老年白内障手术心率变异性观察

目的观察非超声乳化老年白内障手术的心率变异性（HRV）改变，了解围手术期心脏自主神经系统（AbIS）功能的影响，为评估手术风险性研究提供理论依据。方法采用前瞻性研究方法，随机选择60例（60只眼）年龄〉／60岁无心血管病史的白内障摘除术患者，统一在局部麻醉下进行非超声乳化白内障囊外摘除＋人工晶体植入手术。在手术前1d17：00开始至次日术后17：00，进行24h动态心电图（DCG）记录测定HRV频域指标。观察老年白内障患者手术前00：00～05：00时段（术前）、手术时段（术中）及术后12：00～17：00时段（术后）频域指标（LF、HF、LF／HF）的变化；分析其改变特点和原因。结果全部患者在围手术期间，三个时点HRV频域比较差异有统计学意义（P〈0．01）；术中和术后HRV频域指标均明显低于术前（P〈0．05或〈0．01），术中HRV频域指标又明显低于术后（P〈0．05或P〈0．01）。结果表明在局部麻醉下进行非超声乳化白内障囊外摘除联合人工晶状体植入，术中和术后时点的HRV频域指标比术前明显降低，以术中时点的下降更为显著。结论局部麻醉或白内障手术创伤等应激刺激，对老年白内障患者ANS功能影响较为明显，提示术中和术后均可能是发生心血管事件的易发时期，应采取相应预防措施降低手术风险。

Observation of heart rate variability in senile cataract surgery

Objective To observe the heart rate variability（HRV） change in senile non-phacoemulsifica-tion, to explore the influence of cataract surgery on perioperative cardiac autonomic nervous system（ANS） function, and to provide a theoretical basis for evaluation of surgical risk. Methods Using prospective method, 60 senile cata- ract patients （60 eyes） aged over 60 without cardiovascular disease histories were randomly selected; under local an- aesthesia, all patients underwent non-phacoemulsification extracapsular cataract extraction plus intraocular lens im- plantation surgery. 24 h dynamic electrocardiogram（DCG） was recorded for measurement of HRV frequency domain indexes at 17 h one day before surgery and at 17 h the post-operative day. Observed the senile patients, and the fre- quency domain index（LF, HF and LF/HF） changes from 0 h to 5 h before surgery, during, and 12 h to 17 h after surgery were recorded. The detecting data and calculation material were statistically analyzed in each group, and the changes＇ characteristics and reasons were compared. Results In the perioperative period, all patients were found that frequency domain index during and after surgery were significantly lower than those before surgery（ P 〈 0.05 or P 〈 0. 01 ）. The HRV frequency domain before surgery was significantly lower than that after surgery（ P 〈 0. 05 or P 〈 0. 01 ）. The results showed that under local anesthesia, HRV during and after surgery were significantly lower than that before surgery in patients who undergone non-phaeoemulsification extracapsular cataract extraction plus intraocu- lar lens implantation surgery, which declined more significantly during surgery. Conclusion The stress simulations from local anesthesia and cataract surgery can evidently influence ANS function in patients with senile cataract, which prompt that both during and after surgery may be the periods easy to trigger cardiovascular events, and corresponding prevention measures should be taken to reduce the surgical risk.