冠心病患者腹部手术全麻诱导气管插管过程中自主神经功能的变化

Changes of the autonomic nervous system during induction and intubation in patients with coronary artery disease undergoing abdominal surgery

目的 探讨冠心病非心脏手术患者在全麻诱导气管插管过程中自主神经系统功能的变化。方法 应用心率变异性 (HRV)分析法对 30例择期冠心病患者腹部手术 (Ⅰ组 )和 30例择期无冠心病腹部手术患者 (Ⅱ组 )麻醉前、麻醉诱导后、气管插管后的心率变异性改变进行分析。结果麻醉诱导后Ⅰ组LF、HF、LF/HF、TP显著降低 ,Ⅱ组LF、LF/HF及TP亦显著降低而HF未见明显改变。气管插管后两组HRV值均显著升高 ;组间比较显示 ,麻醉诱导后及气管插管后Ⅰ组HF和TP显著低于Ⅱ组 ,而LF组间无明显差异。结论 麻醉诱导气管插管过程中 ,冠心病患者迷走神经活性及总自主神经张力显著低于非冠心病患者 。

Objective To investigate the changes of the autonomic nervous system during induction and intubation in patients with coronary artery disease undergoing abdominal operation.Methods Thirty patients with coronary artery disease (group Ⅰ) and thirty patients without coronary artery disease (group Ⅱ)scheduled for elective abdominal operation were selected.Heart rate variability (HRV) was assessed before operation,after anesthesia induction and after trachea intubation using heart rate power spectrum analysis(HRPSA).Results After anesthesia induction,LF,HF,LF/HF and TP decreased significantly in group Ⅰ,and LF,LF/HF and TP decreased significantly in group Ⅱ.After trachea intubation,LF,HF,LF/HF and TP increased significantly in both groups.During induction and intubation,HF anf TP in group Ⅰ was lower than those in group Ⅱ significantly,but LF did not changed markedly in both groups.Conclusion Parasympathetic nervous activity and the total power of autonomic nervous system are decreased significantly during induction and intubation in patients with coronary artery disease compared with those in patients without coronary artery disease,indicating that the efect of parasympathetic nervous activity on the sinoatrial node is impaired. [