频域分析法探讨高位硬膜外阻滞对冠心病心率变异性的影响

To Research the Effect and Clinical Meaning of Heart Rate Variability of Coronary Disease Sufferer with Thoracic Epidura Anesthesia

目的:明确高位硬膜外阻滞对冠心痛患者的植物神经调节作用及治疗意义,以便为这一新方法提供经验和理论依据。方法:选择ASAⅡ～Ⅳ级冠心病患者60例,随机分成两组,每组30例。Ⅰ组为对照组,常规内科治疗,Ⅱ组患者选取T_(4-5)硬膜外间隙穿刺置管,以微量注射泵继续输注0.8%利多卡因约(2～3)ml/h,持续5d,给药后30min,12h,24h,72h,120h分别记录患者的HRV低频(LF),高频(HF)及低高比值(LF/HF),并比较两组患者血压心率的变化情况。结果:常规内科治疗患者,血压心率变化不明显,而应用高位硬膜外阻滞后患者的血压和心率下降明显,高位硬膜外阻滞后,患者LF、HF、LF/HF均降低(P<0.05),LF降低程度显著大于HF的降低程度,LF/HF同时降低(与阻滞前相比,P<0.05),阻滞12h之后患者HRV的各项指标与3min之内相比略有升高,但不存在显著性差异(P>0.05)。结论:高位硬膜外阻滞可相对提高迷走神经的张力,局限性、可逆性地阻滞T_(1-5)支配心脏的交感神经传入和传出纤维,引起冠状血管扩张,由此改善缺血区的血供和氧供,对于冠心病临床治疗具有可行性。

Objective：To investigate the clinical effect and regulating plant-nerve effect of thoracic epidura anesthesia for coronary disease sufferers.Methods：To choose 60 coronary disease sufferers, ASA [l-IV,divide into two groups：Group I is collate group, general medical therapy;Group II is therapy group,choose T^5 epidural space insert catheter, drug use 0.8% Lidocaine,control level of anesthesia between T~_s,then continue infuse 0.8% Lidocaine （2-3）ml/h with syringe pump,last 5 days,enregister the sufferers＇s Heart Rate Variability（HRV）： low frequency（LF）;high frequency（HF） and their ratio（LF/HF） after inject 30min,12h,24h,72h,120h.Resuits：After epidural anesthesia,all of the sufferers＇s LF, HF, LF/HF fell（P〈0.05）;LF fell markedly than HF, so LF/HF fell too（P〈0.05）;all the sufferers＇s guide line of Heart Rate Variability with 12h appreciably rise than those within 3h,but there is not statistical significanee（P〉0.05）;after pull out epidural catheter 6h,guide line of HRV has significant difference between those after epidural anesthesia（P〈0.05）;guide line of HRV has no significant difference between preoperative and postoperation（P〉0.05）.Condusion：Thoracic Epidura Anesthesia can comparatively enhance pneumogastric nerve strain,partly,reversibly hocus T.s sympathetic nerve afferent fibers and centrifugal fiber, lead to a dilatation of vasa coronaria,and ameliorate the blood supply and oxygen supply of Izeg（ischemic region）,it has feasibility for clinical treatment of coronary disease.