Abstract
Objectif
Comparer la technique d’analyse spectrale de l’électrocardiogramme (ECG) au monitorage de la tension artérielle moyenne (TAM) et la fréquence cardiaque (FC) dans la détection de l’hyperréflexie autonome (HRA) induite par la stimulation des racines sacrées.
Méthode
Dix blessés médullaires candidats à l’implantation d’un stimulateur des racines sacrées pour rétention urinaire ont été inclus. Sous anesthésie iv à objectif de concentration (4 μg·mL−1 de propofol, 4 ng·mL−1 de rémifentanil), les patients étaient installés en génu-pectoral. Les racines sacrées étaient exposées par une laminectomie (L2 à S1) et leur fonction évaluée par électrostimulation sous contrôle urodynamique et cardiovasculaire. L’analyse spectrale était obtenue en temps réel grâce au logiciel (MemCalc™) d’un ordinateur connecté au moniteur d’anesthésie. L’intervalle R-R de l’ECG était décomposé, par la méthode d’entropie maximum, en spectres de fréquences sympathiques (LF: 0,04–0,15 Hz) et parasympathiques (HF: 0,15–0,4 Hz). La valeur la plus extrême de chaque paramètre était notée avant et à chaque stimulation. Une différence Δ) supérieure à 10 % était considérée comme l’expression d’HRA. La comparaison (ΔLF vs ΔTAM et ΔHF vs ΔFC) était faite par un test de concordance basé sur un coefficient kappa (k): −1 = discordance totale à 1 = concordance totale.
Résultats
L’HRA était détectée chez six patients sous forme: d’augmentation de LF et TAM (n = 4); d’augmentation de LF, HF, TAM et diminution de la FC (n = 2). Le délai de détection était de 5,3 ± 1 sec pour l’ECG spectral et 10 ± 1,2 sec pour la TAM et la FC. La concordance observée était de 85 % entre LF et TAM (k = 0,7) et 90 % entre HF et FC (k = 0,8).
Conclusion
L’HRA induite par la stimulation des racines sacrées est détectée par l’ECG spectral de manière plus précoce que la TAM et la FC. Ces résultats demandent une confirmation par d’autres études.
Abstract
Purpose
To compare spectral analysis of the electrocardiogram (ECG) with mean arterial pressure (MAP) and heart rate (HR) monitoring in the detection of autonomic hyperreflexia (AHR) induced by sacral root stimulation.
Methods
Ten spinal cord injured patients scheduled for implantation of a sacral root stimulator for bladder retention were included. Under target controlled anesthesia with propofol 4 μg·mL−1 and remifentanil 4 ng·mL−1, the patients were placed in the knee chest position. The sacral roots were exposed by laminectomy (L2-S1) and their function assessed by electrostimulation under urodynamic and cardiovascular monitoring. Online power spectrum densities were calculated from the ECG R-R interval by the MemCalc™ software using the maximum entropy method. Low frequency (LF: 0.04–0.15 Hz) and high frequency (HF: 0.15–0.4 Hz) spectra were associated with sympathetic and parasympathetic activities respectively. The most extreme value of each variable was noted before and during each stimulation. A difference (Δ) of more than 10% signified AHR. The comparison (ΔLF vs ΔMAP and ΔHF vs ΔHR) was done by a concordance test with a kappa coefficient (k): −1 = total discordance to 1 = total concordance.
Results
AHR was detected in six patients as an increase in LF and MAP (n = 4); an increase in LF, HF, MAP with a decrease in HR (n = 2). The detection delay was 5.3 ± 1 sec (LF, HF) and 10.4 ± 1.2 sec (MAP and HR). Concordance was 85% (LF vs MAP: k = 0.7) and 90% (HF vs HR: k = 0.8).
Conclusion
AHR induced by sacral root stimulation is detected by spectral analysis of the ECG earlier than MAP and HR. Other studies are needed to confirm these results.
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Sources de financement: ce travail a été financé par des contrats de recherche 1999 de la Société française d’anesthésie-réanimation et du Centre hospitalier universitaire de Bordeaux. Présenté aux congrès 2002 de la SFAR à Paris et de l’ASA à Orlando.
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Sesay, M., Vignes, JR., Liguoro, D. et al. L’hyperréflexie autonome induite par la stimulation des racines sacrées est détectée par l’analyse spectrale de l’ECG. Can J Anesth 49, 936–941 (2002). https://doi.org/10.1007/BF03016878
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DOI: https://doi.org/10.1007/BF03016878