%in 29,by 15%-20%in 23,by 20%-50%in 39,by 50%-100%in four,six had a cardiac arrest,and 28 had an increase in heart rate.Considering the possible impact of exonic SNPs on the phenotypes,TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)were analyzed.The haplotype analysis suggested that the haplotypes CTT[odds ratio(OR)=2.018,95%confidence interval(CI):1.012-4.025,P=0.0430]and GCC(OR=2.293,95%CI:1.174-4.477,P=0.0131)of TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)increased the risk of a drop in heart rate>30%.CONCLUSION The TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)SNPs were associated with changes in heart rate≥30%during intraperitoneal lavage using distilled water after gastrectomy for gastric cancer.
文摘Introduction: Transcranial Magnetic Stimulation (TMS) is a non-invasive technique for brain stimulation. Repetitive TMS (rTMS) over the medial Prefrontal Cortex (mPFC), Broadman Area 10 (BA10) may stimulate transynaptically perigenual Anterior Cingulate Cortex (pACC, BA 33), insula, amigdala, hypothalamus and connected branches of the Autonomic Nervous System (ANS) involved in stressorevoked cardiovascular reactivity. Stressors are associated with an increase in sympathetic cardiac control, a decrease in parasympathetic control, or both, and, consequently, an increase in systolic/stroke volume, total vascular impedance/resistance and heart rate, a decrease of baroreflex sensitivity, i.e., an increase in blood pressure/arterial tension. Objectives and Aims: The present work aims, using TMS and accordingly to Gianaros modeling, based on functional neuroimaging studies and previous neuroanatomical data from animal models, to probe the connectivity of brain systems involved in stressor-evoked cardiovascular reactivity and to explore TMS potential as a tool for detection and stratification of individual differences concerning this reactivity and hemorreological risk factors correlated with the development of Coronary Heart Disease (CHD). Methods: Both subjects, a 52 years old male and a 40 years old female with previous increased Low Frequency (LF)/High Frequency (HF) Heart Rate Variability (HRV) ratios (respectively, 4.209/3.028) without decompensated cardiorespiratory symptoms, gave informed consent, and ethico-legal issues have been observed. Electroencephalographic (EEG) monitoring has been performed for safety purposes. Immediately after administration, over the mPFC, of 15 pulses of rTMS, during 60 second, with an inductive electrical current, at the stimulating coil, of 85.9 Ampère per μsecond and 66 Ampère per μsecond, respectively, for male and female subjects (a “figure-of-eight” coil and magnetic stimulator MagLite, Dantec/Medtronic, have been used), HRV spectrum analysis (cStress software) has been performed (during 5 minutes, in supine position). Results: In both subjects, LF power, HF power and LF/HF ratio results, before and after rTMS administration, pointed towards sympathetic attenuation and parasympathetic augmentation (respectively, in male/female subject: decreased LF power—65.1 nu/69.3 nu, before rTMS;56.1 nu/41.6 nu, after rTMS;increased HF power—15.5 nu/22.9 nu, before rTMS;30.9 nu/45.5 nu, after rTMS). Conclusions: In this preliminary investigation, the existence of a link between “mind” and heart’s function has been put in evidence, through a reversible “virtual” lesion, of brain systems involved in cardiovascular control, caused by TMS. Repetitive TMS over mPFC decreased brain function involved in stressorevoked cardiovascular reactivity, suggesting the importance of TMS in the management of stress-related cardiovascular disorders.
