Kingma René, TenVoorde Ben J, Scheffer Gert Jan, Karemaker John M, Mackaay Albert J C, Wesseling Karel H, de Lange Jaap J
Department of Anaesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
Clin Auton Res. 2002 Feb;12(1):35-42. doi: 10.1007/s102860200008.
Endoscopic thoracic sympathectomy at T2-T4 is an effective and safe treatment for primary axillary and palmar hyperhidrosis and facial blushing refractory to conventional treatment. T2 and T4 ganglia however are in the direct pathway of sympathetic innervation of the heart and part of the vasomotor nerves. In this study we investigate possible changes in steady-state hemodynamics as well as in beat-to-beat cardiovascular control after thoracoscopic sympathectomy of T2-T4. In 12 patients we measured continuously heart rate (HR) and blood pressure (BP) (non-invasively with Finapres) during rest and during deep inspiration, in supine and sitting position as well as during a change from lying to standing. Stroke volume (SV) and total peripheral resistance (TPR) were estimated from the BP recordings by the Modelflow method. Markers for cardiovascular control were obtained from power and cross-spectra of BP and HR. After sympathectomy, only in the sitting position was mean HR decreased, while TPR and BP (diastolic and mean) were lower in the supine as well as sitting positions. SV clearly increased. Low frequency power in HR and BP was significantly decreased, just like the max/min ratio in HR after standing up, indicating a diminished capacity in sympathetic vasomotor control. High frequency power of HR as well as baroreflex sensitivity, both parasympathetic markers, did not change in a statistically significant manner.
Besides altering steady-state hemodynamics, a thoracic sympathectomy causes relatively small, though measurable changes in cardiovascular control, in particular of peripheral vasomotion.
T2 - T4节段的内镜下胸交感神经切除术是治疗原发性腋窝和手掌多汗症以及对传统治疗无效的面部潮红的一种有效且安全的方法。然而，T2和T4神经节位于心脏交感神经支配和部分血管运动神经的直接路径上。在本研究中，我们调查了T2 - T4节段胸腔镜交感神经切除术后稳态血流动力学以及逐搏心血管控制的可能变化。在12例患者中，我们在静息、深吸气、仰卧位和坐位以及从卧位到站立位改变过程中，连续测量心率（HR）和血压（BP）（使用Finapres进行无创测量）。通过Modelflow方法从血压记录中估算每搏输出量（SV）和总外周阻力（TPR）。从BP和HR的功率及交叉谱中获取心血管控制指标。交感神经切除术后，仅在坐位时平均HR降低，而TPR以及仰卧位和坐位时的BP（舒张压和平均压）均降低。SV明显增加。HR和BP的低频功率显著降低，就像站立后HR的最大/最小比值一样，表明交感神经血管运动控制能力减弱。HR的高频功率以及压力反射敏感性这两个副交感神经指标均未发生具有统计学意义的变化。
除了改变稳态血流动力学外，胸交感神经切除术还会引起心血管控制方面相对较小但可测量的变化，尤其是外周血管运动方面。
