麻醉诱导过程对行腹腔镜手术患者心脏节律影响的观察

Observation of the effect of anesthesia induction on cardiac rhythm of patients undergoing laparoscopic surgery

目的目的探讨腹腔镜手术麻醉诱导过程中中心静脉穿刺(CVC)、麻醉药物及基础情况对患者心脏节律的影响。方法选取本院2020年12月至2021年6月期间行腹腔镜手术的患者共57例,根据术前是否行CVC、麻醉诱导过程中房性早搏(简称房早)、室性早搏(简称室早)的变化分为CVC组与无CVC组、房早增加组与减少组、室早增加与减少组,在麻醉诱导期间使用单导联24 h动态心电图仪记录长程心电图,根据麻醉操作的不同分为基础期间、麻醉给药期间及气管插管期间,并采用时间-RR散点图和Lorenz-RR散点图观察并分析患者心电指标变化。结果 CVC组较无CVC组在CVC期间及麻醉给药期间房早明显增加[每分钟房早个数:0.283(0.113,0.910)vs 0.093(0.000,0.230);0.426(<0.001,0.917)vs <0.001(<0.001,0.430);P均<0.05];麻醉给药期间患者仅心率减慢[(848.4±138.5)ms vs(889.1±162.2)ms,P<0.05];气管插管期间患者仅心率减慢[(889.1±162.2)ms vs(938.6±161.0)ms,P<0.05]。结论腹腔镜手术麻醉诱导过程中,CVC能引起患者房早显著增加;麻醉给药及气管插管仅引起心率减慢。

Objective To investigate the effects of central venous catheter(CVC),anesthetic drugs and basic conditions on cardiac rhythm during anesthesia induction in laparoscopic surgery.Methods A total of 57 patients who underwent laparoscopic surgery in our hospital from December 2020 to June 2021 were selected.According to whether they underwent CVC before operation and the changes of atrial premature beats and ventricular premature beats during anesthesia induction,they were divided into CVC group and non CVC group,atrial premature increase group and decrease group,ventricular premature increase and decrease group.During anesthesia induction,single lead 24 h ambulatory electrocardiograph was used to record long-range electrocardiogram.According to different anesthesia operations,it was divided into basic period,anesthesia administration period and endotracheal intubation period.The changes of cardiac rhythm were analyzed by t-RR scatter diagram and Lorenz-RR scatter diagram.Results Compared with non CVC group,atrial premature beats in CVC group increased significantly during CVC and anesthesia administration [number of atrial premature beats per minute:0.283(0.113,0.910)vs 0.093(0.000,0.230);0.426(<0.001,0.917)vs <0.001(<0.001,0.430);both P<0.05].Only the heart rate decreased during anesthesia administration [(848.4±138.5)ms vs(889.1±162.2)ms,P<0.05].Only the heart rate decreased during endotracheal intubation[(889.1±162.2)ms vs(938.6±161.0)ms,P<0.05].Conclusion During the induction of anesthesia in laparoscopic surgery,CVC can cause a significant increase in atrial premature contractions;anesthesia administration and tracheal intubation only cause heart rate slow.