阿托品试验对术中使用心脏起搏治疗预测价值的临床研究

Clinical Study of Value of Atrapine Test in Predicting the Necessity of Cardiac Pacing During Operation

研究阿托品试验对预测手术过程中需行心脏起搏治疗的临床价值。方法:窦性心动过缓并需手术治疗的患者,术前行阿托品试验,并在麻醉前后和关腹前测窦房结恢复时间(SNRT)、校正窦房结恢复时间(cSNRT)、窦房传导时间(SACT),观察术中最慢心率及使用心脏起搏治疗情况。结果:阿托品试验最快心率(HR_(max))≤80bpm组术中应用心脏起搏者较HR_(max)>80bpm组明显增多,术中最慢心率(HR_(min))明显减低(均P<0.01);术前SNRT≥2000ms组术中应用心脏起搏者较SNRT<1500ms组增多(P<0.05);连硬外组术中应用心脏起搏者较全麻组多(P<0.01)。阿托品试验HR_(max)与关腹前SNRT呈负相关(P<0.05);术中HR_(min)与麻醉前后及关腹前SNRT呈负相关(分别P<0.01,P<0.01,P<0.05)。结论:阿托品试验HR_(max)≤80bpm,必须做术中心脏起搏治疗准备,麻醉方式首选全麻。对80bpm<HR_(max)<90bpm的患者,应谨慎抉择,最好结合其SNRT、cSNRT、SACT综合判断,若3项中有1项异常,仍需做术中心脏起搏治疗准备;如果1500ms≤SNRT<2000ms应在术前放置心脏起搏电极备用。

To study clinical value of atropine test in predicting the necessity of cardiac pacing during operation.Methods: In patients with sinus bradycardia, sinus nodal recovery time (SNRT), corrected sinus nodal recovery time(cSNRT) and sinus a-trial conduction time( SACT) were determined before and during operation and before abdomen - closing. HRmin and usage of cardiac pacing during operation were recorded. Results: According to atropine test, the patients in HRmax≤ 80bpm group needing cardiac pacing was more than those in HRmax> 80bpm,and HRmin during operation was obviously decreased average (all P < 0.01);the patients in SNRT>2000ms before operation needing cardiac pacing was more than those in SNRT< 1500ms( P < 0.05) ; and the patients in continuous epidural anesthesia meeding cardiac pacing was more than those in general anesthesia( P < 0.01);HRmax in at-roping test had negative correlation with WNRT befroe abdomen - closing ( P < 0.05) ; HRmin during operation had negative correlation with SNRT before, during anesthesia and before abdomen - closing(each P < 0.01, P < 0.01, P < 0.05). Conclusion:Cardiac pacing should be prepared for the patients with HRmax ≤80bpm in atropine test during operation, and general anesthesia is of the first choice. As for padents with HRmax between 80bpm and 90bpm, design should be made cautiously; if one of SNRT, cSNRT, SACT is abnonnal, cardiac pacing should be prepared for operation too; if 1500ms≤SNRT< 2000ms,cardiac pacing electrode should be positioned in esophagus for preparation before operation.