腹腔镜胆囊切除术中CO_2气腹对老年患者肝功能的影响

目的观察腹腔镜胆囊切除术(LC)中CO2气腹对老年患者肝功能的影响。方法选择60~73岁ASAⅠ或Ⅱ级择期行LC患者52例,随机分成两组各26例:L组采用低气腹压力9±1 mmHg;S组采用标准气腹压力15±1mmHg;分别于术前24 h(T1)及术后2 h(T2)、24 h(T3)、72 h(T4)抽取外周静脉血送检肝功能,检测记录各项指标进行统计学处理。结果 L组术后2 h、24 h的丙氨酸氨基转移酶(ALT)、门冬氨酸转移酶(AST)均较术前升高(P0.05);S组术后2 h、24 h的ALT、AST、γ-谷氨酸转肽酶(GGT)、乳酸脱氢酶(LDH)与L组比较升高更显著(P0.05);两组各指标均于72 h趋于术前水平。结论老年患者在LC中CO2气腹可引起术后一过性肝功能异常,采取低气腹压有利于保护肝功能。     

腹腔镜胆囊切除术中二氧化碳气腹对肥胖患者呼吸和循环的影响

目的 探讨腹腔镜胆囊切除术中CO2气腹对肥胖患者呼吸和循环系统的影响。方法 择期行腹腔镜胆囊切除手术患者80例，其中体质量正常组（A组）20例，术中气腹压力设定为14mmHg；肥胖患者组（B组）60例，根据气腹压力不同又分为B，组（12mmHg）、B2组（14mmHg）和风组（15mmHg），每组20例。首先观察A组和B2组气腹前5min、气腹后10min，以及术毕10min时的各项血气指标，然后观察B1、B2和B3组在气腹前5min、气腹后10min，以及术毕10min时的各项血气指标和各组手术时间。结果 A组与B2组，两者分别与气腹前相比较：HR、SBP、DBP和PETC02明显上升（P〈0.01）。B2组与A组相比较，在气腹前5min，两者各指标间并无统计学意义；而在气腹后10min，B2组HR、SBP和PETC02明显增高（P〈0．01或P〈0．05），DBP、PH和SaO2指标间则无统计学意义。在B组中，各组分别与气腹前比较，HR差异有显著性（P〈0.01），而在PETCO2、SBP和DBP指标上，B1组与气腹前比较并无统计学意义，而B2和B3组则差异有显著性（P〈0.01）。在各组的组间比较中，B2和B3组与B1组相比，其HR、SBP、DBP和PETCO2各指标均有显著性增高（P〈0.01）。B2和风组的组间比较无统计学意义。手术时间比较三组间无统计学意义。结论 腹腔镜胆囊切除术中CO2气腹对肥胖患者呼吸和循环系统的影响较体重正常患者显著，术中如能选用低压气腹（12mmHg），则能明显减轻气腹对肥胖患者上述系统的影响。     

不同气腹压行腹腔镜胆囊切除术时对呼吸循环的影响

腹腔镜胆囊切除术（LC）的广泛开展，使人们对其引起的机体，变化越来越关注．本文就不同气腹压下行LC时呼吸循环的变化进行探讨。     

腹腔镜胆囊切除术中二氧化碳气腹对心血管的影响

目的 :观察腹腔镜胆囊切除术 (LC)中二氧化碳气腹对患者心血管的影响。方法 :选择 4 0例ASAⅠⅡ级胆囊结石或胆囊息肉择期行LC的患者 ,术前 30min肌注阿托品 0 .5mg和鲁米那钠 10 0mg ,入室后连接Dash 2 0 0 0监护仪 ,麻醉诱导用药 :咪达唑仑 30 μg/kg ,芬太尼 3μg/kg ,维库溴铵 0 .1mg/kg ,乙咪酯 0 .3mg/kg ,术中以0 .0 8% 0 .1%异丙酚维持 ,并间断吸安氟醚 ,监测并记录入室时、诱导前、插管后、气腹前、气腹后 1,3,5 ,10min的收缩压(SBP)、舒张压 (DBP)、平均动脉压 (MAP)、心率 (HR)、血氧饱和度 (SPO2 )。结果 :病人诱导前的血压、HR、SPO2 与入室时比较无明显变化 (P >0 .0 5 ) ,插管后SBP、MAP显著升高 (P <0 .0 1) ,SBP、DBP、MAP在气腹后 1、3、5、10min都显著的升高 ,与入室时比较差异有非常显著性 (P <0 .0 1) ,但升高的幅度呈下降趋势。HR在整个麻醉过程中无明显变化 (P >0 .0 5 )。SPO2 在插管后显著上升 (P <0 .0 1)。结论 :腹腔镜胆囊切除术中二氧化碳气腹对循环和呼吸虽有一定的影响 ,但在全身麻醉下加强监测和管理 ,这种影响是可以减少或避免的。     

