麻醉中输液量对老年高血压病人心率变异性的影响

The Transfusion Effect on Heart Rate Variability of the Senile Hypertensive Patients during Anesthesia

目的探讨麻醉手术过程中液体治疗与老年高血压病人心率变异性之间的相关性．方法90例高血压Ⅱ期的择期手术老年病人，采用随机、双盲的方法将其分为I组（45例）和Ⅱ组（45例），所有患者均采用吸人加静脉全麻，两组病人人手术室后，开放静脉，分别按3：1的比例输注勃脉力一A和琥珀酰明胶，Ⅰ组病人在麻醉开始前输入液体1200mL，后以15mL／（k·h）的速度补液；Ⅱ组病人在麻醉开始前输入液体600mL，后以10mL／（kg·h）的速度补液．两组病人均以先晶体后胶体的顺序进行．并记录麻醉前（T0）、手术开始前10min（T1）、手术开始后1h（T2）、结束前30min（T3）和拔管后30min（T4）的脑电双频指数（BIS）、心率变异率（HRV）以及血压、CVP、SPO2、PETCO2、尿量、失血量等各相指标．结果（1）病人一般资料比较，两组间无显著性差异（P〉0．05）；（2）Ⅱ组病人各时间点输液量均比Ⅰ组病人显著性的低（P〈0．01），尿量在T2比Ⅰ组病人低（P〈0．05），在T3、T4显著性降低（P〈0．01）；（3）血压与麻醉前比较，Ⅱ组病人各时间点有降低（P〈0．05）；组间比较，Ⅰ组病人的收缩压在T1～T3各时间点均比Ⅱ组病人显著性高（P〈0．01），T4时间点高，舒张压在T1时间点高（P〈0．05）；（4）心率变异性，各时间点与麻醉前比较，两组病人心率变异性的各项指标均有降低（P〈0．05），组间比较，Ⅱ组的代表交感兴奋性占优势的指标的变化较Ⅰ组的大（P〈0．01）．结论在合适的麻醉深度下，术中输注适量的液体有利于降低老年高血压病人术中和术后交感神经活性、维护交感／迷走神经均衡性和自主神经总张力，以及机体循环的稳定性．

Objective To investigate the dependability of fluids management and the heart rate variability of the senile hypertensive patients during anesthesia and operation. Methods 90 senile patients with Ⅱ stage hypertensive who were going to undergo operations were randomly divided into two groups with double - blind method： group Ⅰ（n =45） and groupⅡ （n = 45）. Inhalation anesthesia and intravenous anesthesia were performed on all the patients. Vein was opened and plasma - lyre A and Gelofusine was infused with the ratio of three to one. In group Ⅰ, 1 200 mL fluids was infused before anesthesia, then fluid replacement was followed at the speed of 15mL/（ kg. h）. In group Ⅱ , 600 mL fluids was infused before anesthesia, then fluid replacement was followed at the speed of 10 mL/ （kg·h）. All were conducted with crystal first and then colloid. Simultaneously, the parameters such as BIS, HRV, BP, CVP, SPO2, PETCO2, urinary volume and the loss blood volume were recorded before anesthesia （T0） ,10 min before the operation （T1 ）, 1 hour after the operation （T2 ）, 30 min before the termination （T3 ） and 30 min after the termination （T4 ）. Results （ 1 ） To compare the general documents of the patients, there was no significant difference （P 〉 0. 05 ）. （2） To compare the transfusion volumes, those in group Ⅱwere significantly lower than those in group Ⅰ （ P 〈 0. 01 ） ; And to compare the urinary volumes, those in group Ⅱwere lower than those in group Ⅰat T2 （ P 〈 0. 05 ） and significantly lower than those in group Ⅰat T3 and T, （P 〈0. 01 ）. （3） To compare the blood pressure, those in groups Ⅱwere lower than those before anesthesia （ P 〈 0. 05 ）. SBP in group Ⅰwas significantly higher than that in group Ⅱat the every time of T1 to T3 （P 〈0. 01） and higher at T4. DBP was higher than group Ⅱat T1 （P 〈0. 05）. （4） To compare the heart rate variability, every index of heart rate variability of the two group patients at each time of post - anesthesia were lower than those before anesthesia （ P 〈 0. 05 ）. The change of indexes of typify sympathetic excitability in group Ⅱ was larger than that in group Ⅰ（ P 〈 0. 01 ）. Conclusion Under the suitable depth of anesthesia, infusion with compatible volume of fluids is beneficial to decreasing the sympathetic activity, handling the balance of sympathetic and pneumogastric nerve and the con -tension of autonomic nerve, and the stability of organism circulation in senile hypertensive patients before and after the operation.