Controle autonômico do ritmo cardíaco e leucemia: uma revisão sistemática e estudo controlado sobre impacto de incentivadores respiratórios no controle autonômico do ritmo cardíaco em crianças com leucemia em tratamento
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Data
2019-12-10
Autores
Kirizawa, Jociele Martins
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A função cardiovascular autonômica é prejudicada durante o tratamento e a recuperação da leucemia. Nesse contexto, a variabilidade da frequência cardíaca (VFC) é uma medida não invasiva que descreve as oscilações dos intervalos entre batimentos cardíacos consecutivos (intervalos RR) influenciados pelo sistema nervoso autônomo. Revisamos a literatura mostrando as alterações da VFC em indivíduos com leucemia. Os artigos foram eleitos nas cinco bases de dados eletrônicas: Medline, Base de Dados de Evidência Fisioterapêutica – PEDro, Ensaios Clínicos Cochrane, Scientific Electronic Library Online - SciELO e Excerpta Medica dataBASE - EMBASE. Nove estudos foram incluídos. Indivíduos submetidos a tratamento para leucemia e sobreviventes reduziram a VFC, significando diminuição do controle vagal da freqüência cardíaca. A VFC é reduzida em indivíduos com leucemia que evoluem para a neuropatia secundária à quimioterapia, acompanhada de disfunção cardíaca. Nossa revisão reforça o uso da VFC para avaliar a função autonômica e colaborar para direcionar o tratamento em indivíduos com leucemia. Considerando que o controle autonômico da frequência cardíaca (FC) está alterado no câncer e que o esforço respiratório subsequente pode sobrecarregar o coração, nosso objetivo foi avaliar o efeito de uma sessão de fisioterapia respiratória na regulação autonômica da FC em crianças com leucemia, a fim de confirmar sua segurança. Foram selecionadas crianças com leucemia (n = 8) e crianças saudáveis (n = 11), que foram submetidas a uma sessão de fisioterapia respiratória. Usamos Respiron infantil (NCS, Brasil), Voldyne infantil (HUDSON RCI, EUA) e Shaker (NCS, Brasil) como dispositivos respiratórios. Os protocolos de exercícios respiratórios foram fundamentados em três protocolos padronizados. A variabilidade da FC (VFC) foi analisada antes, no primeiro minuto e 5 a 10 minutos após a intervenção. Não houve mudança entre repouso e recuperação da intervenção na VFC (rMSSD - Controle: p = 0,8111, Leucemia: p = 0,1197, entre os grupos: p = 0,6574 ; SD1 - Controle: p = 0,8111, Leucemia: p = 0,131, entre os grupos: p = 0,6556 ; 0V - Controle: p = 0,3679, Leucemia: p = 0,3553, entre os grupos: p = 0,7421 ; 2UV - Controle: p = 0,3679, Leucemia: p = 0,2359, entre os grupos: p = 0,4007 ) . A HF diminuiu 0 a 1 minuto após a intervenção no grupo com leucemia (p = 0,0303) e nenhuma alteração foi observada no grupo controle entre o repouso versus a recuperação da intervenção (p = 0,9761). Nenhuma mudança significativa foi observada na HF entre os grupos (p = 0,8700). Uma sessão de fisioterapia respiratória não alterou significativamente o controle autonômico da FC em crianças com leucemia.
