自主神经竞争性机制在肺叶切除术后房颤发生中的作用

The role of competitive mechanism of autonomic nerves in triggering atrial fibrillation after lobectomia pulmonalis

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前24 h、术后连续96 h的动态心电图监测,对出现房颤患者术前2 h、房颤发生前60 min、30 min、5 min的动态心电图的心率变异性指标进行分析,选取5 min的阶段,研究心率变异性在房颤发生前4个时间点的变化趋势,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例出现房颤,发生率17.1%;房颤发生前60 min、30 min、5 min反映迷走神经张力的指标SDNN、r MSSD、p NN50、HF均有明显升高,而反映交感/副交感神经平衡的指标LF/HF则有逐渐降低趋势;在房颤发生前5 min的SDNN、r MSSD、p NN50、HF明显升高,而LF/HF比值明显降低,表明迷走神经张力明显升高,RR间期在房颤发生前逐渐缩短。结论肺叶切除术后的房颤发生前心率变异性存在明显升高的表现,肺叶切除术后交感神经张力明显升高的背景下迷走神经张力竞争性升高可能是导致房颤发生的重要机制。

Objective To evaluate the role of competitive mechanism of autonomic nerves in triggering atrial fibrillation( AF) after lobectomia pulmonalis.Methods Ambulatory electrocardiography( AECG) monitoring was carried out 24 hours before the operation and consecutively 96 hours after the operation on 281 patients over 60 who had received total pneumonectomy or lobectomia pulmonalis.For patients with appearance of AF,it was 2 hours before the operation,and 60 minutes,30 minutes,and 5 minutes before the onset of AF when the heart rate variability( HRV) indices of AECG were analyzed.With an interval of 5 minutes chosen,the trend of HRV changes at the four time points before the onset of AF was studied,and so were tension variations of autonomic nerves and vagus.Results In 281 pneumonectomy patients,48 was diagnosed with AF postoperatively,with an incidence of 17.1%.The indexes reflecting tension of vagus such as SDNN,r MSSD,p NN50,and HF all increased significantly,60 minutes,30 minutes,and 5 minutes before the onset of AF,however,the index of LF / HF which reflected the balance of autonomic nerves and parasympathetic was proned to descend gradually.The fact that the indexes of SDNN,r MSSD,p NN50,and HF increased significantly and the ratio of LF / HF decreased significantly 5 minutes before the onset of AF indicated a significant increase of vagus tension and a gradual decrease of RR interval before the onset of AF.Conclusion After lobectomia pulmonalis and before the onset of AF,there is a significant increase in HRV.Against the background of significantly increased autonomic nerves tension after lobectomia pulmonalis,the competitive increase of vagus tension may be an important mechanism of the onset of AF.