文摘Objective To evaluate the acute toxicity of 2-deoxy-D-glucose （2DG） by oral （p.o.） and intravenous （i.v.） routes, and also the cardio-respiratory effects following high doses of 2DG in animal models. Methods The LD50 of 2DG （in water） was determined in rats and mice by p.o. route and in mice by i.v. route. The effect of 2-DG （250 mg/kg, 500 mg/kg, and 1000 mg/kg, i.v.） was studied on various cardio-respiratory parameters viz., mean arterial blood pressure, heart rate and respiratory rate in anaesthetised rats. The effect of 2DG （500 mg/kg, 1000 mg/kg, and 2000 mg/kg, p.o.） was also studied on various respiratory parameters viz., respiratory rate and tidal volume in conscious rats and mice using a computer program. Results The p.o. LD50 of 2DG was found to be 〉8000 mg/kg in mice and rats, and at this dose no death was observed. The LD50 in mice by i.v. route was found to be 8000 mg/kg. At this dose 2 out of 4 mice died and the death occurred within 6 h. A significant increase in the body weight was observed after p.o. administration of 2DG in rats at 500 mg/kg, 1000 mg/kg, and 2000 mg/kg doses. There was no significant change in the body weight at 4000 mg/kg and 8000 mg/kg by the p.o. route in rats and up to 8000 mg/kg by p.o. as well as i.v. routes in mice. Intravenous administration of 2DG （250 mg/kg, 500 mg/kg, and 1000 mg/kg） in anaesthetised rats showed a time-dependent decrease in the mean arterial blood pressure. There was no change in the heart rate in any of the treatment groups. The tidal volume was not changed significantly by p.o administration in conscious rats, but a significant decrease in the respiratory frequency at 500 mg/kg and 1000 mg/kg doses was observed. In the mice also there was no change in the tidal volume after p.o, administration, but the respiratory frequency decreased significantly at 2000 mg/kg dose. Conclusion 2DG is a safe compound but can cause a fall in the blood pressure and a decrease in respiratory frequency at high doses.
文摘Microinjection of 0.5μg guanabenz(GB)into the nucleus tractus solitarii(NTS)orintravenous(i.v.)injection of 10μg/kg of GB significantly lowered plasma renin activity(PRA).blood pressure(BP)and heart rate(HR)in rats i.v.10 μg/kg GB,after the bilateral NIS were de-stroyed by electric current(1 mA 20s),did not decrease PRA,BP and HR.These findings suggestthat the inhibitory action of GB on PRA,BP and HR is related to the activation of alpha-2adrenoceptors in the NTS.
文摘This aim of the present study was to analyze the hemodynamic responses during resistance exercise performed at different intensities and with different recovery intervals. This study was conducted on twenty-four apparently healthy male individuals (25.50 ± 3.72 years and 76.50 ± 4.50 kg) experienced in strength training. The volunteers performed a 1RM test to determine the training load for the study. Blood pressure and Rate Pressure Product were measured before and at the end of the exercise training. The only significant difference observed was in SBP during strength training at 70% intensity (121.7 ± 8.68, p = 0.039), which was lower than SBP at the remaining intensities of 80% (126.3 ± 7.11) and 90% (127.1 ± 7.51). It was concluded that strength training performed at different intensities and recovery intervals did not significantly alter most variables, changing only the SBP due to the intensity employed.
文摘The purpose of this work is to identify in the anthropometrical indicators used here in this study the percentage of body fat, the body mass index (BMI) and the waist-hip ratio (WHR), which present a correlation with the metabolic variables of heart rate, blood pressure (systolic and diastolic) and double product. A population of 69 subjects averaging 41.7 ± 6.6 years old had their data registered by applying the Bruce Protocol modified to calculate metabolic variables;to obtain the percentage of fat, the formula of Petroski was used. The data collected received statistical treatment by the “Statistical 5.0” program with correlation being made by the calculation of the simple coefficient of Pearson “r” by means of a statistical significance test (p < 0.05). In the results, heart rate appeared to be correlated essentially with the intensity of force, associating itself with the percentage of fat and the BMI. Blood pressure presented a good correlation with the BMI, principally in the female group. In the male group, the anthropometrical indicator that had major associations with blood pressure was the WHR, showing an association between the pattern of male body fat distribution (android) and blood pressure. The double-product had a major correlation with the BMI;however, this variable really reflects the work of the myocardium since the BMI is the only indicator used here that includes lean mass in its values. The time spent on the treadmill was correlated in a negative way only with the percentage of fat;in other words, the greater the percentage, the lesser time spent on the treadmill.
