硬膜外麻醉对心率变异性的影响.doc

硬膜外麻醉对心率变异性的影响 段思源1 ，庄心良2，李继昌2 [摘要] 目的：观察硬膜外麻醉对心率变异性(HRV)的影响。方法：25例ASAⅠ～Ⅱ级择期手术患者，以硬膜外穿刺部位的高低分为A、B两组：A组15例为中胸段硬膜外麻醉组；B组10例为腰段硬膜外麻醉组。分别测定硬膜外麻醉前后心率变异性的功率谱及心率、血压变化。结果：中胸段硬膜外麻醉后低频(LF)、总功率(TF)及平均动脉压(MAP)均显著下降(P0.01)，LF、TF值与血压的变化之间存在正相关。腰段硬膜外麻醉对HRV未见明显影响。腰段麻醉10min后LF、TF、MAP均高于中胸段麻醉(P0.05～P0.01)。结论：中胸段硬膜外麻醉可影响心率变异性，使反映交感神经张力的LF值明显下降，其对心率变异性的影响与麻醉平面有关。 [关键词] 麻醉，硬膜外；心率变异性；心率功率谱分析 [中国图书资料分类法分类号]R614.42 [文献标识码]A The effects of epidural anesthesia on heart rate variability DUAN Si-yuan, ZHUANG Xin-liang, LI Ji-chang. (Department of Anesthesiology, Shanghai Traditional Chinese Medicine Integrated Hospital, Shanghai 200082, China) [Abstract] Objective: The purpose of this study was to observe the effects of epidural anesthesia on heart rate variability(HRV). Methods: Twenty-five ASA ⅠtoⅡ patients scheduled for elective surgery under epidural anesthesia were included in this study. They were divided into two groups according to the segment of epidural block. Group A included 15 patients undergoing cholecystectomy or gastrectomy under epidural anesthesia on middle chest segment and group B included 10 patients undergoing orthopaedics operation __________________________ [作者单位]1.上海市中西医结合医院 麻醉科，200082；2。上海市第一人民医院 麻醉科，200080 [作者简介]段思源(1964 - )，男，上海人，主治医师. on lower limbs under epidural anesthesia on lumbar segment. The Power spectrum of HRV, heart rate and blood pressure(BP) were observed before and after epidural anesthesia respectively. Results: (1)The value of low frequency(LF), total frequency(TF) and BP were markedly reduced 5, 10, 15 and 20 minutes after epidural anesthesia on middle chest segment(P0.01). LF and TF correlated closely with BP(r=0.9802, 0.9683, P0.01). (2)HRV changed little after epidural anesthesia on lumbar segment. Conclusion: The epidural anesthesia on middle chest segment has the influence to HRV which correlates with the level of epidural block and reduces the value of LF reflecting the tension of the sympathetic nerve. [Key words] anesthesia, epidura