Alijani A, Hanna G B, Band M, Struthers A D, Cuschieri A
Department of Surgery, Ninewells Hospital and Medical School, DD1 9SY, Dundee, Scotland, UK.
Surg Endosc. 2004 Jun;18(6):915-8. doi: 10.1007/s00464-003-8265-z. Epub 2004 Apr 21.
This study hypothesized that patients in whom bradycardia and hypotension develop with induction of positive-pressure capnoperitoneum have an underlying autonomic cardiovascular dysfunction.
A case-control study was conducted to examine the baseline autonomic function of patients in whom bradycardia and hypotension develop with induction of positive-pressure capnoperitoneum. The control group consisted of patients who maintained normal cardiac rhythm and blood pressure during the same procedure. Two groups of tests were performed: bedside stress tests of cardiovascular autonomic function (response graded 1 (normal) to 4 (severely abnormal) and heart rate variability analysis (spectral and time domain components).
The study evaluated 6 patients in the bradycardia group and 10 in the control group. The group in whom bradycardia had developed scored significantly worse on the bedside stress tests than the control group (for grades I to IV: chi2 = 6.5, p = 0.022; for trend: chi2 = 5.6, p = 0.018). In contrast, both groups had similar baseline autonomic tone, as measured by heart rate variability.
Patients in whom bradycardia and hypotension develop with induction of positive-pressure capnoperitoneum have cardiovascular autonomic dysfunction, which is identifiable by bedside stress tests of autonomic function.
本研究假设，在正压二氧化碳气腹诱导过程中出现心动过缓和低血压的患者存在潜在的自主神经心血管功能障碍。
进行一项病例对照研究，以检查在正压二氧化碳气腹诱导过程中出现心动过缓和低血压的患者的基线自主神经功能。对照组由在相同手术过程中维持正常心律和血压的患者组成。进行了两组测试：心血管自主神经功能的床边应激测试（反应分为1级（正常）至4级（严重异常））和心率变异性分析（频谱和时域成分）。
该研究评估了心动过缓组的6名患者和对照组的10名患者。出现心动过缓的组在床边应激测试中的得分明显低于对照组（对于I至IV级：χ2 = 6.5，p = 0.022；对于趋势：χ2 = 5.6，p = 0.018）。相比之下，通过心率变异性测量，两组的基线自主神经张力相似。
在正压二氧化碳气腹诱导过程中出现心动过缓和低血压的患者存在心血管自主神经功能障碍，这可以通过自主神经功能的床边应激测试来识别。
