围术期高危室早患者HRV的监测及临床意义

The change of heart rate variability (HRV) in patients with perioperative high risk ventricular ectopic beats.

目的探讨围术期高危室早(HRVEB)患者心率变异性(HRV)的变化规律。方法选择150例择期手术患者,以动态心 电图(DCG)监测围术期心率变异性(HRV)及室性早搏(VEB)的发生情况,于术前一日内监测至少12h,术后监测48h。HRVEB包括 频发室早(FVEB即≥10VEB／h)、成对室早(VC)、室速(VT)和Lown更高级别的VEB。根据围术期是否发生HRVEB将患者分为 HRVEB组(Ⅰ组)和非HRVEB组(Ⅱ组)。结果共发生HRVEB 44例(29．3％)为Ⅰ组,其中术前18例(12．0％)、术后39例(26．0％)、重 叠13例(8．7％);未发生HRVEB者为Ⅱ组。术前:Ⅰ组术前低频功率(LF)及极低频功率(VLF)显著低于Ⅱ组(P<0．05);术后:2组HRV 均显著降低(P<0．05或0．01),其中Ⅰ组总功率(TP)、高频功率(Hr)、LF、VLF在术后2天又显著低于Ⅱ组(P<0．05)。结论HRVEB 主要发生于术后。尤其术前已有HRVEB者术后出现HRVEB的机率更高、程度更严重,可能与围术期自主神经功能障碍有关,具体表 现为①HRVEB组术前HRV下降,尤其LF、VLF异常降低;②术后2组HRV下降,但HRVEB组下降更为显著。

Objective To observe the change of heart rate variability （HRV） in patients with perioperative high risk ventricular ectopic beats （HRVEB）. Methods Perioperative HRV and VEB of one hundred and fifty patients with HRVEB scheduled for elective surgery were monitored with dynamic electrocardiogram（DMS5.0 Holter, USA） for at least 12 h before and 48 h after surgery. HRVEB included more than 10 ventricular ectopic beats（VEB） per hour, ventricular couplets （VC）, ventricular tachycardia （VT） or higher Lown grade VEB. All patients with or without HRVEB were assigned into the HRVEB group （GroupⅠ） or no - HRVEB group（GroupⅡ）. Results HRVEB occun＇ed in forty -four patients（GroupⅠ） ： eighteen patients preoperatively and thirty nine patients postoperatively. HRVEB did not occur in the other one hundred and six patients（GroupⅡ）. Group Ⅰ has lower preoperative low- frequency（LF） and very- low- frequency（VLF） than GroupⅡ, Postoperatively, HRV of both groups decreased significantly, of which total - power（TP）, high - frequency（HF）, LF and VLF of GreupIwere significantly lower than ones of Group Ⅱ. Conclusion HRVEB occurred mostly after the end of surgery, especially patients with preoperatively existed HRVEB have the higher incidences and more severity of HRVEB postoperatively. This could be associated with the awfully disturbance of perioperative automatic nervous functions. There were lower preoperative HRV such as markedly deceased LF and VLF in Group Ⅰ. HRV of both GroupⅠ and GroupⅡ decreased postoperatively, in which Group Ⅰ decreased more significantly than Group Ⅱ.