心内直视术病人心率变异性的变化

Changes of heart rate variability in patients undergoing open cardiac surgery

目的 探讨麻醉和手术创伤对心脏自主神经系统的影响。方法 2 0例心内直视术病人 ,采用静吸复合全麻 ,麻醉诱导药为安定、依托咪酯、芬太尼、阿曲库铵和琥珀胆硷。麻醉维持用 ( 0 .5～ 1.0 ) %异氟醚吸入 ,辅以芬太尼、阿曲库铵间断静注。手术过程中采用体外循环控制性降温 ,手术时间 ( 2 4 0± 5 0 )分 ,体外转流 ( 95± 4 3 )分 ,主动脉阻断 ( 72± 3 9)分 ,最低温度 ( 2 7± 2 .5 )℃。结果 未发现依托咪酯、芬太尼和异氟醚等麻醉药物对心率变异性造成的明显影响。体外转流开始后 ,L F、HF和TP明显下降 ,伴随体温降低 ,L F、HF和 TP进一步下降。升温复跳后 L F、HF和 TP下降更为明显 ,并持续至术毕 ,而 L F/HF在整个手术过程中无明显变化。结论 心脏手术中 ,体外循环、低温、主动脉阻断及药物等因素可导致心率变异性下降 ,而选择合理的麻醉药物和剂量 。

Objective To analyse the effects of anesthesia and operative trauma on autonomic cardioneural system Methods Intravenous and inhalational combined anesthesia was used in 20 patients undergoing open cardiac surgery Anesthesia was induced with diazepam,etomidate,atracurium,fentanyl and succinylcholine Anesthesia was maintained with 0 5% 1% isoflurane and intermittent intravenous fentanyl and atracurium The controlled hypothermia under cardiopulmonary bypass(CPB) was used during surgery The mean times of surgery,CPB and the clamp of aorta were 240±50 min,95±43 min and 72±31 min respectively The lowest body temperature was 27℃±2 5℃.Results There were no obvious effects of anesthetic drugs on heart rate variability(HRV) Low freguency LF,high freguency (HF) and total power (TP) decreased significantly after CPB. The decrease of body temperature was accompanied with further decreases of LF,HF and TP After rewarming and restoring heart beats,the LF,HF and TP still decreased significantly and was kept to the end of surgery Conclusion The hypothermia,CPB,clamp of aorta and drugs,etc can lead to decrease of HRV in cardiac surgery,but reasonably selective use of anesthetic drugs dosescam decrease the influence of anesthetic drugs on HRV