心率变异性在雷米芬太尼靶控输注非体外循环冠状动脉搭桥术中的应用

Application of heart rate variability in remifentanil target controlled infusion for the anesthesia in off-pump coronary artery bypass surgery

目的研究心率变异性(HRV)在雷米芬太尼靶控输注用于非体外循环冠状动脉搭桥术(OP-CABG)时的应用价值。方法 65例择期行OP-CABG的患者分为靶控组(Ⅰ组,32例)和恒速组(Ⅱ组,33例)。记录两组诱导前(T0)、诱导后(T1)、气管插管时(T2)、锯胸骨后2 min(T3)、暴露和固定前降支后(T4)、暴露和固定右冠及(或)回旋支后(T5)、手术结束时(T6)、气管拔管时(T7)、术后24 h时(T8)的血流动力学参数及血浆肾上腺素、皮质醇、血糖、乳酸浓度;同时采用频域分析法测定HRV各指标。结果两组患者T7时心率、平均动脉压、血浆肾上腺素、皮质醇较T0时均明显增高(P均<0.05),血糖、乳酸水平均从T3开始增高,且T5、T6、T7时点Ⅱ组均高于Ⅰ组(P均<0.05)。HRV各指标总功率、低频功率、高频功率、低频功率/高频功率从麻醉诱导起均开始降低,但在T5及T7时除高频功率外均升高(P均<0.05);且在T5时,Ⅱ组总功率、低频功率、低频功率/高频功率水平均高于Ⅰ组,差异均有统计学意义(P均<0.05)。结论通过HRV监测,雷米芬太尼靶控输注能更好地抑制OP-CABG中应激反应,维持心脏自主神经平衡。

Objective To investigate the efficacy of heart rate variability in patients receiving off-pump coronary artery bypass grafting （OP-CABG） with remifentanil target controlled infusion for anasthesia. Methods A total of 65 patients undergoing elective OP-CABG were randomly divided into the target controlled infusion group （group 1, 32 cases） and constant infusion group （group Ⅱ, 33 cases）. The hemodynamic parameters and the plasma epinephrine, cortisol, blood glucose, lactate were detected and recorded at a series of time points： before induction （To）, after induction （T1）, during intubation （T2）, 2 min after sternum saw （T3）, exposure and stabilization of the left anterior descending artery （T4）, the circumflex or right coronary artery （T5）, at the end of operation （T6）, during extubation （T7）, and 24 h after operation （T5） HRV indices were also recorded by frequency domain analysis： the total power, low frequency power, high frequency power and low frequency power / high frequency power, at each time point. Results The indices of heart rate, mean artery pressure, epinephrine and cortisol at T~ in the two groups were much higher than those at To （all P 〈 0.05）. The levels of blood glucose and lactic acid in the two groups increased at T3, and were higher at T5, T6, T7 in the group Ⅱ than those in group I （all P 〈 0.05）. HRV indices in the two groups all decreased after theinduction, whereas high frequency power, the total power, low frequency power and low frequency power/high frequency power raised at 3＂5 and ＂Iv, and the total power, low frequency power and low frequency power/high frequency power at T5 were much higher in the group Ⅱ than those in group I （all P 〈 0.05）. Conclusion Remifentanil target controlled infusion can suppress the stress response and maintain the balance of cardiac autonomic nervous system in OP-CABG by HRV.