Autonomic cardiovascular function is impaired during leukemia treatment and recovery. In this context, heart rate variability (HRV) is a noninvasive measure describing the oscillations of the intervals between consecutive heart beats (RR intervals) influenced by the autonomic nervous system. We reviewed the literature showing HRV changes in individuals with leukemia. The articles were chosen from five electronic databases: Medline, Physiotherapeutic Evidence Database - PEDro, Cochrane Clinical Trials, Scientific Electronic Library Online - SciELO and Excerpta Medica dataBASE - EMBASE. Nine studies were included. Subjects undergoing treatment for leukemia and survivors reduced HRV, meaning decreased vagal control of heart rate. HRV is reduced in individuals with leukemia who progress to neuropathy secondary to chemotherapy, accompanied by cardiac dysfunction. Our review reinforces the use of HRV to assess autonomic function and collaborate to direct treatment in individuals with leukemia. Considering that autonomic control of heart rate (HR) is altered in cancer and that subsequent breathing effort can overload the heart, our objective was to evaluate the effect of a respiratory physiotherapy session on the autonomic regulation of HR in children with leukemia, in order to confirm its safety. We selected children with leukemia (n = 8) and healthy children (n = 11) who underwent a respiratory physiotherapy session. We use Infant Respiron (NCS, Brazil), Infant Voldyne (HUDSON RCI, USA) and Shaker (NCS, Brazil) as breathing devices. The breathing exercise protocols were based on three standardized protocols. HR variability (HRV) was analyzed before, in the first minute and 5 to 10 minutes after the intervention. There was no change between rest and HRV intervention recovery (rMSSD - Control: p = 0.8111, Leukemia: p = 0.1197, between groups: p = 0.6574; SD1 - Control: p = 0.8111, Leukemia: p = 0.131, between groups: p = 0.6556,0V - Control: p = 0.3679, Leukemia: p = 0.3553, between groups: p = 0.7421; 2UV - Control: p = 0.3679, Leukemia: p = 0.2359, between groups: p = 0.4007). The HF decreased 0 to 1 minute after intervention in the leukemia group (p = 0.0303) and no change was observed in the control group between rest versus intervention recovery (p = 0.9761). No significant changes were observed in HF between groups (p = 0.8700). One session of respiratory physiotherapy did not significantly alter the autonomic control of HR in children with leukemia.
Autonomic cardiovascular function is impaired during leukemia treatment and recovery. In this context, heart rate variability (HRV) is a noninvasive measure describing the oscillations of the intervals between consecutive heart beats (RR intervals) influenced by the autonomic nervous system. We reviewed the literature showing HRV changes in individuals with leukemia. The articles were chosen from five electronic databases: Medline, Physiotherapeutic Evidence Database - PEDro, Cochrane Clinical Trials, Scientific Electronic Library Online - SciELO and Excerpta Medica dataBASE - EMBASE. Nine studies were included. Subjects undergoing treatment for leukemia and survivors reduced HRV, meaning decreased vagal control of heart rate. HRV is reduced in individuals with leukemia who progress to neuropathy secondary to chemotherapy, accompanied by cardiac dysfunction. Our review reinforces the use of HRV to assess autonomic function and collaborate to direct treatment in individuals with leukemia. Considering that autonomic control of heart rate (HR) is altered in cancer and that subsequent breathing effort can overload the heart, our objective was to evaluate the effect of a respiratory physiotherapy session on the autonomic regulation of HR in children with leukemia, in order to confirm its safety. We selected children with leukemia (n = 8) and healthy children (n = 11) who underwent a respiratory physiotherapy session. We use Infant Respiron (NCS, Brazil), Infant Voldyne (HUDSON RCI, USA) and Shaker (NCS, Brazil) as breathing devices. The breathing exercise protocols were based on three standardized protocols. HR variability (HRV) was analyzed before, in the first minute and 5 to 10 minutes after the intervention. There was no change between rest and HRV intervention recovery (rMSSD - Control: p = 0.8111, Leukemia: p = 0.1197, between groups: p = 0.6574; SD1 - Control: p = 0.8111, Leukemia: p = 0.131, between groups: p = 0.6556,0V - Control: p = 0.3679, Leukemia: p = 0.3553, between groups: p = 0.7421; 2UV - Control: p = 0.3679, Leukemia: p = 0.2359, between groups: p = 0.4007). The HF decreased 0 to 1 minute after intervention in the leukemia group (p = 0.0303) and no change was observed in the control group between rest versus intervention recovery (p = 0.9761). No significant changes were observed in HF between groups (p = 0.8700). One session of respiratory physiotherapy did not significantly alter the autonomic control of HR in children with leukemia.
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Palavras-chave
Fisioterapia, Fisioterapia respiratória, Leucemia, Crianças, Variabilidade da frequência cardíaca, Physiotherapy, Respiratory physiotherapy, Leukemia, Children, Heart rate variability