冠状动脉病变程度与自主神经功能的相关性  

Correlation between severity of coronary artery lesions and autonomic nervous function

作　　者：刘涛[1] 顾晔[1] 李论[1] 郭张强[1] 高波[1] 

机构地区：[1]华中科技大学同济医学院附属普爱医院心内科,湖北武汉430033

出　　处：《上海医学》2013年第7期634-636,共3页Shanghai Medical Journal

摘　　要：目的探讨冠状动脉性心脏病患者冠状动脉病变严重程度与自主神经功能的相关性。方法选择100例行冠状动脉造影的患者,根据造影检查结果分入正常组(36例)、单支病变组(24例)、双支病变组(22例)和三支病变组(18例),测定心率变异性(HRV)、窦性心律震荡(HRT)参数、震荡起始(TO)和震荡斜率(TS)。结果单支病变组、双支病变组、三支病变组间白昼和夜晚的HRV各项指标的差异均有统计学意义(P值均<0.05),且均显著低于正常组同时间段(P值均<0.05)。单支病变组、双支病变组、三支病变组间TO值和TS值的差异均有统计学意义(P值均<0.05),且TO值均显著高于正常组(P值均<0.05),TS值均显著低于正常组(P值均<0.05)。结论冠状动脉病变程度与自主神经功能指标(HRT、动态心电图)异常有关。对冠状动脉性心脏病患者行HRV、HRT检测将有助于了解其病情并指导进一步检查治疗。Objective To explore anesthetic management on the children with Williams-Beuren syndrome combined with congenital cardiovascular diseases undergoing heart surgery.Methods From 2008to 2011,31 children with Williams-Beuren syndrome underwent surgery for supravalvular aortic stenosis in our hospital.General anesthesia was applied by high dose sufentanil combined with midazolam,etomidate,propofol and rocuronium.Dopamine,adrenaline,milrinone and nitroglycerin were infused after clamp off.Blood coagulation function was regulated after cardiopulmonary bypass（CPB）weaning off.According to blood gas analysis,electrolyte was given to maintain acid-base balance.Results All operations were accomplished successfully.The average duration of CPB,crossclamp and later parallel circulation were（99.69±41.66）min,（44.38±16.25）min and（25.26± 16.11）min,respectively.Dopamine（5-10μg·kg-1·h-1）was demanded in all cases.Adrenaline（0.020.5μg·kg-1·h-1）and nitroglycerin（0.5μg·kg-1·h-1）were infused in 15and 8cases,respectively.The complications were as follows：defibrillation in 12cases,ventricular fibrillation in 6cases,and second CPB in 2 cases.One patient suffering supravalvular aotric stenosis with coronary artery-pulmonary artery fistula was attacked by ventricular fibrillation and CPB was created rapidly after defibrillation.Low cardiac output and left ventricular outflow tract obstruction each occurred in 2cases.Chylothorax and pericardial effusion earh occurred in 1case.The average duration of Intensive Care Unit stay and hospital stay were（4.23±2.44）d and（14.88± 4.38）d,respectively.One patient was readmitted due to pericardial effusion 2weeks postoperatively.All cases underwent surgery safely without anesthetic complications or death.Conclusion It is a practical anesthetic management by comprehensive preoperative evaluation,proper anesthetic induction and maintaining during operation,suitable vasopressor agents,strict perioperative monitor and timely treatment for children with Williams

关 键 词：冠状动脉病变 窦性心律震荡 心率变异性 自主神经系统 

分 类 号：R541.4[医药卫生—心血管疾病]