围术期心率变异性改变和心肌缺血的临床观察  

Clinical observation of postoperative heart rate variability and myocardial ischemia

作　　者：张晓光[1] 王俊科[1] 陈晓光[1] 傅文[1] 盛卓人[1] 

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳市110001

出　　处：《临床麻醉学杂志》2001年第8期413-415,共3页Journal of Clinical Anesthesiology

摘　　要：目的　观察冠心病及其高危因素者术后心率变异性 (HRV)改变及心肌缺血的发生情况。方法　择期腹部手术病人 4 0例。冠心病及冠心病高危因素者 2 0例 (高危组 ) ,非冠心病高危因素者 2 0例 (对照组 )。使用Holter监测术后的HRV及ST段变化。根据术后是否发生心肌缺血分为缺血组和非缺血组。结果　术后高危组高频功率 (HF)、高频标准化值 (HFnu)低于对照组 (P <0 0 5 ) ,低频与高频比值 (LF/HF)高于对照组 (P <0 0 5 ) ,心肌缺血发生率明显高于对照组 (P <0 0 1)。缺血组的HF(P <0 0 1)、HFnu(P <0 0 5 )低于非缺血组 ,LF/HF高于非缺血组 (P <0 0 5 )。LF/HF和缺血负荷呈正相关 (r =0 7,P <0 0 1)。结论　冠心病高危因素者术后易发生心肌缺血 ,与迷走神经对心脏的调控作用下降有关。Objective To observe the postoperative change of heart rate variability(HRV) and myocardial ischemia in the patients with coronary artery disease(CAD) or high risk factor for CAD. Methods Twenty patients with CAD or two or more high risk factors for CAD were as high risk group.Twenty patients without high risk factors were as control group.Postoperative HRV and ST segment were monitored with Holter.The patients were divided into ischemic and nonischemic groups according to the occurrence of postoperative myocardial ischemia.Results After surgery,high frequency(HF),normalized high frequency (HFnu)of high risk group and ischemic group were significantly lower than those of control group( P< 0 05) and nonischemic group ( P< 0 05)respectively.The ratio of low frequency to high frequency(LF/HF)( P< 0 05) and the incidence of postoperative myocardial ischemia of high risk group were significantly higher than those of control group( P< 0 01).LF/HF was positively related to ischemic load index( r= 0 7, P< 0 01).Conclusion In patients with high risk factors for CAD,postoperative ischemia is more common and is related to the decrease of cardiac vagal activity.

关 键 词：心率变异性 心肌缺血 冠心病 围术期 高危患者 临床观察 心脏手术 

分 类 号：R614[医药卫生—麻醉学]