不同气腹压对腹腔镜胆囊切除术后肩痛的影响

目的探讨腹腔镜胆囊切除手术不同气腹压对术后肩痛的影响。方法于全身麻醉下为100例患者行腹腔镜胆囊切除术,术中气腹压分两组,A组(低气腹压组,50例)气腹压8～9 mmHg,B组(常规气腹压组,50例)气腹压13～14 mmHg,分别记录术后8 h、24 h、48 h肩背部疼痛的人数,并让患者术后8 h、24 h、48 h用疼痛分级(VAS评分法)评分。结果术后A组不同时间段出现肩痛的人数比率明显低于B组,在术后8 h、24 h、48 h,A组患者肩痛的评分均低于B组患者,差异均有统计学意义(P<0.05)。结论腹腔镜胆囊切除术中低气腹压出现肩痛的人数明显较常规气腹压少,且术中低气腹压出现肩痛的程度明显较常规气腹压轻。     

腹腔镜胆囊切除术气腹前后呼吸和循环的变化观察

观察腹腔镜胆囊切除术患者全麻插管后气腹对肺通气，肺顺应性和循环的影响，方法，监测３０例患者气腹前、气腹后１０，２０，３０ｍｉｎ的顺应性、气道峰值压力、动脉血二氧化碳分 、呼气末二次化碳分压、舒张压、心率、心率收缩压乘积的变化。     

腹腔镜胆囊切除术中气腹对胃肠损伤及血流动力学的影响

目的探究腹腔镜胆囊切除术(LC)中气腹对胃肠损伤及血流动力学的影响。方法选取2016年11月～2017年8月于我院行择期LC患者86例,根据二氧化碳(CO2)气腹压分为低腹压组和高腹压组各43例,前者腹压为12mm Hg,后者为15mm Hg。比较两组气腹时的血气分析及血流动力学指标,同时记录两组并发症发生情况及术后胃肠功能恢复时间。结果两组在T2、T3的Pa CO2均较T1时间点出现升高,且高腹压组较低腹压组更高(P0.05);两组在T2、T3的Pa O2均较T1时间点出现降低,且高腹压组较低腹压组更低(P0.05);两组在T3的MAP均较T1时间点出现升高,且高腹压组较低腹压组更高(P0.05);两组在T2时间点MAP比较无显著性差异(P0.05);两组在T2、T3的HR均较T1时间点出现升高,且高腹压组较低腹压组更高(P0.05);低腹压组进食时间、肠鸣音出现时间、肠道排气时间皆明显短于高腹压组,组间差异显著(P0.05);低腹压组并发症发生率明显低于高腹压组(χ2=5.11,P=0.02)。结论在LC中CO2气腹会影响患者胃肠功能及循环系统,故在保证手术视野清晰的情况下,应尽量应控制在15mm Hg以下,以增强手术安全性。     

低压气腹腹腔镜胆囊切除术100例报告

目的；研究CO2低气腹压腹腔镜胆囊切除术对机体内环境的影响，探讨腹腔镜手术的最佳气腹压。方法：100例腹腔镜胆囊切除术，CO2气腹压均控制在10－12mmHg；按手术充气时间长短分为两组：＜６０min组62例；≥60min组38例。对患术前、术后即刻及术后2d的PT、APTT、Fib、plt、BUN、Cr血气分析、肺顺应性及气道峰压等进行统计学分析。结果：CO2低压气腹腹腔镜胆囊切除手术时间＜60min组患，术后即刻及术后2d的PT、APTT、plt、BUN、Cr、血气分析、肺顺应性及气道峰压等与术前比较均无明显变化。Fib在手术时间≥60min组，术后2d与术前比较有显性差异（P＜0．05），与手术时间＜60min组术后2d比较，差异极显（P＜0．01）。手术时气道峰压明显升高、肺顺应性降低，但术后即迅速恢复至术前水平，与手术时间无明显关系。结论：CO2气腹压控制在10－12mmHg（1.3-1.6kPa），腹腔镜胆囊切除术对患术后机体内环境影响较小，为比较理想的气腹压力。     

