高血压患者腹腔镜手术CO_2气腹过程中自主神经功能的变化

Changes of the autonomic nervous system during CO_2 insufflation in patients with hypertension undergoing laparoscopic surgery

目的探讨高血压患者在腹腔镜手术CO2气腹过程中自主神经功能的变化。方法应用心率变异性(HRV)分析法对25例择期高血压患者腹腔镜手术(Ⅰ组)和25例无高血压腹腔镜手术患者(Ⅱ组)麻醉前、气管插管结束后15 min、腹腔内CO2充气完成后的心率变异性改变进行分析。结果麻醉诱导及插管15 min后Ⅰ组低频(LF)、高频(HF)、低频与高频的比值(LF/HF)及总功率(TP)显著降低(P<0.05),Ⅱ组LF、LF/HF、TP亦显著降低(P<0.05),而HF未见明显改变。腹腔CO2充气完成后两组HRV值均显著升高(P<0.05)。组间比较显示,插管15 min后Ⅰ组HF和TP显著低于Ⅱ组,LF和LF/HF组间差异无统计学意义;气腹后I组HF和TP亦显著低于Ⅱ组,而LF/HF显著高于Ⅱ组,LF组间差异仍无统计学意义。结论高血压患者迷走神经活性及总自主神经张力显著低于非高血压患者,迷走神经对心脏窦房结的调控作用严重受损。

Objective To investigate the changes of the autonomic nervous system during CO2 insufflation in patients with hypertension undergoing laparoscopic surgery. Methods Twenty five patients with hypertension （ group Ⅰ） and twenty five patients without hypertension（ group Ⅱ）scheduled for elective laparoscopic surgery were selected. Heart rate variability （HRV）was assessed before anesthesia operation, at 15 min after tracheal intubation and after CO2 insufflation using heart rate power spectrum analysis （HRPSA）. Results 15 min after tracheal intubation, LF, LF/HF, TP and HF decreased significantly in group Ⅰ, and LF, LF/HF and TP decreased significantly in group Ⅱ. After CO2 insufflation, LF, LF/HF,TP and HF increased significantly in both groups. During 15 min after tracheal intubation and after CO2 insufflation HF and TP in group Ⅰ was lower than those in group Ⅱ significantly, but LF did not change markedly in both groups. Conclusion Parasympathetic nervous activity and total power of autonomic nervous system are decreased significantly during 15 min after tracheal intubation and after CO2 insufflation in patients with hypertension compared with those in patients without hypertension, indicating that the effect of parasympathetic nervous activity on the sinoatrial node is impaired.