急诊胆道手术围术期心率变异性观察

目的 探讨全麻下急诊胆道手术对心脏自主神经反射的影响。方法 15例急诊胆总管结石手术患者,行全身麻醉。测定麻醉前(T0)、气管插管后5分(T1)、胆道探查时(T2)、术中1小时(T3)、2小时(T4)、术毕拔气管导管前(T5)和拔气管导管后15分(T6)的血压、心率和心率变异性。结果 与T0比较,T1血压显著下降(P<0.01),T4、T5和T6血压升高(P<0.05和0.01)。总功率谱(TP)和低频谱(LF)在T1、T5和T6降低(P<0.05);LF在T3、T4升高(P<0.05);高频谱(HF)在T4显著升高(P<0.05),T5、T6显著降低(P<0.01);标化LF(LFnorm)和LF/HF从T1到T4显著下降(P<0.01),而同期标化HF(HFnorm)却显著升高(P<0.01)。结论 急诊胆道病人心率变异性增高;全麻下手术TP稳定,麻醉前异常兴奋的交感神经被抑制;拔管前后心脏自主神经兴奋性下降,交感神经兴奋性占优势。

Change of the heart rate variability in acute biliary tract surgery

Objective To investigate the effect on cardiac autonomic reflex of patients who suffer acute operation of biliary tract under general anesthesia.Methods 15 patients with acute operation of choledocholith received general anesthesia.Change of Bp,HR and the heart rate varibility (HRV)were measured before anesthesia(T 0),at 5min after trachea intubation(T 1),exploring biliary tract(T 2),at 1nd hour(T 3),2nd hour(T 4) during operation,at the moment before extubation(T 5) and 15 minute after extubation(T 6).Results As compared with those at T0,BP was significantly decreased at T1(P<0.01),increased at T 4,T 5,T 6(P<0.05),TP and LF reduced dramatically at T 1,T 5,T 6(P<0.05).But LF was significantly at T 5,T 6(P<0.01).From T1to T 4,both LFnorm and LF/HF decreased singnificantly (P<0.01),HFnorm was increased markedly (P<0.01).Conclusion HRV in acute biliary tract surgery is increased.During perioperation under general anesthesia.TP is stable,excited sympathetic nerve before anesthesia was inhibited.Excitability of cardiac autonomic nerve before and after extubation was decreased and excitability of sympathetic nerve prevails.