Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

详细信息    查看全文

• 作者：Young-Kug Kim (1) (2)
  Kichang Lee (2)
  Gyu-Sam Hwang (1)
  Richard J. Cohen (2)
  
• 关键词：Post ; reperfusion syndrome ; Liver transplantation ; LF/HF ; Heart rate variability
• 刊名：Clinical Autonomic Research
• 出版年：2013
• 出版时间：June 2013
• 年：2013
• 卷：23
• 期：3
• 页码：123-131
• 全文大小：279KB
• 参考文献：1. Aggarwal S, Kang Y, Freeman JA, Fortunato FL, Pinsky MR (1987) Postreperfusion syndrome: cardiovascular collapse following hepatic reperfusion during liver transplantation. Transplant Proc 19:54-5
  2. Hilmi I, Horton CN, Planinsic RM, Sakai T, Nicolau-Raducu R, Damian D, Gligor S, Marcos A (2008) The impact of postreperfusion syndrome on short-term patient and liver allograft outcome in patients undergoing orthotopic liver transplantation. Liver Transpl 14:504-08 CrossRef
  3. Paugam-Burtz C, Kavafyan J, Merckx P, Dahmani S, Sommacale D, Ramsay M, Belghiti J, Mantz J (2009) Postreperfusion syndrome during liver transplantation for cirrhosis: outcome and predictors. Liver Transpl 15:522-29 CrossRef
  4. Bukowicka B, Abi Akar R, Olszewska A, Smoter P, Krawczyk M (2011) The occurrence of postreperfusion syndrome in orthotopic liver transplantation and its significance in terms of complications and short-term survival. Ann Transplant 16:26-0
  5. Akselrod S, Gordon D, Ubel FA, Shannon DC, Berger AC, Cohen RJ (1981) Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 213:220-22 CrossRef
  6. Latson TW, Ashmore TH, Reinhart DJ, Klein KW, Giesecke AH (1994) Autonomic reflex dysfunction in patients presenting for elective surgery is associated with hypotension after anesthesia induction. Anesthesiology 80:326-37 CrossRef
  7. Suhr OB, Wiklund U, Eleborg L, Ando Y, Backman C, Birgersdotter V, Bjerle P, Ericzon BG, Johansson B, Olofsson BO (1997) Impact of autonomic neuropathy on circulatory instability during liver transplantation for familial amyloidotic polyneuropathy. Transplantation 63:675-79 CrossRef
  8. Perez-Pena J, Rincon D, Banares R, Olmedilla L, Garutti I, Arnal D, Calleja J, Clemente G (2003) Autonomic neuropathy is associated with hemodynamic instability during human liver transplantation. Transplant Proc 35:1866-868 CrossRef
  9. Hendrickse MT, Thuluvath PJ, Triger DR (1992) Natural history of autonomic neuropathy in chronic liver disease. Lancet 339:1462-464 CrossRef
  10. Hendrickse MT, Triger DR (1992) Peripheral and cardiovascular autonomic impairment in chronic liver disease: prevalence and relation to hepatic function. J Hepatol 16:177-83 CrossRef
  11. Moller S, Norgaard A, Henriksen JH, Frandsen E, Bendtsen F (2004) Effects of tilting on central hemodynamics and homeostatic mechanisms in cirrhosis. Hepatology 40:811-19
  12. Lunzer MR, Newman SP, Bernard AG, Manghani KK, Sherlock SP, Ginsburg J (1975) Impaired cardiovascular responsiveness in liver disease. Lancet 2:382-85 CrossRef
  13. Rubinger D, Revis N, Pollak A, Luria MH, Sapoznikov D (2004) Predictors of haemodynamic instability and heart rate variability during haemodialysis. Nephrol Dial Transplant 19:2053-060 CrossRef
  14. Hanss R, Bein B, Ledowski T, Lehmkuhl M, Ohnesorge H, Scherkl W, Steinfath M, Scholz J, Tonner PH (2005) Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery. Anesthesiology 102:1086-093 CrossRef
  15. Hanss R, Renner J, Ilies C, Moikow L, Buell O, Steinfath M, Scholz J, Bein B (2008) Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients? Anaesthesia 63:129-35 CrossRef
  16. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 93:1043-065 CrossRef
  17. Tulppo MP, Makikallio TH, Takala TE, Seppanen T, Huikuri HV (1996) Quantitative beat-to-beat analysis of heart rate dynamics during exercise. Am J Physiol 271:H244–H252
  18. Mourot L, Bouhaddi M, Perrey S, Rouillon JD, Regnard J (2004) Quantitative Poincare plot analysis of heart rate variability: effect of endurance training. Eur J Appl Physiol 91:79-7 CrossRef
  19. Richman JS, Moorman JR (2000) Physiological time-series analysis using approximate entropy and sample entropy. Am J Physiol Heart Circ Physiol 278:H2039–H2049
  20. Furlan R, Porta A, Costa F, Tank J, Baker L, Schiavi R, Robertson D, Malliani A, Mosqueda-Garcia R (2000) Oscillatory patterns in sympathetic neural discharge and cardiovascular variables during orthostatic stimulus. Circulation 101:886-92 CrossRef
  21. Pagani M, Montano N, Porta A, Malliani A, Abboud FM, Birkett C, Somers VK (1997) Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation 95:1441-448 CrossRef
  22. Saul JP, Berger RD, Albrecht P, Stein SP, Chen MH, Cohen RJ (1991) Transfer function analysis of the circulation: unique insights into cardiovascular regulation. Am J Physiol 261:H1231–H1245
  23. Pagani M, Somers V, Furlan R, Dell’Orto S, Conway J, Baselli G, Cerutti S, Sleight P, Malliani A (1988) Changes in autonomic regulation induced by physical training in mild hypertension. Hypertension 12:600-10 CrossRef
  24. Lee K, Jackson DN, Cordero DL, Nishiyasu T, Peters JK, Mack GW (2003) Change in spontaneous baroreflex control of pulse interval during heat stress in humans. J Appl Physiol 95:1789-798
  25. Ramsay M (2008) The reperfusion syndrome: have we made any progress? Liver Transpl 14:412-14 CrossRef
  26. Nanashima A, Pillay P, Crawford M, Nakasuji M, Verran DJ, Painter D (2001) Analysis of postrevascularization syndrome after orthotopic liver transplantation: the experience of an Australian liver transplantation center. J Hepatobiliary Pancreat Surg 8:557-63 CrossRef
  27. Appel ML, Berger RD, Saul JP, Smith JM, Cohen RJ (1989) Beat to beat variability in cardiovascular variables: noise or music? J Am Coll Cardiol 14:1139-148 CrossRef
  28. Fleisher LA, Fleckenstein JF, Frank SM, Thuluvath PJ (2000) Heart rate variability as a predictor of autonomic dysfunction in patients awaiting liver transplantation. Dig Dis Sci 45:340-44 CrossRef
  29. Lhuillier F, Dalmas ED, Gratadour PM, Cividjian AA, Boillot OC, Quintin L, Viale JP (2006) Spontaneous baroreflex cardiac sensitivity in end-stage liver disease: effect of liver transplantation. Eur J Anaesthesiol 23:426-32 CrossRef
  30. Lombardi F, Torzillo D, Sandrone G, Dalla Vecchia L, Finocchiaro ML, Bernasconi R, Cappiello E (1992) Beta-blocking effect of propafenone based on spectral analysis of heart rate variability. Am J Cardiol 70:1028-034 CrossRef
  31. Pelosi G, Emdin M, Carpeggiani C, Morales MA, Piacenti M, Dattolo P, Cerrai T, Macerata A, L’Abbate A, Maggiore Q (1999) Impaired sympathetic response before intradialytic hypotension: a study based on spectral analysis of heart rate and pressure variability. Clin Sci (Lond) 96:23-1 CrossRef
  32. Huang CJ, Kuok CH, Kuo TB, Hsu YW, Tsai PS (2006) Pre-operative measurement of heart rate variability predicts hypotension during general anesthesia. Acta Anaesthesiol Scand 50:542-48 CrossRef
  33. O’Flaherty D (1993) Heart rate variability and anaesthesia. Eur J Anaesthesiol 10:419-32
  34. Tanaka M, Nishikawa T (2005) The concentration-dependent effects of general anesthesia on spontaneous baroreflex indices and their correlations with pharmacological gains. Anesth Analg 100:1325-332 CrossRef
  35. Acosta F, Sansano T, Contreras RF, Reche M, Beltran R, Roques V, Rodriguez MA, Robles R, Bueno FS, Ramirez P, Parrilla P (1999) Changes in serum potassium during reperfusion in liver transplantation. Transplant Proc 31:2382-383 CrossRef
  36. Aggarwal S, Kang Y, Freeman JA, Fortunato FL Jr, Pinsky MR (1993) Postreperfusion syndrome: hypotension after reperfusion of the transplanted liver. J Crit Care 8:154-60 CrossRef
  37. Jugan E, Albaladejo P, Jayais P, Ecoffey C (1992) The failure of venovenous bypass to prevent graft liver postreperfusion syndrome. Transplantation 54:81-4 CrossRef
  38. Shin WJ, Kang SJ, Kim YK, Seong SH, Han SM, Hwang GS (2011) Link between heart rate and blood pressure Mayer wave during general anesthesia. Clin Auton Res 21:309-17 CrossRef
  
