经腹腔镜肾上腺嗜铬细胞瘤手术中实时心率变异性与血浆儿茶酚胺的相关性研究

背景本研究采用实时心率变异性（HRV）探讨交感迷走神经活性，并确定其与血浆儿茶酚胺的关系，以明确腹腔镜下肾上腺嗜铬细胞瘤手术的短期心脏调节机制。方法选择20例嗜铬细胞瘤患者（P组）和20例肾上腺偶发瘤患者（I组），连续监测HRV、收缩压和心率。低频和高频频谱分别表示交感和副交感活性，低频／高频（LF／HF）比值代表交感迷走神经的平衡关系。手术前、手术中和手术后收集血样检测肾上腺素和去甲肾上腺素水平。重复测量值经对数转换后，对其均值进行线性回归分析。用Spearman秩和检验计算变量间的相关系数。结果P组在腹腔内注气阶段和肿瘤切除时所有患者肾上腺素和去甲肾上腺素浓度都增加，而I组无显著变化。其中16例患者的收缩压、心率、低频和LF／HF比值同时增加。4例患者的低频和LF／HF比值降低，其中3例收缩压和心率正常，第4例发生低血压和心动过速。15例患者高频部分增加，5例稳定。低频与去甲肾上腺素（r=0．68，P〈0．001）、收缩压（r=0．66，P〈0．01）以及心率（r=0．62，P〈0．05）之间存在相关性。结论本研究证实在嗜铬细胞瘤手术期间低频HRV、血浆去甲肾上腺素、动脉血压和心率之间有显著的相关性。

BACKGROUND： We studied sympathovagal activity using real-time heart rate variability （HRV） and determined its relationship with plasma catecholamines to characterize short-term cardioregulatory mechanisms during laparoscopic adrenal pheochromocytoma surgery. METHODS： We recruited 20 patients with pheochromocytoma （Group P） and 20 with in-cidentaloma （Group I）. HRV, systolic blood pressure and heart rate were continuously monitored. The low frequency and high frequency spectra denoted, respectively, sympathetic and parasympathetic activity. The low frequency/high frequency （LF/HF） ratio represented sympathovagal balance. Blood samples for epinephrine and norepinephrine assays were collected before, during, and after surgery. After log transformation of the repeated measures, a linear regression model was applied on their mean values. The correlation coefficients among variables were calculated using the Spearman rank test. RESULTS： No significant changes were observed in Group I. In Group P, epinephrine and norepinephrine increased in all patients during peritoneal insuffiation and tumor resection. In 16 patients, systolic blood pressure, heart rate, low frequency, and LF/HF ratio increased concurrently. In four patients, low frequency and LF/HF ratio decreased. Three of these patients had normal systolic blood pressure and heart rate, and the fourth patient had hypotension and tachycardia. The high frequency component was enhanced in 15 patients and was stable in five. Low frequency was correlated with norepinephrine （r=0.68, P〈0.001）, systolic blood pressure （r=0.66; P〈0.01）, and heart rate （r=0.62, P〈0.05）. CONCLUSION： This study demonstrated a strong correlation between low frequency HRV.Plasma norepinephrine,arterial blood pressure,and heart rate during pheochromocyteoma surgery.