异丙酚和七氟烷麻醉对心率变异性的不同影响

A Comparison of Heart Rate Variability during Propfol Versus Sevoflurane Anesthesia

目的 观察异丙酚和七氟烷麻醉对心率变异性的不同影响.方法 选择择期行妇科腹腔镜手术病人40例,随机分为两组,异丙酚组（P组,20例）术中以异丙酚麻醉维持,七氟烷组（S组,20例）术中以七氟烷麻醉维持.记录麻醉前、麻醉诱导后、插管后、切皮后、气腹形成后、关气腹、拔管后10min七个时点的心率（HR）、平均动脉压（MAP）、BIS和低频（LF）、高频（HF）、低高频比值（LF/HF）、心率变异指数（HRV）等心率变异性指标.结果 麻醉诱导后两组病人的HR、MAP、BIS、HRV、HF、LF、LF/HF均显著性下降（ P〈0.05）,两组间无显著差异.在麻醉维持过程中P组LF值显著降低,HF值不降低甚至略有升高,LF/HF值显著下降;S组LF及HF均显著降低,与P组相比LF降低更明显（ P〈0.05）,S组LF/HF值无明显变化,与P组有显著性差异（ P〈0.05）.结论 异丙酚对交感神经系统抑制明显,异丙酚麻醉自主神经系统向副交感神经占优势的方向转变;七氟烷对迷走神经系统和交感神经系统均有抑制,对自主神经系统的平衡性无明显影响.

Objective To compare heart rate variability during propfol anesthesia versus sevoflurane in gyne- cology laparoscope. Methods Forty ASA Ⅰ-Ⅱ patients aged 18 - 60 yr undergoing gynecology laparoscope were enrolled in this study.They were randomly divided into two groups：P group（n=20） and S group （n=20）.Propfol anesthesia was conducted in P group, while sevoflurane anesthesia was conducted in S group. HR, MAP, BIS and four HRV parameters were continuously monitored and recorded at seven points： baseline before anesthesia （T1）,after induction （T2）,after tracheal induction（T3）,after skin incision（T4）,pneumoperitoneum（T5）,cease of pneumoperitoneum（T6）, 10 minutes after extubation （T7）.HRV was analyzed by power spectrum analysis：low fre- quency （LF）,high frequency （HF）,LF/HF ratio. Results LF and LF/HF were dramatically decreased but HF was not dramatically in P group,LF and HF were dramatically decreased but LF/HF was not dramatically in S group. HR, MAP, BIS, HRV, HF, LF, LF/HF were significantiydecreased after anesthesia induction（P〈0.05）,but there was no significant difference between two groups. During anesthesia maintenance,LF was significantly de- creased in two groups,S group was significantly lower（P〈0.05）.HF was not decreased, even increased in P group, while it was significantly decreased in S group compared with baseline（P〈0.05）.LF/HF was significantly decreased in P group（P〈0.05）,while it was not significantly decreased in S group.There was significant difference in two groups（P〈0.05）. Conclusion Propfol can depress the sympathetic nerve, and so the automatic nervous system balance tends to parasympathetic nerve.While sevoflurane can depress both sympathetic and vagus nerve,and the automatic nervous system balance is not changed.