围手术期成对室早或短阵室速发生前心率变异性的动态变化

Changes of heart rate variability before the onset of perioperative ventricular couplets or nonsustained ventricular tachycardias

目的 探讨围手术期成对室早或短阵室速发生前心率变异性的变化规律。方法 以动态心电图监测 12 1例择期手术病人 ,术前监测至少 12小时、术后 48小时 ,记录每次成对室早(VC)、短阵室速 (NSVT)发生前 4～ 3、3～ 2、2～ 1、1～ 0小时 ,6 0～ 45、45～ 30、30～ 15、15～ 0、15～ 10、10～ 5、5～ 0分钟各时间段的心率变异性总功率 (TP)、高频 (HF)、低频 (LF)、极低频 (VLF)、LF/HF和平均RR间期 (meanRR)。结果 VC、NSVT发生前 1～ 0小时的TP、HF、LF、meanRR明显降低 ;LF/HF在VC发生前 1～ 0小时也有显著下降 ,而在NSVT发生前无变化 ;在VC、NSVT发生前 1～ 0小时内的心率变异性 (HRV)无明显变化趋势。结论 围手术期VC、NSVT的发生与自主神经功能的受损有关 ,表现为VC、NSVT发生前存在TP、HF、LF、meanRR的下降 ,提示HRV的降低可能是VC。

Objective To observe the changes of heart rate variability (HRV) before the onset of perioperative ventricular couplets (VC)or nonsustained ventricular tachycardias (NSVT).Methods One hundred and twenty one patients scheduled for elective surgery were monitered with dynamic electrocardiogram for at least 12h before surgery and 48h after surgery.The changes of HRV,including total-power(TP),high-frequency(HF),low-frequency(LF),very-low-frequency(VLF),LF/HF and mean RR intervals,were recorded and analyzed in 4-3,3-2,2-1,1-0h,60-45,45-30,30-15,15-0,15-10,10-5 and 5-0min before each ventricular couplet(VC)or each nonsustained ventricular tachycardia(NSVT).Results TP,HF,LF,meanRR in 1-0h before VC and NSVT decreased significantly;LF/HF in 1-0h before VC decreased significantly,but not that before NSVT;No significant trends or alterations of HRV were observed within 1-0h before VC or NSVT.Conclusion Perioperative VC and NSVT are associated with automatic nervous dysfunction.It is suggested that the depressed HRV could be a prognostic indicator of perioperative VC and NSVT.