文摘Purpose: In this study, we investigated physical and psychological effects of the shiatsu (finger pressure) stimulation in a sitting position. Subjects and Methods: A crossover test was conducted on 20 subjects (average 34.5 ± 7.6 years old;male = 10, female = 10). First they were randomly divided into two groups: Group A (shiatsu stimulation/control) and group B (control/shiatsu stimulation). They had shiatsu stimulation (Namikoshi basic methods in the sitting position, five minutes). At the same time, POMS (profile of mood states), SBP (systolic blood pressure, DBP (diastolic blood pressure) and HR (heart rate) were measured. Results: Physical result—Compared to the baseline, the shiatsu stimulation showed statistical decreased SBP and HR while the control (no shiatsu stimulation) did not. Psychological result (POMS)— Compared to the baseline, the stimulation showed significant change in all six mood states (Tension-Anxiety, Depression-Dejection, Fatigue and Confusion decreased while Vigor elevated). Male showed statistical decrease in Tension-Anxiety, Depression-Dejection, Anger, Fatigue and Confusion as well as significant increase in Vigor. Female only showed decrease in Depression-Dejection and Anger. Discussion and Conclusion: The shiatsu stimulation in the sitting position could modulate autonomic nerve system and it could affect human body. Gender differences were found in physiological effect.
基金financially supported by our department (Department of DentalAnesthesiology,Osaka University Graduate School of Dentistry)
文摘Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses;however,the effects of anesthesia with pentobarbital sodium on these responses are unclear.Pentobarbital sodium was infused intravenously at a nominal rate and the lingual nerve was electrically stimulated at each infusion rate.Increases in systolic blood pressure（SBP） and heart rate（HR） were evoked by lingual nerve stimulation at an infusion rate between 5 and 7 mg？kg 21 ？h 21.This response was associated with an increase in the low-frequency band of SBP variability（SBP-LF）.As the infusion rate increased to 10 mg？kg 21 ？h 21 or more,decreases in SBP and HR were observed.This response was associated with the reduction of SBP-LF.In conclusion,lingual nerve stimulation has both sympathomimetic and sympathoinhibitory effects,depending on the depth of pentobarbital anesthesia.The reaction pattern seems to be closely related to the autonomic balance produced by pentobarbital anesthesia.
文摘目的 探讨收缩压变异性(SBPV)和心率变异性(HRV)对维持性血液透析(MHD)患者主要不良心血管事件(MACE)发生风险的预测价值。方法 纳入2017年3月—2018年3月在宜昌市中心人民医院肾病内科血液净化中心接受规律治疗的MHD患者120例,根据是否发生MACE分为MACE组(n=59)与无MACE组(n=61)。在患者行血液透析前佩戴Holter,收集24 h心电活动信息,计算均值(MEAN)、RR间期总体标准差(SDNN)、RR间期平均值的标准差(SDANN)和相邻RR间期差值的均方根(r-MSSD)。采用自动血压监测系统记录24 h血压变化,计算白昼收缩压变异性(dSBPV)、夜间收缩压变异性(nSBPV)和24 h收缩压变异性(24 h SBPV)。Logistic回归分析MHD患者MACE发生的危险因素。调整混杂因素后,采用Cox比例风险模型回归分析24 h SBPV和SDNN与MHD患者MACE发生的关系。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)、灵敏度、特异度,分析SDNN和收缩压变异性单独及联合对维持性MHD患者发生MACE的预测价值。根据SDNN和24 h SBPV水平将患者分成3组,绘制Kaplan-Meier生存曲线评价不同SDNN和收缩压变异性的MHD患者MACE发生情况。结果 与无MACE组相比,MACE组年龄较大,24 h SBPV、dSBPV、nSBPV较高,SDNN、SDANN较低,差异具有统计学意义(P<0.05)。Logistic回归分析显示,年龄、Kt/V、24 h SBPV、dSBPV、nSBPV、SDNN、SDANN是MHD患者MACE发生的独立危险因素(P<0.05)。调整混杂因素后,多因素COX比例风险模型回归分析,24 h SBPV为MHD患者发生MACE的危险因素,而SDNN为MHD患者发生MACE的保护性因素(P<0.05)。SDNN与收缩压变异性联合预测MHD患者发生MACE的AUC为0.879,预测效能高于单项检测(P<0.05)。组1随访期间累积MACE发生率显著低于组2和组3(19.15%vs 65.12%vs 73.33%,P<0.001)。结论 MHD不良预后患者中24 h SBPV升高,SDNN降低,24 h SBPV和SDNN单独预测MACE的具体价值尚可,两者联合预测效果更佳,可为临床上及早识别及干预MHD患者MACE发生提供参考依据。
