超声引导下臂丛神经阻滞对冠心病患者心率变异性的影响

Effects of ultrasound-guided brachial plexus block on heart rate variability in patients with coronary heart disease

目的 探讨超声引导下臂丛神经阻滞对冠心病患者心率变异性(HRV)的影响。方法 60例冠心病患者,依据麻醉方式不同分为对照组及观察组,各30例。对照组采用单纯臂丛神经阻滞,观察组采用超声引导下臂丛神经阻滞。比较两组患者阻滞前后心率变异性结果 [低频(LF)、高频(HF)、LF/HF、相邻RR间期差值的均方根(RMSSD)、全部窦性心博RR间期的标准差(SDNN)、相邻NN之差>50 ms的个数占窦性心律个数百分比(PNN50%)]及血氧饱和度(SpO2)、心率、平均动脉压水平。结果 阻滞后,两组患者的LF、HF、LF/HF、RMSSD、SDNN、PNN50%水平均低于本组阻滞前,差异均有统计学意义(P<0.05)。观察组患者阻滞后的LF、HF、LF/HF、RMSSD、SDNN、PNN50%水平分别为(300.8±33.7)、(255.3±46.3)、(0.8±0.2)、(32.9±3.7)ms、(45.3±5.6)ms、(4.5±2.7)%,均低于对照组的(820.9±46.3)、(410.9±59.1)、(1.1±0.4)、(35.4±4.2)ms、(52.6±7.0)ms、(7.7±3.6)%,差异均有统计学意义(P<0.05)。两组患者阻滞前后SpO2、心率、平均动脉压水平组间组内比较,差异均无统计学意义(P>0.05)。结论 超声引导下臂丛神经阻滞应用在冠心病患者中,心率变异性小,值得临床推广应用。

Objective To discuss the effect of ultrasound-guided brachial plexus block on heart rate variability(HRV)in patients with coronary heart disease.Methods A total of 60 patients with coronary heart disease were divided into control group and observation group by different anesthesia methods,with 30 cases in each group.The control group received brachial plexus block,and the observation group received ultrasoundguided brachial plexus block.The heart rate variability results[low frequency(LF),high frequency(HF),LF/HF,square root of the mean of the squares of successive RR interval differences(RMSSD),standard deviation of the R-R intervals(SDNN),percentage of differences between adjacent NN intervals>50 ms(PNN50%)]before and after block,blood oxygen saturation(SpO2),heart rate and mean arterial pressure were compare between the two groups.Results After block,the levels of LF,HF,LF/HF,RMSSD,SDNN and PNN50%in the two groups was lower than those before block,and their difference was statistically significant(P<0.05).After block,the levels of LF,HF,LF/HF,RMSSD,SDNN and PNN50%in the observation group were(300.8±33.7),(255.3±46.3),(0.8±0.2),(32.9±3.7)ms,(45.3±5.6)ms and(4.5±2.7)% in the observation group,which were lower than(820.9±46.3),(410.9±59.1),(1.1±0.4),(35.4±4.2)ms,(52.6±7.0)ms and(7.7±3.6)% in the control group,and their difference was statistically significant(P<0.05).There were no significant differences in SpO2,heart rate,and mean arterial pressure between the two groups before and after block(P>0.05).Conclusion The application of ultrasound-guided brachial plexus block in patients with coronary heart disease has little heart rate variability,which is worthy of clinical promotion and application.