依托咪酯或丙泊酚对老年冠心病非心脏手术围插管期心率变异性的影响

目的研究依托咪酯和丙泊酚对老年冠心病患者行非心脏手术时在全身麻醉诱导气管插管期间心率变异性（HRV）的影响。方法将90例择期行中上腹部手术的老年冠心病患者随机分成依托咪酯组（E组）和丙泊酚组（P组），每组各45例。分别于麻醉前、麻醉诱导后及气管插管后用心率变异功率谱分析技术观察两组患者的HRV变化。结果麻醉诱导后，E组总功率（11P）和HRV低频（LF）（756±535）ms^2／Hz和（316±301）ms^2／Hz]，P组LF、HRV高频（HF）、LF／HF及TP（187±168）ms^2]Hz、（89±48）ms^2／Hz、2．3±1．6和（616±462）ms^2／Hz]均较麻醉前显著降低（P〈0．05）；组间比较，麻醉诱导后，E组LF、HF、LF／HF及11P均显著高于P组（p〈0．05）。气管插管后，两组LF、HF、LF／HF及11P均较麻醉前显著升高（P〈0．05）；组间比较，气管插管后两组HRV各指标比较差异均无统计学意义（P〉0．05）。结论丙泊酚在麻醉诱导时对老年冠心病自主神经功能的抑制作用强于依托咪酯；而对于气管插管引起的心血管反应而言依托咪酯和丙泊酚药效相似。

Heart rate variability during intubation under etomidate or propofol general anesthesia with elderly coronary heart disease patients in non-cardiac surgery

Objective To research etomidate or propofol in the whole intubation during the induction of elderly coronary heart disease autonomic nervous system function. Methods Ninety patients undergoing abdominal surgery patients with coronary heart disease were randomly divided into etomidate group （E group, 45 cases） and propofol group （P group, 45 cases）. In pre-anesthesia, after the induction of anesthesia and after intubation with power spectral analysis of heart rate variability （HRPSA） observed in patients with heart rate variability （HRV） changes. Results After the induction of anesthesia, the low frequency（LF） （316 ±301 ） ms^2/Hz ] and total power（TP） （756 ± 535） ms^2/Hz ] decreased significantly in E group（P 〈 0.05 ） and LF, high frequency （HF）, LF/HF ratio（LF/HF）and TP decreased significantly in P group （ 187 ± 168 ） ms^2/Hz, （ 89 ± 48） ms^2/Hz, 2.3 ± 1.6 and （616 ± 462） ms^2/Hz ] （P 〈 0.05 ）. The duction degree of LF, HF, TP and LF/HF in E group was more significant than that in P group （P 〈 0.05）. After intubation, LF, HF, LF/HF and TP increased significantly in both groups and no significant difference of HRV was observed between the two groups （P 〉 0.05 ）. Conclusions Propofol decreases the activity of autonomic nervous system, wherea etomidate produces minimal changes under anesthesia induction in elderly coronary heart disease patients.There is no remarkable difference in cardiovasological changes induced by etomidate and propofol during tracheal intubation.