电针预处理联合α2AR激动剂对围手术期心率变异性的影响

Effect of Pre-intervention with Electroacupuncture at Neiguan(PC 6) plus Intra-operative Administration of α2-adrenoceptor Agonist on Peri-operative Heart Rate Variability

目的观察电针预处理联合α2肾上腺素能受体(α2AR)激动剂对围手术期患者心率变异性的影响。方法将择期行下肢骨科手术患者120例,采用查随机数字表法随机均分为4组,对照组(A组)、电针组(C组)、α2AR组(D组)和针药复合组(N组),每组30例。记录4组术前1 d、术后1 d HRV各项指标,具体为SDNN、SDANN、rMSSD、pNN50、LF、HF、LF/HF及TP;同时记录插管前(T0)、插管后即刻(T1)、插管后5 min(T2)、拔管后即刻(T3)、拔管后5 min(T4)、拔管后60 min(T5)、拔管后180 min(T6)患者平均动脉压(MAP)、心率(HR)的变化情况。结果N组各时点HR、MAP与T0比较差异无统计学意义(P>0.05),A组T1~T6时点HR、MAP较T0明显升高(P<0.05),C组、D组T1~T4时点HR、MAP较同组T0明显升高(P<0.05);N组T1~T6时点HR、MAP明显低于A组(P<0.05),T1~T4时点HR、MAP明显低于C、D组(P<0.05);C组、D组T5、T6时点HR、MAP明显低于A组(P<0.05)。与术前1 d比较,A组术后1 d LF、HF、LF/TF、TP均明显增高(P<0.05),A组、D组术后1 dSDDN、SDANN、rMSSD、pNN50明显降低(P<0.05);C组、D组、N组术后1 dLF、HF、LF/TF、TP较A组均显著降低(P<0.05);C组、N组术后1 dSDDN、SDANN、rMSSD、pNN50较A组、D组均显著升高(P<0.05)。结论电针预处理联合α2AR激动剂改善心脏交感/迷走神经的平衡状态,更好地维持围手术期血流动力学稳定。

Objective To observe the effect of pre-intervention with electroacupuncture at Neiguan （PC 6） plusα2-adrenoceptor （α2AR） agonist on peri-operative heart rate variability （HRV）.Method A total of 120 patients going to receive lower limb orthopedic surgery were randomized into four groups by using the random number table, namely a control group （group A）, an electroacupuncture group （group C）, anα2AR agonist group （group D） and an electroacupuncture plus medication group （group N）, 30 cases in each group. The indicators of heart rate variability （HRV）, including the standard deviation of normal-to-normal （N-N） intervals （SDNN）, standard deviation of the average of N-N intervals （SDANN）, root mean square successive differences （rMSSD）, percentage of adjacent N-N intervals〉50 ms apart （pNN50）, low-frequency power （LF）, high-frequency power （HF）, LF/HF and total power （TP） were recorded 1 d prior and 1 d after the operation; meanwhile, the mean arterial pressure （MAP） and heart rate （HR） were recorded before incubation （T0）, right after incubation （T1）, 5 min after incubation （T2）, right afterextubation （T3）, 5 min after extubation （T4）, 60 min after extubation （T5）, and 180 after extubation （T6）.Result In group N, the HR and MAP at the other time points were insignificantly different from those at T0 （P〉0.05）; in group A, the HR and MAP at T1-T6 were significantly different from those at T0 （P〈0.05）; in group C and D, the HR and MAP at T1-T4 were significantly different from those at T0 （P〈0.05）; the HR and MAP in group N were significantly lower than those in group A at T1-T6 （P〈0.05） and were significantly lower than those in group C and D at T1-T4 （P〈0.05）; the HR and MAP in group C and D were significantly lower than those in group A at T5 and T6 （P〈0.05）. In group A, the LF, HF, LF/HF and TP 1 d after the operation were significantly increased compared to those 1 d prior to the operation （P〈0.05）; in group A and D, the SDNN, SDANN, rMSSD, and pNN501 d after the operation were significantly lower than those 1 d prior to the operation （P〈0.05）; the LF, HF, LF/HF, and TP in group C, D and N were significantly lower than those in group A 1 d after the operation （P〈0.05）; the SDNN, SDANN, rMSSD, and pNN50 in group C and N were significantly higher than those in group A and D 1 d after the operation （P〈0.05）. Conclusion Pre-intervention electroacupuncture plusα2AR agonist can improve the balance of cardiac sympathetic and vagus nerves, and better maintain the peri-operative hemodynamic stability.