Abstract
The investigation was undertaken to study the adaptive capacities of the cardiovascular system (CVS) in physiological full-term pregnancy, by using the active orthostatic test (AOT) and to analyze cardiac rhythm variability (CRV). The study covered 49 low-risk group females during 38—39-week physiological pregnancy, who had indications for planned surgery -cesarean section. Before surgery, during an anesthesiological examination, all the pregnant females performed AOT during which ECG was continuously recorded. For CRV estimation, 5-min ECG fragments recorded in the standing and lying positions. AOT could reveal a normal orthostatic response (NOR) in 37 pregnant females, postural orthostatic tachycardia (POT) in 8 and orthostatic hypotension in 4. No relationship was found between the clinical characteristics and the types of responses to AOT. At the same time, comparison of CVS demonstrated that the baseline enhanced activity of the sympathetic portion of the autonomic nervous system was typical of females with POT as compared with females showing a NOR. Thus, estimation of CRV parameters in pregnant females permits predetermination of adaptive CVS capacities, which is important to be taken into account in choosing an anesthesiological support and modes of hemodynamic correction when cesarean section is performed.
Highlights
Кафедра анестезиологии и реаниматологии ФПК и ППС ВПО ВГМА им
The investigation was undertaken to study the adaptive capacities of the cardiovascular system (CVS) in physiological full term pregnancy, by using the active orthostatic test (AOT) and to analyze cardiac rhythm variability (CRV)
Comparison of CVS demonstrated that the baseline enhanced activity of the sym pathetic portion of the autonomic nervous system was typical of females with postural orthostatic tachycardia (POT) as compared with females showing a normal orthostatic response (NOR)
Summary
В исследование было включено 49 женщин с нормально прогрессирующей доношенной беременностью, без сопутству ющей соматической патологии (заболевания сердечно сосуди стой системы, почек, сахарный диабет и пр.), имевших показа ния к плановому оперативному родоразрешению путем операции кесарева сечения. Дополнительно накануне операции, во время анестезио логического осмотра, выполнялась АОП с регистрацией пара метров гемодинамики и параллельной записью ЭКГ для после дующего анализа ВСР. Беременные в соответствии с рекомендациями занимали положение на левом боку и после 10 минутного периода адап тации, в течение 5 и минут проводилась регистрация ЭКГ, и оп ределялся исходный уровень АД. После записи сигнал передавался на IBM совместимый компьютер, где проводилось его редакти рование и окончательная обработка с помощью программы Поли Спектр© Нейрософт (ООО «Нейрософт» Иваново, Рос сия) с расчетом основных параметров ВСР. Непосредственно для оценки ВСР использовались 5 ми нутные фрагменты ЭКГ, записанные в положении лежа и в те чение последних 5 минут ортостаза.
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