连续小波变换时频分析对全麻下行剖腹胆囊切除术患者自主神经功能的实时评价  

The real-time evaluation for autonomic nervous function in patients undergoing open cholecystectomy under general anesthesia by continuous wavelet transform time-frequency analysis

作　　者：张清玉[1] 申岱[1] 王娟娟[1] 贾晓宁[1] 余剑波[2] 周鹏[3] 

机构地区：[1]天津医科大学口腔医院麻醉科,300070 [2]天津市南开医院麻醉科 [3]天津大学精密仪器与光电子工程学院

出　　处：《临床麻醉学杂志》2013年第7期629-632,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨心率变异性(HRV)时频分析中的连续小波变换(CWT)法对术中伤害性刺激的实时评价。方法随机选取全麻下行剖腹胆囊切除术患者21例,ASAⅠ或Ⅱ级。术中连续采集心电信号,观察麻醉诱导前(T0)、诱导插管时(T1)、术中无牵拉胆囊时(T2)、术中牵拉胆囊时(T3)、拔管前(T4)各时段5min信号HRV常规时域指标:所有窦性RR间期的标准差(SDNN)、所有邻近窦性RR间期长度差异的均方根(RMSSD);频域指标:总功率(TP)、标准化的低频功率(LFn)、标准化的高频功率(HFn)、低频率功率/高频率功率(LF/HF)及HF/LF;非线性指标:散点图短轴(SD1)、散点图长轴(SD2)。时频分析采用CWT法,信号截取自以上各段5min信号中正在操作刺激时的30s时段进行分析,以获取总功率值(TPc)、低频标化值(LFcn)、高频标化值(HFcn)、LFc/HFc及HFc/LFc。结果与T0时比较,T1时SDNN、lgTP、LFn、LF/HF、SD2均明显升高,RMSSD、HFn、SD1则明显降低(P<0.01);T2～T4时SDNN、lgTP、SD1均明显降低(P<0.05或P<0.01)。与T2时比较,T3时LFn明显降低,HFn、HF/LF和SD2明显升高(P<0.05)。与T0时比较,T1时lgTPc、LFcn、LFc/HFc明显升高,HFcn、HFc/LFc明显降低(P<0.05或P<0.01);T2～T4时lgTPc明显降低(P<0.05);T3时LFcn、LFc/HFc明显降低,HFcn、HFc/LFc明显升高(P<0.01);T4时LFcn、LFc/HFc明显升高,HFcn、HFc/LFc明显降低(P<0.01)。与T2时比较,T3时LFcn、LFc/HFc明显降低,HFcn、HFc/LFc明显升高(P<0.05)。结论 HRV时频分析CWT法能敏感、定量地反映术中伤害性刺激造成的自主神经即时活动的改变,有可能成为全面评价麻醉深度的一条新途径。Objective The study is conducted to make a real-time evaluatxon for noxious stimulation by using continuous wavelet transform （CWT） analysis of heart rate variability time-frequency analysis. Methods Twenty-one patients ,SA I- or scheduled for elective open cholecystectomy under general anesthesia were enrolled randomly;.Tbe electrocardiosig was collected continuously perioperatively and recoreded at the following time points： before induction （To）, intubation （T1）, intraoperative without traction gallbladder （T2）, intraoperative with traction gallbladder （T3）, and before extubation （T4）. At each time point the signals were recorded for 5 rain by the methods of time domain, frequency domain and nonlinear analysis. The CWT analysis was made according to the 30-secund-signals during operating or stimulating within the time period of 5 minutes. Restflts Compared with To, SDNN, lgTP, LFn, LF/HF, SD2 were significantly increased, RMSSD, HFn, SD1 was significantly lower at T1 （Pc0. 01）; SDNN, lgTP, SD1 were significantly lower at Ta-T4 （P〈0. 05 or P%0. 01）. Compared with T2, LFn was significantly lower, HFn, HF/LF and SD2 significantly increased at ＂1＂3 （P〈0. 05）. Compared with To, lgTPc, LFcn, LFo/HFc were significantly increased, HFcn, HFc/LFc significantly lower at T1 （P〈0. 05 or P〈0. 01） lgTPc significantly lower at TO-T4 （P〈0. 05）; LFcn, LFJHFo significantly reduced, HFcn, HFc/LFc significantly higher at ＂1＂3 （P〈0. 01） ; LFcn, LFc/HFc significantly increased, HFon, HFc/LFc were significantly lower at TO （P〈0. 01）. Compared with TO, LFcn, LFc/HFc were significantly reduced, HFcn, HFc/LFc were significantly higher at Ta （P〈0.05）. Conclusion CWT analysis of heart rate variability timeffrequency analysis could reflect the autonomic nerve＇s instant activities after noxious stimulation during operation and night be a new way to evaluate the depth of anesthesia.

关 键 词：伤害性刺激 自主神经系统 心率变异性 时频分析 麻醉深度 

分 类 号：R614[医药卫生—麻醉学]