利多卡因联合阿托品对全麻下择期手术的老年患者心率变异性的影响

Effect of lidocaine combined with atropine on heart rate variability in elderly patients with elective surgery under general anesthesia

目的探讨静脉注射利多卡因联合阿托品对全麻下择期手术的老年患者心率变异性的影响。方法将60例美国麻醉医师协会(ASA)Ⅱ~Ⅲ级的患者随机分为利多卡因联合阿托品组(LA组)、阿托品组(A组)和生理盐水对照组(S组),每组20例。LA组在诱导前先静脉注射2%利多卡因1.5 mg/kg,A组和S组注射等量生理盐水。插入喉罩5 min后,LA组、A组注射阿托品0.5 mg,S组注射等量生理盐水。记录各组患者麻醉诱导前(T0)、诱导后1 min(T1)、3 min(T2)、静脉注射阿托品或生理盐水后1 min(T3)、3 min(T4)心率变异性(HRV)的变化。结果与T0时点比较,3组T1及T2时点低频段(LF)、高频段(HF)及总功率频段(TP)均显著下降(P<0.05),A组和S组低频段与高频段比值(LF/HF)显著下降(P<0.05);LA组HF高于A组和S组,LF/HF低于A组和S组,差异均有统计学意义(P<0.05)。与T2时点比较,3组T3、T4时点LF、TP均显著升高(P<0.05);LA组和S组T3、T4时点LF/HF与T2时点比较,差异无统计学意义(P>0.05),A组T3、T4时点LF/HF较T2时点显著升高(P<0.05)。与T2时点比较,LA组T3、T4时点LF、TP升高程度及HF下降程度低于A组,但高于S组,差异有统计学意义(P<0.05)。结论静脉注射利多卡因能显著抑制交感神经兴奋,联合使用阿托品后能减弱对老年患者心率变异性的影响,维持老年患者自主神经调节的平衡状态。

Objective To study the effect of intravenous injection of lidocaine combined with atropine on heart rate variability in elderly patients with elective surgery under general anesthesia.Methods Sixty patients with class Ⅱ or Ⅲ of American Society of Anesthesiologists (ASA) were randomly assigned into three groups: lidocaine combined with atropine group (LA group),atropine group (A group) and normal saline control group (S group),with 20 cases in each group. Group LA was given 2% of lidocaine for 1. 5 mL/kg before anesthesia induction,groups A and S were given the same volume of saline. After insertion of laryngeal mask for 5 minutes,group LA and A were given 0.5 mg of atropine,while group S was given same volume of saline. Change of heart rate variability was recorded before induction (T0),at 1 min (T1) and 3 min (T2) after induction,and at 1 min (T3) and 3 min (T4) after intravenous infusion of atropine or saline. Results Compared with T0,the low frequency band (LF),high frequency band (HF) and total power band (TP) at T1 and T2 were significantly decreased in three groups (P < 0. 05),the LF to HF ratios (LF/HF) in groups A and S were significantly decreased at T1 and T2 (P < 0. 05). The HF of group LA was significantly higher than group A and S,but the LF was significantly lower than group A and S (P < 0. 05). Compared with T2,the LF and TP at T3 and T4 of all three groups were significantly increased (P < 0. 05),the LF/HF of groups LA and S showed no significant difference (P > 0. 05),while was significantly increased in group A at T3 and T4 (P < 0. 05). Compared with T2,the increase of the LF and TP and the decrease of the HF in group LA were significantly less than those in group A (P < 0. 05),but were significantly higher than that in group S. Conclusion Intravenous injection of lidocaine can significantly inhibit the excitement of sympathetic nervous. Lidocaine combined with atropine can decrease the effect on the heart rate variability in elderly patients,and maintain the balance between the autonomic nerve.