Keyl C, Lemberger P, Palitzsch K D, Hochmuth K, Liebold A, Hobbhahn J
Department of Anesthesiology, University Medical Center, Regensburg, Germany.
Anesth Analg. 1999 May;88(5):985-91. doi: 10.1097/00000539-199905000-00004.
Autonomic neuropathy is a major complication of diabetes mellitus and is reported to be associated with increased perioperative hemodynamic instability. We investigated the relationship between autonomic dysfunction and hemodynamic response to anesthetic induction in diabetic and nondiabetic patients with coronary artery disease. We studied 60 patients scheduled for coronary artery surgery, 30 suffering from diabetes mellitus. Preoperative evaluation included traditional cardiovascular autonomic function tests (coefficient of variation of 150 beat-to-beat intervals in heart rate at rest, heart rate response to deep breathing, and heart rate and arterial blood pressure response to standing), spectral analysis of blood pressure and heart rate variability (HRV), and the computation of spontaneous baroreflex sensitivity. After premedication with clorazepate, anesthesia was induced with sufentanil (0.5 microg/kg), etomidate (0.1-0.2 mg/kg), and vecuronium (0.1 mg/kg). Heart rate and blood pressure before anesthetic induction and before and after tracheal intubation were compared between groups. Autonomic function tests, spectral analysis of HRV, and spontaneous baroreflex sensitivity revealed significant differences between patient groups. Most diabetic patients (n = 23) had one or more abnormal test results, in contrast to most nondiabetic patients, who did not show signs of autonomic neuropathy (n = 23). There was no relationship between cardiovascular autonomic function and hemodynamic behavior during anesthetic induction. The blood pressure response to anesthetic induction was not different between patient groups, even when comparing the subgroups with and without abnormal autonomic function tests. These findings indicate that increased hemodynamic instability during anesthetic induction is not obligatory in patients with diabetes mellitus and autonomic dysfunction.
This study indicates that increased hemodynamic instability during anesthetic induction is not obligatory in patients with coronary artery disease and autonomic dysfunction.
自主神经病变是糖尿病的主要并发症，据报道与围手术期血流动力学不稳定增加有关。我们研究了冠心病糖尿病患者和非糖尿病患者自主神经功能障碍与麻醉诱导血流动力学反应之间的关系。我们研究了60例计划进行冠状动脉手术的患者，其中30例患有糖尿病。术前评估包括传统的心血管自主功能测试（静息心率逐搏间期变异系数、深呼吸时心率反应以及站立时心率和动脉血压反应）、血压和心率变异性（HRV）的频谱分析以及自发性压力反射敏感性的计算。在使用氯氮卓预处理后，用舒芬太尼（0.5μg/kg）、依托咪酯（0.1 - 0.2mg/kg）和维库溴铵（0.1mg/kg）诱导麻醉。比较了两组在麻醉诱导前以及气管插管前后的心率和血压。自主功能测试、HRV频谱分析和自发性压力反射敏感性显示患者组之间存在显著差异。大多数糖尿病患者（n = 23）有一项或多项异常测试结果，相比之下，大多数非糖尿病患者未表现出自主神经病变迹象（n = 23）。麻醉诱导期间心血管自主功能与血流动力学行为之间无相关性。即使比较自主功能测试正常和异常的亚组，患者组之间对麻醉诱导的血压反应也无差异。这些发现表明，糖尿病和自主神经功能障碍患者在麻醉诱导期间血流动力学不稳定增加并非必然。
本研究表明，冠状动脉疾病和自主神经功能障碍患者在麻醉诱导期间血流动力学不稳定增加并非必然。