二氧化碳气腹腹腔镜胆囊切除术后吸氧时间的研究

目的观察二氧化碳气腹腹腔镜胆囊切除术后最佳吸氧时间及意义。方法将120例二氧化碳气腹腹腔镜胆囊切除术后患者随机分成6组,观察吸氧2h、4h、8h、12h、18h、24h血气分析指标和综合心电监护指标及肩部疼痛程度。结果血气分析指标、综合心电监护指标差异无显著意义（P〉0．05）。术后吸氧12h、18h、24h同术后吸氧2h、4h、8h相比能显著地改善患者肩部疼痛,差异有极显著意义（P〈0．01）。结论腹腔镜胆囊切除术后吸氧时间至少需要12h。     

Blood pressure and heart rate changes during apnoea testing with or without CO2 insufflation

Objective: To determine changes of blood pressure and heart rate during apnoea testing for brain death without (A) and with (B) artificial CO₂ augmentation. Design: Prospective, consecutive study. Setting: 12 intensive care units in six towns in Northern Bavaria. Patients and participants: A total of 55 apnoea tests were performed on 55 consecutive patients as part of the determination of brain death, 27 without and 28 with CO₂ augmentation. Interventions: Apnoea tests following oxygenation with 100 % O₂ either after reduction of ventilatory volume (A) or after insufflation of CO₂ during normoventilation (B). In each case, an arterial partial CO₂ pressure of at least 8 kPa was documented. Results: All apnoea tests were without serious adverse effects (hypoxia, newly induced cardiac arrhythmia, cardiac asystole). An increased dopamine infusion rate was deemed necessary in only one case of group (A) because of marked systolic hypotension ( < 8 kPa). Individual variation of systolic and diastolic blood pressure (BP) did not exceed + 62 to –46 % and + 49 to –52 % respectively, in group (A) and + 35 to –57 % and + 40 to –48 % respectively, in group (B). Variation of heart rate (HR) remained within the range + 24 to –31 % in group (A) and + 37 to –22 % in group (B). Conclusions: HR varied less than BP. The possibility of a marked relative rise or fall of BP in group (A) was equal; in group (B) there was a lower chance of rising BP. The chances for a rise or fall in HR were equal for the two groups. There was a tendency for less variation of cardiovascular parameters in group (B). Received: 22 November 1996 Accepted: 16 June 1997     

腹腔镜手术对小儿心率变异性的影响

目的观察腹腔镜手术下小儿心率变异性（Heart rate variability，HRV）的变化，为小儿术中及术后心血管的康复提供依据。方法选择ASAⅠ或Ⅱ级择期行腹腔镜手术的患儿20例，全部采用静吸复合全麻，气管内插管，呼吸机行间歇正压通气。分别于麻醉前、气腹前、气腹5min、气腹20min、气腹30min和放气腹5min观察心率变异性指标总功率（TP）、高频功率（HF）、低频功率（LF）、低频标准化值（LFNU）、高频标准化值（HFNU）和低频高频功率比（LF／HF）的变化。结果与气腹前比较，TP、LF、LFNU和LF／HF显著升高（P〈0．01），Hk，无明显变化（P〉0．05）。结论腹腔镜手术气腹后小儿交感神经占优势。HRV可作为麻醉循环监测的敏感指标，动态反映小儿自主神经的变化。     

