窦性心动过缓者麻醉期间需心脏起搏治疗指征的研究

Investigation on indications of cardiac pacing for the patients with sinus bradycardia during anesthesia

目的：探讨窦性心动过缓者麻醉期间需心脏起搏治疗的指征。方法：在麻醉前和麻醉后１５～３０分钟内测定窦性心动过缓患者的窦房结恢复时间（ＳＮＲＴ）、校正窦房结恢复时间（ｃＳＮＲＴ）、窦房传导时间（ＳＡＣＴ）和文氏点值，同时观察麻醉期间患者窦性心律时最快与最慢心率。结果：麻醉后ＳＮＲＴ、ｃＳＮＲＴ和ＳＡＣＴ较麻醉前明显缩短，文氏点值增加；窦房结功能低下者麻醉后ＳＮＲＴ缩短较窦房结功能正常者明显，术中最快与最慢心率也较低，窦房结功能障碍者麻醉后ＳＡＣＴ缩短最少、术中最快与最慢心率也最低。结论：麻醉初期患者窦房结和房室结功能并未受到抑制；阿托品试验最快心率低于９０ｂｐｍ者，若ＳＮＲＴ＜１５００ｍｓ仍可耐受手术，ＳＮＲＴ≥２０００ｍｓ者术中应作心脏起搏治疗准备，１５００ｍｓ≤ＳＮＲＴ＜２０００ｍｓ者应根据ｃＳＮＲＴ和ＳＡＣＴ值综合评定是否需术中心脏起搏治疗。

Objective:Indications of cardiac pacing for the patients with sinus bradycardia during anesthesia were studied Methods:Sinus nodal recovery time (SNRT),corrected sinus nodal recovery time (cSNRT),sinus atrial conduction time (SACT) and Wenckebachs point were determined in 20 patients with sinus bradycardia before anesthesia and 15 30 min following anesthesia,additionally,the patients HRmax and HRmini of sinus rhythm during anesthesia Results:After anesthesia,SNRT cSNRT and SACT of the patients were shortenedr and Wenckebachs point count became larger;the shortened amount of SNRT of the patients with sinus nodal dysfunction was more than and HRmax or HRmini was lower those of the patients with normal sinus nodal function;the shortened amount of SACT of the patients with sick sinus syndrome was the least and HRmax or HRmini was the lowest The function of sinus node and atrioventricular node of the patients were not inhibited at early stage of the anesthesia Conclusion:In patients whose HRmax was less than 90 bpm in atropine test,while SNRT is less than 1500ms,they can tolerate operation;if SNRT no less than 2000ms,cardiac pacing treatment should be considered;if 1500ms≤SNRT<2000ms,whether cardiac pacing treatment is needed during anesthesia depends on the levels of cSNRT and SACT