频域分析法探讨高位硬膜外阻滞对冠心病心率变异性的影响  

To research the effect and clinical meaning of heart rate variability of coronary disease sufferer with thoracic epidura anesthesia

作　　者：刘晖[1] 屈军[1] 刘锦[1] Qu Jun;Liu Jin;Liu Hui(the Xixiang People＇s Hospital,Guangdong, Shenzhen, 518102,China)

机构地区：[1]广东医学院附属西乡人民医院麻醉科,518102

出　　处：《中华心脏与心律电子杂志》2016年第1期16-18,共3页Chinese Journal of Heart and Heart Rhythm(Electronic Edition)

基　　金：深圳市科技计划项目(200703116)

摘　　要：目的明确高位硬膜外阻滞对冠心病患者植物神经调节作用及治疗意义,以便为这一新方法提供经验和理论依据。方法选择ASAⅡ-Ⅳ级冠心患者60例,随机分成二组,每组30例,Ⅰ组为对照组,常规内科治疗,Ⅱ组患者选取T4-5硬膜外间隙穿刺置管,以微量注射泵继续输注0.8%利多卡因约2~3 ml/h,持续5 d,给药后30 min,12 h,24 h,72 h,120 h分别记录患者的HRV低频（LF）,高频（HF）及低高比值（LF/HF）,并比较两组患者血压心率的变化情况。结果常规内科治疗患者,血压心率变化不明显,而应用高位硬膜外阻滞后患者的血压和心率下降明显,高位硬膜外阻滞后,患者LF、HF、LF/HF均降低（P〈0.05）,LF降低程度显著大于HF的降低程度,LF/HF同时降低（与阻滞前相比P〈0.05）,阻滞12 h之后患者HRV的各项指标与3 min之内相比略有升高,但不存在显著性差异（P〉0.05）。结论高位硬膜外阻滞可相对提高迷走神经的张力,局限性、可逆性地阻滞T1-5支配心脏的交感神经传入和传出纤维,引起冠状血管扩张,由此改善缺血区的血供和氧供,对于冠心病临床治疗具有可行性。Objective To investigate the clinical effect and regulating plant-nerve effect of thoracic epidura anesthesia for coronary disease sufferers. Methods To choose 60 coronary disease sufferers,ASAⅡ-Ⅳ,divide into two groups： Group I is collate group,general medical therapy; Group II is therapy group,choose T4-5 epidural space insert catheter,drug use 0. 8% Lidocaine,control level of anesthesia between T1-5,then continue infuse 0. 8% Lidocaine 2-3 ml/h with syringe pump,last 5 days,enregister the sufferers’ s Heart Rate Variability（ HRV） ： low frequency（ LF）; high frequency（ HF） and their ratio（ LF/HF） after inject 30 min,12 h,24 h,72 h,120 h. Results After epidural anesthesia,all of the sufferers’ s LF,HF,LF/HF fell（ P 〈 0. 05）; LF fell markedly than HF,so LF/HF fell too（ P 〈 0. 05）; all the sufferers’ s guide line of Heart Rate Variability with 12 h appreciably rise than those within 3 h,but there is not statistical significance（ P 〉 0. 05）; after pull out epidural catheter 6 h,guide line of HRV has significant difference between those after epidural anesthesia（ P 〈 0. 05）; guide line of HRV has no significant difference between preoperative and postoperation（ P 〉 0. 05）. Condusion Thoracic Epidura Anesthesia can comparatively enhance pneumogastric nerve strain,partly,reversibly hocus T1-5 sympathetic nerve afferent fibers and centrifugal fiber,lead to a dilatation of vasa coronaria,and ameliorate the blood supply and oxygen supply of Izeg（ ischemic region）,it has feasibility for clinical treatment of coronary disease.

关 键 词：频域分析法 高位硬膜外阻滞 冠心病 心率变异性 

分 类 号：R541.4[医药卫生—心血管疾病]