Ristikankare M, Julkunen R, Heikkinen M, Laitinen T, Wang S-X, Hartikainen J
Laakso Hospital, City of Helsinki Health Centre, 00099 Helsinki, Finland.
Dig Liver Dis. 2009 Sep;41(9):648-52. doi: 10.1016/j.dld.2009.01.008. Epub 2009 Feb 23.
Gastroscopy is sometimes associated with adverse cardiovascular events.
We evaluated the effects of sedation and pharyngeal anaesthesia on cardiac autonomic regulation during gastroscopy.
Two hundred thirteen outpatients undergoing gastroscopy.
The patients were assigned to 4 groups: (1) sedation with intravenous midazolam and placebo throat spray (midazolam group), (2) placebo sedation and pharyngeal anaesthesia with lidocaine (lidocaine group), (3) placebo sedation and placebo throat spray (placebo group), and (4) no intravenous cannula nor throat spray (control group). Continuous electrocardiogram was recorded. Heart rate variability was assessed; the powers of low frequency (0.04-0.15 Hz) and high frequency (0.15-0.40 Hz) components as well as total power (0.0-0.4 Hz) were calculated.
Gastroscopy was associated with a decrease in high frequency normalized units, increases in low frequency normalized units and low frequency/high frequency ratio indicating activation of sympathetic and withdrawal of vagal modulation. Sympathetic activation resulted in a decrease in total power and all components of heart rate variability. The decrease was most prominent in the midazolam treated patients (p<0.001 vs the lidocaine group and p<0.01 vs placebo and control groups during the postendoscopy phase).
Gastroscopy induces a shift towards dominance of the sympathetic modulation of the heart. Premedication with midazolam potentiates this shift.
胃镜检查有时会伴有不良心血管事件。
我们评估了镇静和咽部麻醉对胃镜检查期间心脏自主神经调节的影响。
213名接受胃镜检查的门诊患者。
将患者分为4组：（1）静脉注射咪达唑仑并使用安慰剂咽喉喷雾（咪达唑仑组），（2）安慰剂镇静并使用利多卡因进行咽部麻醉（利多卡因组），（3）安慰剂镇静并使用安慰剂咽喉喷雾（安慰剂组），以及（4）既不进行静脉插管也不使用咽喉喷雾（对照组）。记录连续心电图。评估心率变异性；计算低频（0.04 - 0.15Hz）和高频（0.15 - 0.40Hz）成分的功率以及总功率（0.0 - 0.4Hz）。
胃镜检查与高频标准化单位降低、低频标准化单位增加以及低频/高频比值增加相关，表明交感神经激活和迷走神经调节减弱。交感神经激活导致总功率和心率变异性的所有成分降低。这种降低在咪达唑仑治疗的患者中最为显著（在内镜检查后阶段，与利多卡因组相比p<0.001，与安慰剂组和对照组相比p<0.01）。
胃镜检查会导致心脏交感神经调节占主导地位的转变。咪达唑仑预处理会增强这种转变。
