摘要
目的:通过改变全麻期间呼气末二氧化碳分压(PETCO2),观察对老年患者心率变异性(HRV)的影响。方法:将60例术前血气分析值正常,心功能～级非心脏手术年龄65岁以上老年患者,静吸复合气管插管全麻后,通过调整呼吸频率改变PETCO2,随机分为:A组PETCO2维持25～30mmHg;B组PETCO231～35mmHg;C组PETCO236～45mmHg,以动态心电图(DCG)监测全麻期间调控PETCO2后对HRV的影响,记录、分析和比较各组麻醉前、气管插管PETCO2水平稳定后15min、插管后60min、插管后120min、插管后180min(PETCO2恢复至36～45mmHg)5个时段的短时程频域指标。结果:以麻醉前相比,3组患者气管插管后所有时段TP、LF、HF均显著降低(P<0.05);麻醉前及气管插管PETCO2水平稳定后15min,3组组间HRV各指标差值无统计学差异(P>0.05);气管插管后60min、120min,A、B两组LF与LF/HF降低明显(P<0.05),表明交感神经受抑制较迷走神经明显;且A组LF与LF/HF降低非常显著(P<0.01),表明A组交感神经受抑制较为明显;C组LF/HF较A、B两组增加(P<0.05),表明交感节律增加;气管插管后180min3组组间HRV各指标无统计学差异(P>0.05)。结论:全麻期间维持适当过度通气有利于降低全麻老年患者手术期间交感神经活性,对于维护心脏自主神经的张力、均衡性及机体循环系统的稳定也许是有利的。
Objective： To investigate the effects of different PETCO2 on the heart rate variability （HRV） of elderly patients during the period of general anesthesia. Methods： Sixty heart function Ⅱ-Ⅲ elderly patients, blood gas analysis were scheduled for non-cardiac surgery randomly divided into 3 groups （n = 20,each） according to the different PETCO2 through adjust the respiratory frequency after tracheal intubation induced by intravenous and inhalation. Group A PETCO2 25 - 30mmHg ; group B PETCO2 31-35 mmHg ; group C PETCO2 36-45 mmHg. Monitoring the change of heart rate variability （HRV） during the period of general anesthesia by use of Holter monitoring electrocardiogram （DCG）. Adjust the PETCO2 after endotracheal anesthesia was began and the PETCO2 adjusted to 31 35mmHg after intubation for 120 minutes. Data of the short time frequency domain index were recorded at five different time points ： before anesthesia, and at min 15,60,120,180 after intubation after the PETCO2 was stable. Results ： Compared to the pre-anesthesia,TP, L F,HF in all the three groups was significantly lower after intubation（P〈0. 05）. The data of HRV in the three groups had no significant change（P0. 05）. Pre-anesthesia and after intubation when the PETCO2was stable for 15 minutes ; LF and LF/HF was significantly higher （P〈0.05） in group A compared to group B and C after the surgery began for 60 and 120 minutes, it could make clear that the rhythm of the sympathetic nerve was increased. The LF and LF/HF in group B and C was very lower at the two points compared to the group A（P〈0.01） ,it can direct that the sympathetic system was more depressed than the vagus nerve in group B and C; especially for group C,that was more depressed（P〈0. 01）. The data of HRV for the three groups were no significant difference 180 minutes after the surgery began （P〉0. 05）. Conclusion： In the general anesthesia, keeping appropriate over ventilation can reduce the sympathetic nerve sensitive of the elderly patients, maybe it is good for maintaining the balance of the circulation system.
出处
《华夏医学》
CAS
2008年第1期16-19,共4页
Acta Medicinae Sinica
关键词
PETCO2
老年患者
心率变异性
自主神经
pressure of end-tidal CO2
elderly patients
heart rate variability
autonomic nerve
作者简介
马莉（1964-）,女,云南昆明人，1990年毕业于昆明医学院，硕士学位。现任昆明医学院第一附属医院麻醉科副教授。研究方向：老年患者麻醉。
