支气管镜检查患者动态心电图、心率变异性分析及不同术前用药对心脏功能的影响

目的观察支气管镜检查前后动态心电图、心率变异性（HRV）的变化情况，了解术中交感、迷走神经张力及其对心血管活动的影响情况，并检测不同术前用药对心脏功能的影响，探讨其发生机制及防治措施。方法80例支气管镜检查患者随机分为三组，A组（30例）常规利多卡因雾化吸入局部麻醉，B组（30例）术前半小时肌注阿托品1mg及利多卡因雾化吸入局部麻醉，C组（20例）丙泊酚静脉麻醉，记录麻醉前（T0）、麻醉后（T1）、术中（T2）及术毕（T3）各时点心律、心率、ST—T及HRV等各项指标。结果A、B组术中、术后心肌缺血、心动过速、早搏较术前显著增多，C组心动过速较术前增多，但较A、B组少（P〈0．05），且早搏及心肌缺血控制较好（P〈0．05）。A组在术中及术后出现心动过缓病例，B、C组未出现（P〈0．01）；A、B组患者LF、HF、TP较术前均明显升高，但LF升高更明显，LF／HF及HRV下降（P〈0．05）。C组患者LF／HF及HRV较麻醉前虽有轻度下降，但无统计学意义（P〉0．05）。结论支气管镜检查术有诱发HRV降低、心律失常、心肌缺血的作用，但同时也存在迷走神经兴奋。阿托品可减少迷走神经兴奋，对HRV无影响。丙泊酚静脉麻醉能有效抑制支气管镜刺激所致的交感神经张力，又能控制迷走神经的兴奋性，有助于保持稳定的血液动力学状态。

Changes of Dynamic Electrocardiogram and Heart Rate Variability in Patients Underwent Bronchofiberscopy and Effects of Different Preoperative Medication

Objective To assess the changes of cardiac autonomic nerves’s function in patients underwent bronchofiberscopy by observing the dynamic electrocardiogram(DCG) and heart rate variability(HRV),and investigate the effect of different preoperative medications on heart function.Methods Eighty patients underwent bronchofiberscopy were randomly divided into three groups according to different anaesthesia.Group A(n=30) were local anaesthetized by nebulized lidocaine,group B(n=30) received atropine 1 mg injection intramuscularly and nebulized lidocaine,group C(n=20) were anaesthetized by propofol intravenously.The DCG and HRV of three groups were mornitored at pre-inductive point(T0),post inductive point(T1),point during the operation(T2),and point after operation(T3).Results The incidences of ST-T change,tachycardia,and bearing premature in group A and B were increased.The incidence of tachycardia in group C was also increased,but lower than group A and B while the ST-T change and bearing premature were milder(P<0.05).Episodes of bradycardia occurred 3 times in group A and none in group B and C(P<0.01).The low-frequency(LF),high-frequency(HF),total power(TP) in group A and B were raised,but the LF was highly raised,and the LF/HF and HRV significantly decreased.The LF/HF and HRV decreased lightly in group C(P>0.05).Conclusions Bronchofiberscopy examination can decrease HRV and induce arrhythmia and ST-T change,but also excite vagus nerve.Atropine can inhibit the excitability of vagus nerve and have no influence on HRV.The propofol may obviously decrease the sympathetic nervous activation,balance sympathetic and vagus nerves,which is beneficial to the stability of hemodynamics.