1,6--二磷酸果糖联合局部封闭Calot三角对胆囊切除术心率

Effect of prophylactic fructose-1,6-diphosphate (FDP) combined with local block at the neck of gallbladder on heart rate variability (HRV) in cholecystectomy

目的:观察胆囊切除术围术期输注1,6--磷酸果糖联合术中局部封闭Calot三角对血流动力学及心率变异性的影响。方法:择期胆囊切除术患者40例,年龄28-67岁,ASA分级Ⅰ-Ⅱ级,分为对照组(n=20)和试验组,试验组(n=20)患者在切皮前静脉滴注1,6--二磷酸果糖,在胆囊牵拉前在Calot三角注射2%利多卡因5ml,选择全凭静脉麻醉(TIVA),气管内插管,机控通气。分别于胆囊牵拉前5分钟(T0)、牵拉时(T1)、牵拉五分钟(T2),牵拉十分钟(T3)监测两组患者心率变异性和血流动力学。结果:牵拉瞬间对照组和试验组,TP值降低(p<0.05);牵拉五分钟时,对照组MAP、HR、HFnu较牵拉前和牵拉时降低有显著差异(p<0.01),且LF/HF比值较其他时间点降低(p<0.05);试验组HR牵拉前和牵拉时降低有统计学意义(p<0.05)。牵拉十分钟时,两组TP较牵拉前降低有统计学意义(p<0.05);对照组MAP、HR较牵拉前和牵拉时降低有统计学意义(p<0.05)。结论:切皮前静脉滴注1,6--二磷酸果糖联合局部封闭Calot三角对心率变异性和血流动力学影响小,可降低胆心反射对自主神经功能的影响。

Objective：To appraise the effect of prophylactic fructose-1,6-diphosphate（FDP） combined with local block at the neck of gallbladder on heart rate variability（HRV） and hemodynamics in cholecystectomy. Methods：Forty patients,ASA gradeⅠ-Ⅱ,aged 28 to 67 years,undergoing elective cholecystectomy,were divided two groups in this study. They were undergoing intravenous anaesthesia with trachea intubatton. In test group,in addition to local block,the patients received FDP（200mg/kg） intravenously before skin incision. MAP,HR,Low frequency（LF） ,high frequency（HF） ,LF/HF,LFnu（LF/TP×100%） ,HFnu（HF/TP×100%） and total power（TP） ,were monitored 5 minutes before dragging cholecyst,at the moment of dragging cholecyst and 5,10 minutes after dragging cholecyst during cholecystectomy. Results：At the moment of dragging cholecyst,TP was decreased significantly（p〈0.05） in both groups. At 5 minutes after dragging cholecys,MAP,HR,HFnu and LF/HF were decreased significantly（p〈0.01） in control group,and HR was decreased significantly（p〈0.05） in test group. At 10 minutes after dragging cholecys,TP was decreased significantly（p〈0.05） in both groups,and MAP,HR decreased significantly（p〈0.05） compared with the moment of dragging cholecyst. Conclusion：Our results support that prophylactic fructose-1,6-diphosphate（FDP） combined with local block at the neck of gallbladder has less influence on hemodynamics and HRV,and can be effective in dealing with cholecystocardiac reflex.