雷米芬太尼对上腹部手术患者心率变异性的影响

目的观察雷米芬太尼对上腹部手术患者心率变异性(HRV)的影响。方法择期胃癌手术患者40例,年龄35~60岁,随机均分为雷米芬太尼全麻组(R组)和硬膜外阻滞复合全麻组(E组)。观察麻醉前(T0)、麻醉诱导后插管前(T1)、腹腔探查时(T2)、手术1h(T3)、2h(T4)和拔管后10min(T5)的平均动脉压(MAP)、心率(HR)和HRV各参数:低频功率(LF)、高频功率(HF)、低频功率/高频功率比(LF/HF)、总功率(TP)。结果与T0时相比,E组T3和T4时TP下降(P<0.05),低频百分率(LFR)、高频百分率(HFR)、LF/HF变化不明显;R组TP、LFR均明显下降(P<0.01),LFR、LF/HF低于E组(P<0.05或P<0.01)。E组T2时HFR明显下降(P<0.01),TP、LF/HF升高不明显;R组TP、HFR明显升高(P<0.01),而LFR、LF/HF明显下降(P<0.01)。E组HR在T2时与术中比有明显升高(P<0.01),R组HR在T2~T4时明显下降(P<0.01)。结论硬膜外复合全麻可维持植物神经的均衡性。雷米芬太尼显著兴奋迷走神经,易致交感-迷走神经失平衡。

Effects of remifentanil on the heart rate variability in patients undergoing upper abdominal surgery

Objective To study the effects of remifentanil on heart rate variability (HRV)in surgical patients.Methods Forty patients (35-60 years old )undergoing selective upper abdominal surgery were divided randomly into remifentanil group(R)and general anesthesia combined with epidural block group(E) with 20 cases each.The changes of HRV were analized before anesthesia(T0),after induction (T1),exploring abdomen(T2),at 1 h(T3),2 h(T4)during operation and 10 min after extubation(T5).Results Compared with those at T0,TP and LFR decreased significantly at T3 and T4 in group R(P<0.01).HFR in group R was lower than that in group E.HFR decreased significantly in group E at T2. TP,LFR and LF/HF were not changed much.TP and HFR increased significantly in group R at T2 (P<0.01),but LF and LF/HF decreased significantly(P<0.01).Compared with that at T3,HR increased significantly in group R at T2,but decreased significantly in group R at T2,T3 and T4 .Conclusion The balance of sympathetic and parasympathetic nervous activity could be kept during general anesthesia combined with epidural block.Remifentanil depresses sympathetic activity obviously resulting in imbalance of autonomic nervous system.