前列地尔控制性降压对老年患者心率变异性的影响

目的研究前列地尔用于老年患者控制性降压时对心率变异性（HRV）的影响。方法86例择期全身麻醉下行鼻内窥镜手术的老年患者按随机数字表法分为前列地尔组（43例）和硝酸甘油组（43例）。两组术中分别以前列地尔和硝酸甘油持续输注，使平均动脉压（MAP）下降25％～30％。以降压前（To）、降至目标血压时（T1）、降至目标血压后5min（T2）、降至目标血压后30min（L）、停降压时（T4）及停降压后30min（T5）为时间点，记录两组MAP、心率（HR）、血浆乳酸（LAC）水平及HRV各指标[总功率（TP）、低频功率（LF）、高频功率（HF）及LF／HF]，并进行比较。结果 硝酸甘油组Tl∽T4时HR较T0时增快（P〈0．05），且较前列地尔组同时间点显著增快（P〈0．05），T5时硝酸甘油组HR较T0时仍增快（P〈O．05）；而前列地尔组T1～T5时HR与T0时比较差异无统计学意义（P〉0．05）。两组各时间点LAC水平组内及组间比较差异均无统计学意义（P〉0．05）。T1～T4时两组TP、LF、HF较T0时明显下降（P〈0．05），前列地尔组T1～T4时HF明显高于硝酸甘油组（P〈0．05）；T1∽T4时前列地尔组LF/HF与T0时比较差异无统计学意义（P〉O．05），而硝酸甘油组T1～T4时LF／HF显著升高（P〈0．05），同时也高于前列地尔组（P〈0．05）；B时两组TP、LF、HF均回升，T5时前列地尔组HF高于硝酸甘油组（P〈0．05）；T5时前列地尔组LF／HF仍维持在T0时水平，而硝酸甘油组LF／HF水平虽下降但仍高于T0时水平且高于前列地尔组（P〈O．05）。结论前列地尔用于控制性降压时更易维持心脏自主神经的均衡性，有利于老年患者围手术期安全。

bjective To clarify the heart rate variability (HRV) changes in patients subjected to deliberate hypotension with alprostadil.Methods Eighty-six elderly patients scheduled for nasal endoscopic surgery in general anesthesia were divided into alprostadil group (group A) and nitroglycerin group (group N) with 43 cases each by random digits table.Hypotension was induced with alprostadil and nitroglycerin through continuous infusion respectively,and the mean arterial pressure (MAP) was reduced to about 25％-30％ of baseline MAP.The MAP,heart rate (HR),total power ( TP ),low frequency (LF),high frequency (HF),and LF/HF were continuously monitored and blood was taken for analysis of lactate (LAC) before deliberate hypotension (T0),at the time of dropping to target blood pressure (T1),at 5 and 30 min after deliberate hypotension (T2 and T3),stopping deliberate hypotersion (T4) and 30 min after recovery from hypotension (T5).Results HR at T1-T4 was faster than that at T0in group N(P ＜ 0.05),and faster than that in group A( P ＜ 0.05 ),HR at T5 was faster than that at T0 in group N( P ＜ 0.05 ),but HR was stable at T1-T5 in group A (P ＞ 0.05 ).There was no significant difference in LAC of group A and group N whether in interior group or between two groups (P＞ 0.05).TP,LF and HF at T1-T4 were lower than those at T0 in two groups ( P ＜ 0.05 ),HF at T1-T4 was higher in group A than that in group N(P ＜ 0.05 ) ; LF/HF was no change at T1-T4 compared with that at T0 in group A (P ＞ 0.05),but increased in group N (P ＜ 0.05 ) which was higher than that in group A at the same time ( P ＜ 0.05 ) ;TP,LF and HF was recovered at Ts in two groups,and HF at T5 in group A was higher than that in group N( P ＜ 0.05 ) ; LF/HF at T5 in group A maintained the level at T0,but decreased in group N and lower than that at T5 in group N(P ＜ 0.05).Conclusion Alprostadil for deliberate hypotension is more likely to maintain cardiac autonomic nerve balance that is helpful for perioperative security of elderly patients.