摘要
目的 探讨围术期心率变异性 (HRV)降低的病理生理机制。方法 成人ASAⅠ～Ⅱ级静吸复合全身麻醉下行胸腹部择期手术 2 0例 ,6 0岁以上 (A组 )和 6 0岁以下 (B组 )各 1 0例。术前、麻醉后、术后清醒时、术后 1、3和 7d等时间点监测HRV5min短程频域分析各成分的变化 ,并测定淋巴细胞 β 肾上腺素能受体表面密度分布 (Bmax) ,以及血浆肾上腺素 (E)、去甲肾上腺素 (NE)和异丙肾上腺素刺激淋巴细胞产生的环磷酸腺苷 (cAMP)。结果 麻醉和手术后两组HRV较术前下降显著 ,术后 1周恢复 ;两组病人E和NE于术后显著升高 ;两组病人Bmax于术后 1周内下降 ;上述结果均以A组尤为显著。两组病人的cAMP于全麻后就出现明显下降 ,于术后 7d恢复 ,以A组降低更为显著。排除全麻药的影响 ,围术期NE血浆浓度与cAMP呈线性负相关 ,HRV与cAMP呈线性正相关。结论 麻醉和手术后 1周机体 (尤其老年人 )心率变异性大幅降低 ,其与围术期 β
Objective To investigate the pathological and physiological mechanisms of the perioperative decline of heart rate variability (HRV).Methods 20 ASAⅠ Ⅱ adult patients,undergoing elective thoracic or abdominal surgery under general anesthesia,were assigned into two groups:group A(age≥60 years old, n= 10)and group B(age<60 years old, n= 10).While changes of each component of HRV analysis in the frequency domain in five minutes were observed,Density of β adrenergic receptor(Bmax),isoproterenol stimulated cAMP product in lymphocytes and catecholamines in the plasma were measured during different perioperative periods:before sugery,after general anesthesia,during waking and on the 1st,3rd 7th day after surgery.Results Compared with the baselines before surgery,HRV.decreased significantly after general anesthesia and the surgery.Plasma E and NE in both groups increased significantly after surgery.Bmax in both groups significantly decreased within one week after surgery,which were more significant in.group.A.The isoproterenol stimulated cAMP product in lymphocytes significantly decreased and did not return to the baselines until one week after surgery.Also,cAMP product in group A decreased more significantly than that in group B during perioperative periods.Excluding the effects of general anesthesia,NE inversely correlated with isoproterenol stimulated cAMP product,while HRV positively correlated with cAMP perioperatively.Conclusions HRV in human,especially in the elderly,significantly decreases one week after general anesthesia and surgery,which may relate to the downregulation and desensitization of β adrenergic receptor. [
出处
《临床麻醉学杂志》
CAS
CSCD
2003年第4期204-206,共3页
Journal of Clinical Anesthesiology
