摘要
目的 探讨全身麻醉对合并高血压的老年腹腔镜胆囊切除术(LC)患者心率变异性、血压波动的影响.方法 前瞻性选取2022年5月至2023年3月北京协和医院收治的合并高血压的老年LC患者59例为高血压组,按1:1比例纳入同期收治的未合并高血压的老年LC患者59例为非高血压组.观察两组麻醉诱导前(T1)、麻醉诱导即刻(T2)、气腹10 min(T3)、气腹30 min(T4)心率变异性的变化,包括低频功率(LF)、高频功率(HF)、LF/HF,并比较两组T1、T2、T3及拔管时(T5)的舒张压、收缩压变化及血清皮质醇、丙二醛水平,记录两组睁眼时间、自主呼吸恢复时间、定向力恢复时间、肌力恢复时间.结果 T,时,两组各指标比较,差异均无统计学意义(P＞0.05);T2、T3、T4时,高血压组LF、LF/HF均高于非高血压组,HF低于非高血压组,差异均有统计学意义(P＜0.05).高血压组T1、T2、T3、T5时收缩压、舒张压均高于非高血压组,差异均有统计学意义(P＜0.05).高血压组T1、T2、T3、T5时血清皮质醇、丙二醛水平均高于非高血压组,差异均有统计学意义(P＜0.05).高血压组睁眼时间、自主呼吸恢复时间分别为(23.40±2.65)、(13.09±4.05)min,均长于非高血压组[(21.45±4.42)、(11.42±2.64)min],差异均有统计学意义(P＜0.05);两组定向力恢复时间、肌力恢复时间比较,差异均无统计学意义(P＞0.05).结论 全身麻醉可加重合并高血压的老年LC患者心率变异性以及术中血压的波动,且会加剧应激反应,延长睁眼、自主呼吸恢复时间,临床需引起重视,针对这类患者密切观察生命体征变化,根据情况适度调整给药剂量与麻醉方案.
Abstract
Objective To investigate the effect of general anesthesia on heart rate variability and intraoperative blood pressure fluctuation in elderly patients undergoing laparoscopic cholecystectomy(LC)complicated with hypertension.Methods Fifty-nine elderly LC patients with hypertension admitted to Peking Union Medical College Hospital from May 2022 to March 2023 were prospectively selected as the hypertension group,and according to 1:1 ratio,59 elderly LC patients without concomitant hypertension admitted to the same period were included as the non hypertension group.The changes of heart rate variability before anesthesia induction(T1),immediately after anesthesia induction(T2),10 min of pneumoperitoneum(T3),30 min of pneumoperitoneum(T4)were observed in the two groups,including low frequency power(LF),high fre-quency power(HF),LF/HF.The diastolic blood pressure,systolic blood pressure and serum cortisol and malondialdehyde levels were compared between the two groups at the time of extubation(T5),and the eye opening time,spontaneous breathing recovery time,orientation recovery time and muscle strength recovery time were recorded between the two groups.Results At T1,there was no statistically significant difference in vari-ous indicators between the two groups(P＞0.05);at T2,T3,and T4,LF,LF/HF in the hypertensive group were higher than those in the non hypertensive group,and HF was lower than those in the non hypertensive group,the differences were statistically significant(P＜0.05).The systolic and diastolic blood pressure of the hypertensive group at T1,T2,T3,and T5 were higher than those of the non hypertensive group,and the differences were statistically significant(P＜0.05).The serum cortisol and malondialdehyde levels in the hypertensive group at T1,T2,T3,and T5 were higher than those in the non hypertensive group,and the differences were statistically significant(P＜0.05).The eye opening time and spontaneous breathing recovery time of the hypertensive group were(23.40±2.65)and(13.09±4.05)minutes,respectively,which were lon-ger than those of the non hypertensive group[(21.45±4.42)and(11.42±2.64)minutes],and the differences were statistically significant(P＜0.05);and there was no statistically significant difference in the orientation recovery time and muscle strength between the two groups(P＞0.05).Conclusion General anesthesia can aggravate the heart rate variability and intraoperative blood pressure fluctuation in elderly LC pa-tients with hypertension,aggravate the stress response,and prolong the recovery time of eye opening and spontaneous respiration.Clinical attention should be paid to this.For these patients,the changes of vital signs should be closely observed,and the dosage and anesthesia program should be appropriately adjusted according to the situation.
基金项目
首都卫生发展科研专项(HT[2021]000514)
维普
万方数据