肺叶切除术后自主神经在房颤中的作用

The role of autonomic competing mechanism in the trigger of atrial fibrillation after pumonary sugery

目的探讨自主神经在肺叶切除术后房颤发生中的作用。方法对281例60岁以上接受肺叶或全肺切除术的患者进行术后连续96h的动态心电图监测,对出现房颤患者在房颤发生前2h的心率变异性指标进行分析,并与同期性别、年龄相匹配未发生房颤患者相应时间段的心率变异性指标进行对比研究,分析交感神经张力与迷走神经张力在房颤发生前的变化。结果 281例肺切除患者术后有48例患者出现房颤,发生率17.1%;房颤组及对照组的病例基本资料无明显统计学差异,房颤组在房颤发生前2h反映迷走神经张力的指标SDNN、rMSSD、pNN50、HF明显增高,而反映交感/副交感神经平衡的指标LF/HF与对照组降低无统计学差异;而在房颤发生前5min SDNN、rMSSD、pNN50、HF明显增高,而LF/HF比值明显降低,表明迷走神经张力明显增高。结论肺叶切除术后的房颤发生前心率变异性存在明显增高的表现,肺叶切除术后交感神经张力明显增高的背景下迷走神经张力竞争性增高可能是导致房颤发生的重要机制。

Objective This study was designed to evaluate autonomic nervous changes preceding atrial fibrillation after pulmonary surgery. Methods 96 h Holter was recorded in cosecutive 281 patients who received pulmonary surgery with age over 60 years, and 48 patients occured atrial fibrillation. 2h Holter recordings before the onset of atrial fibrillation was compared with corresponding data from 48 age- and gender- matched surgical controls without AF. Five- minute segement of heart rate variability were studied. Results There was a signifaicant trend for RR interval among patients with AF to be lower than controls(p=0.06), where as SDNN、r MSSD、p NN50、HF were significantly higher in patients with AF,and LF/HF was significantly lower in patients with AF 5 minutes before the onset of AF, respectively. Conclusions In the period before the onset of postoperative AF, there was a significant increases in HRV during a time when heart rate also increase. The parasympathetic resurgence competing with increasing sympathetic activity may be the important mechanism for postoperative AF.