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目的探讨高血压患者在腹腔镜手术CO2气腹过程中自主神经功能的变化。方法应用心率变异性(HRV)分析法对25例择期高血压患者腹腔镜手术(Ⅰ组)和25例无高血压腹腔镜手术患者(Ⅱ组)麻醉前、气管插管结束后15 min、腹腔内CO2充气完成后的心率变异性改变进行分析。结果麻醉诱导及插管15 min后Ⅰ组低频(LF)、高频(HF)、低频与高频的比值(LF/HF)及总功率(TP)显著降低(P<0.05),Ⅱ组LF、LF/HF、TP亦显著降低(P<0.05),而HF未见明显改变。腹腔CO2充气完成后两组HRV值均显著升高(P<0.05)。组间比较显示,插管15 min后Ⅰ组HF和TP显著低于Ⅱ组,LF和LF/HF组间差异无统计学意义;气腹后I组HF和TP亦显著低于Ⅱ组,而LF/HF显著高于Ⅱ组,LF组间差异仍无统计学意义。结论高血压患者迷走神经活性及总自主神经张力显著低于非高血压患者,迷走神经对心脏窦房结的调控作用严重受损。
Objective To investigate the changes of autonomic nervous function in hypertensive patients undergoing pneumoperitoneum during laparoscopic surgery. Methods Twenty-five patients undergoing laparoscopic surgery (group Ⅰ) and 25 patients without hypertension laparoscopic surgery (group Ⅱ) undergoing anesthesia before anesthesia were anesthetized with HRV analysis. Twenty-five minutes after endotracheal intubation, Changes in heart rate variability after completion of CO2 insufflation were analyzed. Results After induction of anesthesia and intubation for 15 min, the LF, HF, LF / HF and total power (TP) of group Ⅰ were significantly decreased (P <0.05) , LF / HF, TP also significantly decreased (P <0.05), while HF had no significant change. HRV values of both groups were significantly increased after abdominal CO2 insufflation (P <0.05). Compared between two groups, HF and TP in group Ⅰ were significantly lower than those in group Ⅱ after intubation for 15 min, and there was no significant difference between LF and LF / HF group. After pneumoperitoneum, HF and TP in group Ⅰ were also significantly lower than those in group Ⅱ LF / HF was significantly higher than that in group Ⅱ, but there was no significant difference between LF groups. Conclusion Vagus nerve activity and total autonomic nervous tone in patients with hypertension are significantly lower than those in non-hypertensive patients. The regulation of the vagus nerve on the heart sinus node is severely impaired.