小儿与成人腹腔镜手术心率变异性变化的比较

目的 比较小儿与成人腹腔镜手术下心率变异性（heart rate variability，HRV）变化的不同。方法 选择ASAI或Ⅱ级择期行腹腔镜手术的患儿20例（小儿组），成人20例（成人组）。全部采用静吸复合全麻，气管内插管，呼吸机行间歇正压通气。分别于麻醉诱导前（T1）、气腹前（T2）、气腹5min（T3）、气腹20min（T4）、气腹30min（T5）、放气腹后5min（T6），观察心率变异性指标低频（LF）、高频（HF）、低频高频功率比（LF／HF）、低频标准化值（LFNU）、高频标准化值（HFNU）的变化。结果 与小儿组比较，成人组气腹后LFNU、LF／HF显著升高（P〈0．01），HFNU两组无统计学意义（P〉0．05）。结论 小儿的交感神经发育成熟度晚于副交感神经，对麻醉和手术的反应性较成人差。     

Long-term effects of cardiac resynchronization therapy on heart rate and heart rate variability

Congestive heart failure is characterized by significant autonomic dysfunction. Development of left bundle branch block in congestive heart failure is a predictor of worse outcome. There are several lines of evidence that cardiac resynchronization therapy (CRT), by biventricular stimulation in patients with severe heart failure and left bundle branch block, improves autonomic functions which can be quantified by measuring heart rate variability. The aim of the present study was to assess the effect of CRT on autonomic functions quantified by heart rate variability and mean heart rate (HR) in patients with advanced heart failure and left bundle branch block in short and long-term follow-up. A total of 35 patients with systolic heart failure and left bundle branch block (mean-age 60 +/- 11 years; 24 male and 11 female; mean left ventricular ejection fraction [EF]: 22.3 +/- 3%) were enrolled. Clinical assessment and echocardiographic examination were performed at baseline and every three months. Continuous electrocardiographic monitorization by 24-hour Holter recordings was performed pre-implantation, 3 months and 2 years after implantation. Mean HR and one of the time-domain parameters of heart rate variability, standard deviation of the R-R intervals (SDNN) were measured. CRT was associated with a decrease in the mean duration of QRS, and an increase in diastolic filling time, the rate with which the left ventricular pressure rises (dP/dt), and left ventricular ejection fraction. Decrease in mean heart rate and increase in SDNN were statistically significant in the third month and second year recordings when compared to baseline recording (p values were < 0.001 for both). In conclusion, CRT with biventricular pacing provides sustained improvement in autonomic function in patients with advanced heart failure and left bundle branch block.     

Neural correlates of heart rate variability during emotion

The vagal (high frequency [HF]) component of heart rate variability (HRV) predicts survival in post-myocardial infarction patients and is considered to reflect vagal antagonism of sympathetic influences. Previous studies of the neural correlates of vagal tone involved mental stress tasks that included cognitive and emotional elements. To differentiate the neural substrates of vagal tone due to emotion, we correlated HF-HRV with measures of regional cerebral blood flow (rCBF) derived from positron emission tomography (PET) and (15)O-water in 12 healthy women during different emotional states. Happiness, sadness, disgust and three neutral conditions were each induced by film clips and recall of personal experiences (12 conditions). Inter-beat intervals derived from electrocardiographic recordings during the 60-second scans were spectrally-analyzed, generating 12 separate measures of HF-HRV in each subject. The six emotion and six neutral conditions were grouped together and contrasted. We observed substantial overlap between emotion-specific rCBF and the correlation between emotion-specific rCBF and HF-HRV, particularly in the medial prefrontal cortex. Emotion-specific rCBF also correlated with HF-HRV in the caudate nucleus, periacqueductal gray and left mid-insula. We also observed that the elements of cognitive control inherent in this experiment (that involved focusing on the target mental state) had definable neural substrates that correlated with HF-HRV and to a large extent differed from the emotion-specific correlates of HF-HRV. No statistically significant asymmetries were observed. Our findings are consistent with the view that the medial visceromotor network is a final common pathway by which emotional and cognitive functions recruit autonomic support.     

