老年冠心病患者腹腔镜胆囊切除术中CO2气腹对心率变异性的影响及星状神经节阻滞对气腹的干预作用

Effect of CO2 Pneumoperitoneum on Heart Rate Variability in Elderly Patients with Coronary Heart Disease and Right Stellate Ganglion Block Intervention

【目的】观察老年冠心病患者在腹腔镜胆囊切除术（TVLC）中CO2气腹对心率变异性的影响以及术前经右侧星状神经节阻滞对CO2气腹的干预作用。【方法】选择2008年5月至2008年12月择期在全麻下行TVLC的老年冠心病患者60例。随机分为两组，对照组和右侧星状神经节阻滞组（R-SGB组）各30例。分别于麻醉后SGB前（T0）、SGB后（T1）、气腹后10min（T2）、20min（T3）和30min（T4）记录HR、MAP并分析患者的心率变异性（heart rate variability，HRV）。HRV通过功率谱分析：低频率（LF），高频率（HF），LF／HF比率，总能量（TP）。【结果】CO2气腹后老年冠心病患者LF、LF／HF、TP均升高（P〈0．05）。R-SGB组气腹后各时点LF、LF／HF、TP升高低于对照组（P〈0．05）。两组HF未见明显改变（P〉0．05）。【结论】CO2气腹使老年冠心病患者交感神经活性显著升高，右侧星状神经节阻滞可减轻CO2气腹时的心血管反应，维持CO2气腹时的交感／迷走神经张力的均衡。

[Objective]To investigate the effect of pneumoperitoneum during laparoseopie choleeysteetomy （TVLC） on heart rate variability in the elderly patients with coronary heart disease, and the ifitervention of right stellate ganglion block （R-SBG） on it. [Methods] Sixty elderly patients with coronary heart disease from May to December in 2008 scheduled for elective pneumoperitoneum operation were selected anti.classified to two groups randomly ： control group （Group Ⅰ , n = 30） and R-SGB group （Group Ⅱ , n = 30）. Heart rate variability （HRV） was assessed after anesthesia （ before SGB）, after SGB, 10, 20, and 30 minutes after pneumoperitoneum by using heart rate power spectrum analysis （HRPSA）. [Results]As compared with pre-pneumo- peritoneum, low frequency （LF）, low frequency/high frequency （LF/HF） and total spectral power （TP） were significantly higher after pneumoperitoneum（ P 〈0.05）. LF and LF/HF in the Group Ⅱ at all time points after pneumoperitoneum were significantly lower than in those in the Group Ⅰ （ P 〈0.05）. There was no obvious difference in HF between the two groups（ P〉0.05）. [Conclusion] CO2 pneumoperitoneum can increase sympathetic nervous activity significantly. R-SGB can maintain the autonomic nervous system.