• 作者单位：Young-Kug Kim (1) (2)
  Kichang Lee (2)
  Gyu-Sam Hwang (1)
  Richard J. Cohen (2)
  
  1. Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea
  2. Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
  
• ISSN：1619-1560

文摘

Objective Post-reperfusion syndrome (PRS), severe hypotension after graft reperfusion during liver transplantation, is an adverse clinical event associated with poorer patient outcomes. The purpose of this study was to determine whether alterations in autonomic control in liver transplant recipients prior to graft reperfusion are associated with the subsequent development of PRS. Methods Heart rate variability (HRV), systolic arterial blood pressure (SBP) variability, and baroreflex sensitivity of 218 liver transplant recipients were evaluated using 5?min of ECG and arterial blood pressure signals 10?min before graft reperfusion along with other clinical parameters. Logistic regression analyses were performed to assess predictors of PRS occurrence. Results Seventy-seven patients (35?%) developed PRS while 141 did not. There were significant differences in SBP (110?±?16 vs. 119?±?16?mmHg, P?<?0.001) and the ratio of low frequency power to high frequency power (LF/HF) of HRV (1.0?±?1.4 vs. 2.1?±?3.7, P?=?0.003) between the PRS group and No-PRS group. In multivariate logistic regression analysis, predictors were LF/HF (odds ratio 0.817, P?=?0.028) and SBP (odds ratio 0.966, P?<?0.001). Interpretation Low LF/HF and SBP measured before hepatic graft reperfusion were significantly correlated with subsequent PRS occurrence, suggesting that sympathovagal imbalance and depressed SBP may be key factors predisposing to reperfusion-related severe hypotension in liver transplant recipients.