Jeanne Mathieu, Logier Régis, De Jonckheere Julien, Tavernier Benoît
Pôle d'Anesthésie Réanimation, hôpital Roger Salengro, CHU de Lille, France.
Auton Neurosci. 2009 May 11;147(1-2):91-6. doi: 10.1016/j.autneu.2009.01.005. Epub 2009 Feb 8.
Changes in heart rate variability (HRV) during anesthesia likely result from the interaction of hypnosis, surgical stimulation, analgesia and direct cardiovascular effects of drugs, but the interaction between these variables is unclear. This study was designed to characterize the impact of both surgical nociception and analgesia on HRV in propofol-anesthetized patients.
HRV was analyzed using wavelet transform in 49 patients (ASA status 1-2) before induction of anesthesia and then throughout stable anesthesia with propofol, in the absence of nociceptive stimulation, and then during surgery, in the presence of deep (adequate) or light (inadequate) analgesia provided by various opioids (sufentanil [n=19], alfentanil [n=18], or remifentanil [n=12].
Anesthesia reduced total power as well as high frequency (HF) and low frequency (LF) powers (all: P<0.01), with an increase (P=0.002) in the proportional part of HF power (HFnu). During nociception, HFnu decreased in a sensitive and reproducible way (P<0.01) in case of light analgesia, whereas HRV did not change when patient received adequate analgesia.
The nociception-analgesia balance is a direct determinant of HRV during surgical anesthesia. HFnu may behave like an early indicator of inadequate analgesia. These results have potential implication for monitoring adequacy of analgesia in healthy patients undergoing intravenous anesthesia. Additional work is needed for application across patient populations.
麻醉期间心率变异性（HRV）的变化可能源于催眠、手术刺激、镇痛以及药物对心血管的直接作用之间的相互影响，但这些变量之间的相互作用尚不清楚。本研究旨在描述手术伤害感受和镇痛对丙泊酚麻醉患者HRV的影响。
对49例患者（ASA分级1-2级）在麻醉诱导前、丙泊酚维持稳定麻醉且无伤害性刺激时、以及手术期间（使用各种阿片类药物提供深度[充分]或轻度[不充分]镇痛时，舒芬太尼[n=19]、阿芬太尼[n=18]或瑞芬太尼[n=12]），采用小波变换分析HRV。
麻醉降低了总功率以及高频（HF）和低频（LF）功率（均P<0.01），HF功率比例部分（HFnu）增加（P=0.002）。在伤害感受期间，轻度镇痛时HFnu以敏感且可重复的方式降低（P<0.01），而患者接受充分镇痛时HRV未改变。
伤害感受-镇痛平衡是手术麻醉期间HRV的直接决定因素。HFnu可能是镇痛不足的早期指标。这些结果对监测接受静脉麻醉的健康患者的镇痛充分性具有潜在意义。需要进一步开展工作以应用于不同患者群体。
