Kawamata Yurie T, Kawamata Tomoyuki, Omote Keiichi, Homma Eiji, Hanzawa Tatsuo, Kaneko Toshifumi, Namiki Akiyoshi
Departments of *Anesthesiology and ‡Surgery, Nippon Telegraph and Telephone East Japan Sapporo Hospital, Sapporo, Japan; and †Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Anesth Analg. 2004 Jan;98(1):37-39. doi: 10.1213/01.ANE.0000094984.90178.33.
Endoscopic thoracic (T2-3 or T3-4) sympathectomy (ETS) is a highly effective treatment for palmar hyperhidrosis. Because the T2-3 or T3-4 sympathetic ganglia are involved in direct sympathetic innervation of the heart, sympathectomy at this level may alter baroreflex control of heart rate. The purpose of our study was to examine the influence of ETS on baroreflex responses to pressor and depressor stimuli under small-dose sevoflurane anesthesia. We studied 40 patients with palmar or axillary hyperhidrosis who were scheduled to receive ETS. In the ETS procedure, the sympathetic trunk was identified by using thoracic endoscopy and was transected. Before and after ETS, the pressor or depressor test was performed by using an IV infusion of phenylephrine or nitroglycerin, respectively, under small-dose general anesthesia. Baroreflex sensitivity was calculated from R-R intervals and systolic blood pressure. ETS did not change heart rate and systemic blood pressure at rest, although ETS significantly altered baroreflex in both pressor and depressor tests in all patients. Baroreflex was completely suppressed in 1 of 19 patients in the pressor test and in 9 of 21 patients in the depressor test. We conclude that baroreflex responses are suppressed in patients who receive ETS.
Endoscopic thoracic sympathectomy suppressed the baroreflex control of heart rate during pressor and depressor tests in patients with palmar or axillary hyperhidrosis.
内镜下胸交感神经切除术（T2 - 3或T3 - 4）是治疗手掌多汗症的一种高效方法。由于T2 - 3或T3 - 4交感神经节参与心脏的直接交感神经支配，在此水平进行交感神经切除术可能会改变心率的压力反射控制。我们研究的目的是在小剂量七氟醚麻醉下，检验内镜下胸交感神经切除术对压力反射对升压和降压刺激反应的影响。我们研究了40例计划接受内镜下胸交感神经切除术的手掌或腋窝多汗症患者。在内镜下胸交感神经切除术过程中，通过胸腔镜识别交感干并将其切断。在内镜下胸交感神经切除术前后，分别在小剂量全身麻醉下通过静脉输注去氧肾上腺素或硝酸甘油进行升压或降压试验。根据R - R间期和收缩压计算压力反射敏感性。内镜下胸交感神经切除术在静息状态下未改变心率和全身血压，尽管在所有患者的升压和降压试验中，内镜下胸交感神经切除术均显著改变了压力反射。在升压试验中，19例患者中有1例压力反射完全被抑制；在降压试验中，21例患者中有9例压力反射完全被抑制。我们得出结论，接受内镜下胸交感神经切除术的患者压力反射反应受到抑制。
内镜下胸交感神经切除术在手掌或腋窝多汗症患者的升压和降压试验中抑制了心率的压力反射控制。
