Açık Kalp Ameliyatı Geçiren Hastalarda İnspiratuar Kas Gücündeki Değişimin Derin Solunum Kalp Hızı Değişkenliğindeki Değişim ile İlişkisi

Öz

Amaç: Açık kalp ameliyatı sonrası solunum kas kuvvetinde ve kardiyak otonomik modülasyonda azalma olmasına rağmen, her iki değişkendeki değişimler arasındaki ilişki araştırılmamıştır. Bu çalışmada açık kalp ameliyatı geçirmiş olan hastalarda inspiratuar kas gücündeki değişim ile derin solunum kalp hızı değişkenliğindeki değişim arasındaki korelasyonun belirlenmesi amaçlandı.

Gereç ve Yöntemler: Koroner arter bypass ameliyatı ve kalp kapak ameliyatı geçiren yaşları 35 ile 60 yıl arasında olan 32 katılımcı ile gözlemsel kesitsel bir çalışma yapıldı. İnspiratuar kas gücü, solunum basıncı ölçer (RPM 01, Micro Medical Ltd., Birleşik Krallık) kullanılarak maksimum inspiratuar basıncın ölçülmesiyle değerlendirildi. Derin solunum kalp hızı değişkenliği, yavaş ve derin solunum kontrolü sırasında Polar kalp atım hızı monitörü (Polar Electro Ltd., Finlandiya) kullanılarak ölçüldü. Değerlendirmeler kabul ve taburcu günü yapıldı.

Bulgular: Taburculuk döneminde maksimum inspiratuar basınç ve derin solunum kalp hızı değişkenliği endekslerinde istatistiksel olarak anlamlı şekilde bir azalma vardı (p<0,05). Ekspirasyon/inspirasyon oranı farkı ve inspiratuar-ekspiratuar farkları ile maksimum inspiratuar basınçtaki hem mutlak (sırasıyla r=-0,864; p=0,003 ve r=-0,841; p=0,004) hem de öngörülen değerlerin yüzdelerinin (sırasıyla r=-0,868; p=0,003 ve r=-0,834; p=0,005) değişimi arasında istatistiksel olarak anlamlı bir korelasyon vardı.

Sonuç: İnspiratuar kas güçsüzlüğü, açık kalp ameliyatı geçiren hastalarda kardiyak vagal modülasyonun bozulmasına neden oldu. Bu çalışma inspiratuar kas gücünü ve kardiyak vagal tonusunu iyileştirmek için rehabilitasyon hedefleri sağlayabilir.

Anahtar Kelimeler

• inspiratuar kas gücü,kalp hızı değişkenliği,açık kalp cerrahisi

Alteration of Inspiratory Muscle Strength is Related to Change in Deep Breathing Heart Rate Variability in Patients Submitted to Open-Heart Surgery

Abstract

Aim: Despite the reduction of respiratory muscle strength and cardiac autonomic modulation after open-heart surgery has been demonstrated, the association between changes in both variables has not been investigated. This study aimed to determine the correlation between change in inspiratory muscle strength and change in deep breathing heart rate variability in patients submitted to open-heart surgery.

Material and Methods: An observational cross-sectional study was conducted among 32 participants aged between 35 and 60 years who were undergoing coronary artery bypass graft and cardiac valve surgery. Inspiratory muscle strength was assessed by measuring maximal inspiratory pressure using a respiratory pressure meter (RPM 01, Micro Medical Ltd., United Kingdom). Deep breathing heart rate variability was collected using a Polar heart rate monitor (Polar Electro Ltd., Finland) during a slow and deep breathing control. Evaluations were performed on the day of admission and discharge.

Results: There was statistically significant reduction in maximal inspiratory pressure and deep breathing heart rate variability indices in discharge period (p<0.05). The difference of expiratory/inspiratory ratio and inspiratory-expiratory differences was significantly correlated with  the  change  in  maximal  inspiratory  pressure  in  both  absolute  (r=-0.864, p=0.003 and r=-0.841, p=0.004, respectively) and percentages of predicted values (r=-0.868, p=0.003 and r=-0.834, p=0.005, respectively).

