全麻复合硬膜外阻滞对腹部手术患者心率变异性的影响.docVIP

全麻复合硬膜外阻滞对腹部手术患者心率变异性的影响 作者：景桂霞，朱耀民，叶平安 【关键词】 麻醉 关键词: 麻醉，吸入;安氟醚;硬膜外阻滞;腹部手术;心率 摘 要:目的 探讨全麻复合高位硬膜外阻滞对手术患者心率变异性的影响. 方法 40例择期中上腹部手术患者分为安氟醚吸入组（Ⅰ）和安氟醚吸入复合高位硬膜外阻滞组（Ⅱ），每组20例，利用心率变异功率谱分析法对麻醉前、麻醉诱导后、插管后、麻醉后、切皮后及拔管后心率变异性及血流动力学进行分析. 结果 麻醉诱导后及麻醉后两组LF，LF/HF，TP显著降低;插管后、切皮后及拔管后，Ⅰ组LF，LF/HF及TP显著升高，而Ⅱ组未见明显改变;组间比较显示上述各指标组间均有显著性差异.血流动力学改变与自主神经系统功能变化基本一致. 结论 全麻复合胸段硬膜外阻滞可显著降低交感神经活性、交感/迷走均衡性和植物神经总张力;并显著降低手术刺激对自主神经功能及血流动力学的影响，利于机体血流动力学稳定. 　　Keywords:inhaled anesthesia，inhalation;enflurane;epidural block;abdomen surgery;heart rate 　　Abstract:AIM To investigate the effects of enflurane com-bined with thoracic epidural anesthesia on the autonomic ner-vous system of patients treated surgically.METHODS Forty patients scheduled for elective abdominal operation were randomly allocated into enflurane group（Ⅰ）and enflu-rane combined with epidural anesthesia group（Ⅱ）.Heart rate variability（HRV）was assessed at preanesthesia，after anesthesia induction，after intubation，after anesthesia，after　skin cut and after extubation.RESULTS LF，LF/HF，TP decreased significantly after anesthesia induction and after anesthesia in the two groups;after intubation，after skin cut and after extubation，LF，LF/HF and TP increased signifi-cantly in GroupⅠ，but did not change markedly in GroupⅡ.There was a significant difference between the two groups.CONCLUSION Enflurane combined with thoracic epidural anesthesia can decrease the sympathetic nervous activity，the balance of sympathetic and parasympathetic nervous activity and the total power of sympathetic and parasympathetic ner-vous system significantly;and it can also decrease the influ-ence of operation stimulation on autonomic nervous function and cardiovascular system significantly. 　　0 引言 　　心率变异性（heart rate variability，HRV）是指逐次心搏周期之间的微小差异，产生于自主神经系统对心脏窦房结的调制;心率变异功率谱分析（heart rate variability power spectrum analysis，HRPSA）是一种无创的定量反映自主神经系统功能及其对心血管系统调控作用的方法.我们应用HRPSA观察了安氟醚吸入和安氟醚吸入复合高位硬膜外阻滞过程中手术患者HRV的变化，探讨两种