磷酸肌酸钠对缺血性心肌病心功能及心率变异性的影响

目的探讨磷酸肌酸钠对缺血性心肌病患者心功能及心率变异性的影响。方法缺血性心肌病患者66例,随机分为常规治疗组（A组,n=33）以及磷酸肌酸钠治疗组（B组,n=33）,应用超声心动图检测患者左室射血分数（LVEF）;应用24小时动态心电图（Holter）检测患者心率变异性（HRV）。用药治疗2周,观察治疗前后的指标变化。结果 2组治疗前各项指标差异无统计学意义。治疗2周后2组患者LVEF及HRV均较治疗前升高。但磷酸肌酸钠治疗组改善幅度较常规治疗组大。结论磷酸肌酸钠可以改善缺血性心肌病患者的心功能和心率变异性。     

心率变异logistic判别方程临床应用

在心率变异(HRV)判断中应用logistic判别方程并与单项指标方法对比。方法 综合利用HRV时域法SDNN、SDANN、SDNN Index指标和年龄、平均心率的logistic判别方程诊断38例急性心肌梗塞(AMI)后患者,并与单项指标判断结果对比。结果 logistic方程判结果阳性率50％,显著高于单项指标法(P<0.01)。结论 logistic判断别方程综合利用多项指标优于单项指标法,便于HRV在临床应用。     

The effects of growth hormone therapy on heart rate variability in adults with growth hormone deficiency

Background: Growth hormone (GH) deficiency is associated with increased cardiovascular morbidity and mortality. Abnormalities in heart rate variability (HRV) (such as decreased cardiac sympathetic activity), which is a marker of cardiac autonomic tone, have been found in patients with GH deficiency.Objective: The purpose of this study was to investigate the effects of GH therapy on HRV in adults with GH deficiency.Methods: Adult patients with GH deficiency were eligible. HRV measurements were obtained by 24-hour measurements from Holter electrocardiography before and after 6 months of GH therapy in adult patients with GH deficiency. The following time domain parameters of HRV were calculated: the SD of the normal-to-normal (NN) interval (SDNN), the SD of the average NN interval (SDANN), the square root of the mean squared differences (RMSSD), and the proportion derived by dividing the number of interval differences of successive NN intervals >50 ms (NN50) by the total number of NN intervals (PNN50).Results: A total of 21 patients (7 men, 14 women; mean age, 46.0 ± 11.2 years) were enrolled. Thirteen patients had panhypopituitarism and 8 had normal adrenocorticotropic hormone secretion. At the end of 6 months of GH therapy, the mean values of the sympathetically influenced parameters SDNN (before GH treatment, 134.5 ± 6.0 ms; after GH treatment, 118.5 ± 8.0 ms) and SDANN (before GH treatment, 121.2 ± 6.0 ms; after GH treatment, 96.2 ± 9.1 ms) decreased significantly (P < 0.05), but the parasympathetically influenced parameters RMSSD and PNN50 did not differ significantly from baseline. The mean heart rate and ventricular premature beats were not significantly different from baseline after GH therapy.Conclusions: In this patient population, cardiac sympathetic tone was increased, without an obvious arrhythmogenic effect, after 6 months of GH therapy.     

急性心肌梗死早期溶栓治疗效果与心率变异性的关系

目的：探讨急性心肌梗死（acute myocardial infarction,AMI)早期溶栓治疗对心率变异性（heart rate variability,HRV)的影响。方法：264例首次Q波AMI患者按有无接受早期静脉溶栓治疗分为溶栓组11例、非溶栓组145例；溶栓组根据溶栓治疗成功与否又分为溶栓成功组68例和溶栓失败组51例。264例均在起病14日后行24小时动态心电图检查和HRV分析。结果：（1）溶栓成功组HRV时域分析指标24小时正常R－R间期的标准差、24小时内每5分钟节段平均正常R－R间期的标准差、24小时内每5分钟节段正常R－R间期标准差的平均值、连续正常R－R间期差值均方的平方根、差值超过50ms的R－R间期在一定时间内的百分比及频域分析指标总能谱、低能谱、高能谱均大于溶栓失败组和非溶栓组（P＜0．01），溶栓成功组频域分析指标低能谱／高能谱比值小于溶栓失败组和非溶栓组（P＜0．01）；（2）溶栓失败组与非溶栓组所有HRV分析指标均无统计学差异（P＞0．05）。结论：AMI早期溶栓治疗成功能改善病人的HRV，提示AMI早期梗死相关冠状动脉再通能提高心肌电稳定性。