Effects of pneumoperitoneum on cardiac autonomic nervous activity evaluated by heart rate variability analysis during sevoflurane, isoflurane, or propofol anesthesia
Effects of pneumoperitoneum on cardiac autonomic nervous activity evaluated by heart rate variability analysis during sevoflurane, isoflurane, or propofol anesthesia
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DOI：
10.1007/s004640000155
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发表时间：
2000-04-01
影响因子：
3.1
通讯作者：
Inoue, K
中科院分区：
文献类型：
--
作者：
Sato, N;Kawamoto, M;Inoue, K
背景：气腹对心脏自主神经活动的影响尚不完全清楚。方法：45例成人腹腔镜手术患者，随机分为三组，每组15例，分别用3.5%七氟醚、2%异氟醚或8 mg/kg/h异丙酚麻醉。心率变异性分析评价心脏自主神经活动状态：清醒时1次，全麻诱导后1次，气腹后1次。腹内压通过二氧化碳(CO2)充气器自动维持在10毫米汞柱。对于每一次测量，记录了256人的S的心电图，并离线回放以检测R-R间期。对心率变异性进行功率谱分析，利用快速傅立叶变换算法从R-R间期的功率谱中得到心率变异性的低频(0.04~0.15 Hz)和高频(0.15~0.40 Hz)谱密度频段。结果：三组心率变异性测量结果相似。虽然代表副交感神经活动的HF的功率没有改变，但同时代表交感和副交感神经活动的LF的功率在麻醉期下降，在注气期增加。代表副交感和交感神经活动平衡的HF/LF比值在全麻诱导后升高，在气腹后降低。全麻药的选择对气腹诱导后心脏自主神经功能的改变无明显影响。
Background: The effects of pneumoperitoneum on the activity of the cardiac autonomic nervous system have not been completely understood.Methods: In this study, 45 unpremedicated adult patients who underwent laparoscopic cholecystectomy were anesthetized with either 3.5% sevoflurane, 2% isoflurane, or 8 mg/kg/h propofol (15 patients in each group). The status of cardiac autonomic nervous activity was evaluated by heart rate variability analysis three times: once when the patient was awake, once after induction of general anesthesia, and once after insufflation for pneumoperitoneum. Intraabdominal pressure was maintained automatically at 10 mmHg by a carbon dioxide (CO2) insufflator. For each measurement, electrocardiogram was recorded for 256 s and played back offline to detect R-R intervals. Power spectral analysis of heart rate variability was applied, and the low-frequency (LF, 0.04-0.15 Hz) and high-frequency (HF, 0.15-0.40 Hz) bands of the spectral density of the heart rate variability were obtained from a power spectra of R-R intervals using the fast-Fourier transform algorithm. The HF/LF ratio also was analyzed.Results: Measurements of heart rate variability in the three groups showed similar change. Although the power of HF, which represents parasympathetic nervous activity, did not change, the power of LF, which represents both sympathetic and parasympathetic nervous activity, decreased during the anesthetized stage and increased during the insufflated stage. The HF/LF ratio, which represents the balance of parasympathetic and sympathetic activity, increased after induction of general anesthesia, and decreased after insufflation.Conclusions: Our results suggest that pneumoperitoneum increases sympathetic cardiac activity. The choice of general anesthetic did not seem to have a major influence on the change in the cardiac autonomic nervous system after induction of pneumoperitoneum for laparoscopic cholecystectomy.