癫癎持续状态患者过度换气诱导的心血管自主神经功能变化的临床评价

Hyperventilaiton induces sympathetic overactivation in patients with status epilepticus

目的：过度换气（HV）可诱发癫癎患者全身性癫痫持续状态（SE）发作，其病理生理学原因或许可能与发作期和发作间期自主神经功能异常有关。为此，我们监测癫癎患者非发作状态下HV时心率变异性（HRV）和心室震荡（HRT）参数。方法：38例曾出现过SE的患者与40例相匹配的正常人纳入试验，监测安静时和HV时的HRT、HRV。HRT参数包括震荡仞始（TO）、震荡斜率（TS）。HRV的低频功率（LF）／高频功率（HF）比和HRT参数被公认为是可表示自主神经功能状态的指标。结果：HRV、HRT变化与年龄、性别、病因、治疗方案无统计学相关性。两组在安静状态下HRV和HRT之间比较差异无统计学意义；癫癎组患者在HV时较安静状态下，LF／HF的比值升高，TO升高，TS降低。结论：在HV中，曾出现过SE的患者组较正常人群自主神经功能过度活跃。HRV及HRT提示自主神经功能活跃是HV诱发癎性发作过程中伴随的病理生理过程。癫癎患者中自主神经功能的不稳定性或许是其心率失常高发的原因，或许可作为预测癫癎猝死发生的指标。

Objective： Hyperventilation （HV） may be hypothesized to be related to ictal and interic tal sympathetic nervous system abnormality. In order to test this hypothesis we investigated the effect of HV on heart rate variability （HRV） and heart rate turbulence（HRT） in the group with status epileptic us （SE） in interictal,compared with the group of healthy controls. Methods：38 patients with SE and 40 age- and sex-matched controls were enrolled in the study. A standard 24-hour ambulatory electrocardio gram（ECG）Holter recording was made .and the high and low frequency components （HF, LF） of heart rate variability （HRV） and their ratio （LF/HF） were analyzed. The corrlalion between HV and HRT in the quiet state was observed. Results： HRV and HRT did not differ in both cases with SE and healthy subjects in the quiet state, where as HV induced significanty LF/HF increased, then TO increases and TS decreasesd only in patients with SE. Conclusion： Patients with SE showed an increased sympathetic re- sponse to HV compared with healthy subjects. HRV and HRT shows an autonomic overactivation as a pathophysilogieal pathway subtending seizure triggered by hyperventilation in patients with SE. Auto- nomic susceptibility may help explain the increased prevalence of arrhythmic events in patients with SE, potetiatly predisposing to sudden unexpected death in epilepsy （SUDEP）.