摘要
目的 :观察全身麻醉与硬膜外麻醉对自主神经张力的影响。方法 :3 2例ASAⅠ～Ⅱ级择期行子宫切除术的成年女性患者 ,随机分为硬膜外组 (epiduralanesthesia ,EA组 ,n =16)和全麻组 (generalanesthesia ,GA组 ,n =16) ,应用心率变异功率频谱分析技术 (powerspectralanalysisofheartratevariability ,HRV PSA)观察两组患者在麻醉前 (T1)、麻醉诱导后 15min(T2 )、切皮后 1min(T3)、牵拉子宫 (T4)、子宫切下后 (T5)及术毕时 (T6 )的心率变异性(heartratevariability ,HRV)的变化。结果 :EA组 :与T1比较 ,LF/HF在T4时升高 ,低频 (LF)、高频 (HF)在T5、T6时下降 ,差异有显著性 ,其余各时点LF、HF、LF/HF无明显改变。GA组 :与T1比较 ,LF、HF均下降 ,LF/HF除T6时升高 ,其余各时点均下降 ,差异有显著性。结论 :硬膜外麻醉和全麻对HRV均有一定程度的抑制 ,但前者对其影响较小 ,交感 /迷走神经张力向交感占优势的方向转移 ;全麻对LF、HF抑制较强 ,且交感 /迷走神经张力向副交感占优势的方向转移 ,而术后LF/HF又急剧升高 。
Objective: To evaluate autonomic nervous tone during general and epidural anesthesia. Methods: Thirty two female patients(ASA grade Ⅰ-Ⅱ),scheduled for elective hysterectomy, were randomized to receive epidural anesthesia (group EA, n =16)or general anesthesia (group GA , n =16).The changes of HRV were observed with power spectral analysis of heart rate variability (HRV PSA) at the following time intervals: immediately pre anesthesia (T 1), 15 min after induction (T 2), 1 min after incision (T 3), dragging uterus (T 4), after removing uterus (T 5) and end of surgery (T 6). Results: Patients in group EA demonstrated a significant advance in LF/HF at T 4 and descending in LF and HF at T 5,T 6 to compare with T 1. LF、HF and LF/HF remained unchanged at the rest time intervals. In group GA ,compared with T 1,LF、HF and LF/HF dropped remarkably except for an increase in LF/HF at T 6. Conclusion: The autonomic nervous tone is inhibited by both epidural and general anesthesia. EA reveals a shift in the sympathovagal balance toward sympathetic predominance. GA is associated with a shift toward parasympathetic predominance intraoperatively, while postoperatively appears a dramatic increase in LF/HF.Relative to EA, there is a greater effect on autonomic nervous system with GA.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2003年第2期191-194,共4页
Journal of Peking University:Health Sciences
