老年心血管病白内障手术心率变异性研究

The research of the heart rate variability in cataract surgery among aged patients with cardiovascular disease

目的通过前瞻性研究，观察老年心血管病患者白内障手术心率变异性（HRV）的变化，评估白内障手术心脏自主神经系统（ANS）功能变化，为制定防治围手术期心血管事件发生的干预措施提供参考依据。方法选择60岁以上老年白内障择期手术病例120例，其中合并心血管病老年白内障60例（观察组），无心血管病老年白内障60例（对照组）。所有病例均在局部麻醉下行非超声乳化小切口白内障囊外摘除联合人工晶体植入手术。根据麻醉方式不同（表面麻醉或球周麻醉）每组随机各分2小组，每小组30例。采用24h动态心电图（DCG）观察围手术期HRV时域和频域指标的变化，对所得HRV时域和频域指标数据用统计学方法进行对比分析研究。结果观察组时域指标和频域指标均显著低于对照组。手术麻醉方式方面，无论观察组和对照组，球周麻醉组时域和频域指标亦均明显低于表面麻醉组；不同麻醉方式下的手术分别显示，观察组的频域指标显著低于对照组频域指标。结论老年心血管病患者白内障手术对心脏ANS功能存在着影响和损害，提示可能较易发生心血管事件。与球周麻醉方式相比较，在表面麻醉方式下进行白内障人工晶状体手术，对心脏ANS功能损害和影响较小，表明该麻醉方式下进行的手术更为安全和稳定。

Objective T observe the heart rate variability （HRV） in cataract surgery among aged patients with cardiovascular disease prospectively, to evaluate the function changes of the autonomic nervous system （ANS） of the heart in cataract surgery, and to provide reference in formulating inter- vention measures to control cardiovascular event during perioperative. Methods A total of 120 elec- tive cataract surgery cases with patients＇ age over 60 were chosen, and classified into observation group （60 cases） and control group （60 cases） according to with or without cardiovascular disease conditions. All cases were undergoing non-phacoemulsification small incision cataract extracapsular ex- cision with artificial crystal implants surgery. According to anesthesia mode （surface anesthesia or per- ibulbar anesthesia）, each group classified into 2 sub-groups randomly, 30 cases each sub-group. Twen- ty-four hours dynamic electrocardiogram （DCG） was used to observe the changes of HRV time do- main and frequency domain indexes during perioperative. Contrast analyzed the time domain and fre- quency domain indexes with statistical methods. Results The time domain indexes and frequency domain indexes of the observation group were significantly lower than those of the control group. With anesthesia mode, no matter in observation group or control group, the time domain indexes and frequency domain indexes in peribulbar anesthesia group were significantly lower than surface an- esthesia group. In observation group and control group in different anesthesia mode （peribulbar anes-thesia and surface anesthesia）, all surgery showed that, the frequency domain indexes of the observa- tion group were significantly lower than those of the control group. Conclusions The cataract sur- gery among aged patients with cardiovascular disease show influence and damage in ANS of the heart, which suggests that it may occur cardiovascular events more easily. Compared to peribulbar an- esthesia, the artificial crystal implants surgery undergo with surface anesthesia has less influence and damage to the function of ANS of the heart, which indicate that surface anesthesia give the surgery more security and stability.