Conclusion: Inspiratory muscle weakness was related to impair cardiac vagal modulation in patients who had undergone open-heart surgery. The present study could provide rehabilitation targets to improve inspiratory muscle strength and cardiac vagal tone.

Keywords

• inspiratory muscle strength,heart rate variability,open-heart surgery

References

1. Weissman C. Pulmonary complications after cardiac surgery. Semin Cardiothorac Vasc Anesth. 2004;8(3):185-211.
2. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care. 2004;13(5):384-93.
3. Morsch KT, Leguisamo CP, Camargo MD, Coronel CC, Mattos W, Ortiz LD, et al. Ventilatory profile of patients undergoing CABG surgery. Rev Bras Cir Cardiovasc. 2009;24(2):180-7.
4. Barros GF, Santos Cda S, Granado FB, Costa PT, Limaco RP, Gardenghi G. Respiratory muscle training in patients submitted to coronary arterial bypass graft. Rev Bras Cir Cardiovasc. 2010;25(4):483-90.
5. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J. 2011;45(5):286-93.
6. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043-65.
7. Shields RW Jr. Heart rate variability with deep breathing as a clinical test of cardiovagal function. Cleve Clin J Med. 2009;76(Suppl 2):S37-40.
8. Lakusic N, Mahovic D, Kruzliak P, Cerkez Habek J, Novak M, Cerovec D. Changes in heart rate variability after coronary artery bypass grafting and clinical importance of these findings. Biomed Res Int. 2015;2015:680515.

9. Lakusic N, Slivnjak V, Baborski F, Sonicki Z. Heart rate variability in patients after cardiac valve surgery. Cent Eur J Med. 2008;3(1):65-70.
10. Hayano J, Yasuma F, Okada A, Mukai S, Fujinami T. Respiratory sinus arrhythmia. A phenomenon improving pulmonary gas exchange and circulatory efficiency. Circulation. 1996;94(4):842-7.
11. Yasuma F, Hayano J. Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm? Chest. 2004;125(2):683-90.
12. Reis MS, Arena R, Archiza B, de Toledo CF, Catai AM, Borghi-Silva A. Deep breathing heart rate variability is associated with inspiratory muscle weakness in chronic heart failure. Physiother Res Int. 2014;19(1):16-24.
13. American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518-624.
14. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719-27.
15. Song HS, Lehrer PM. The effects of specific respiratory rates on heart rate and heart rate variability. Appl Psychophysiol Biofeedback. 2003;28(1):13-23.
16. Hayano J, Mukai S, Sakakibara M, Okada A, Takata K, Fujinami T. Effects of respiratory interval on vagal modulation of heart rate. Am J Physiol. 1994;267(1 Pt 2):H33-40.
17. Cavenaghi S, Ferreira LL, Marino LH, Lamari NM. Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery. Rev Bras Cir Cardiovasc. 2011;26(3):455-61.
18. Siafakas N, Mitrouska I, Bouros D, Georgopoulos D. Surgery and the respiratory muscles. Thorax. 1999;54(5):458-65.
19. Wheeler WE, Rubis LJ, Jones CW, Harrah JD. Etiology and prevention of topical cardiac hypothermia-induced phrenic nerve injury and left lower lobe atelectasis during cardiac surgery. Chest. 1985;88(5):680-3.
20. Mazzoni M, Solinas C, Sisillo E, Bortone F, Susini G. Intraoperative phrenic nerve monitoring in cardiac surgery. Chest. 1996;109(6):1455-60.
21. Andrejaitiene J, Sirvinskas E, Bolys R. The influence of cardiopulmonary bypass on respiratory dysfunction in early postoperative period. Medicina (Kaunas). 2004;40(Suppl 1):7-12.
22. Huang AP, Sakata RK. Pain after sternotomy - review. Braz J Anesthesiol. 2016;66(4):395-401.
23. Schelegle ES. Functional morphology and physiology of slowly adapting pulmonary stretch receptors. Anat Rec A Discov Mol Cell Evol Biol. 2003;270(1):11-6.
24. Tryfon S, Kontakiotis T, Mavrofridis E, Patakas D. Hering-Breuer reflex in normal adults and in patients with chronic obstructive pulmonary disease and interstitial fibrosis. Respiration. 2001;68(2):140-4.