Cruz Jorge, Sousa João, Oliveira Antonio G, Silva-Carvalho Luis
Service of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal.
J Thorac Cardiovasc Surg. 2009 Mar;137(3):664-9. doi: 10.1016/j.jtcvs.2008.07.021. Epub 2008 Sep 24.
Endoscopic thoracic sympathectomy is performed to treat primary hyperhidrosis. The second and third sympathetic thoracic ganglia excised also innervate the heart. Some studies have shown decreased heart rate but have not been conclusive regarding other cardiac effects of sympathectomy. We studied the cardiac autonomic effects of endoscopic thoracic sympathectomy in a group of patients with primary hyperhidrosis. Heart rate variability is a simple, noninvasive electrocardiographic marker reflecting the activity and balance of the sympathetic and vagal components of the autonomous nervous system.
We performed a prospective study in 38 patients with primary hyperhidrosis with 24-hour Holter recordings obtained before endoscopic thoracic sympathectomy and 6 months later.
We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity.
These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.
实施内镜下胸交感神经切断术以治疗原发性多汗症。被切除的第二和第三胸交感神经节也支配心脏。一些研究显示心率下降，但对于交感神经切断术的其他心脏效应尚无定论。我们研究了内镜下胸交感神经切断术对一组原发性多汗症患者心脏自主神经的影响。心率变异性是一种简单的非侵入性心电图指标，反映自主神经系统交感和迷走成分的活动及平衡。
我们对38例原发性多汗症患者进行了一项前瞻性研究，在其接受内镜下胸交感神经切断术前及术后6个月进行24小时动态心电图记录。
我们发现时域和频域均存在统计学显著差异（P <.05）。评估整体心脏自主神经活动的参数（总功率、正常R-R间期标准差、平均正常R-R间期标准差）以及迷走神经活动的参数（相对于前一间期，周期大于50毫秒的正常R-R间期百分比对应的节律、连续正常R-R间期均方根差、高频功率、归一化单位下的高频功率）在交感神经切断术后均有统计学显著增加。反映交感神经活动的归一化单位下的低频功率在交感神经切断术后有统计学显著下降。低频/高频功率比值也显著下降，表明交感神经活动相对减少，迷走神经活动增加。
据我们所知，这些结果首次明确证明了内镜下胸交感神经切断术后迷走神经和整体心脏自主神经活动增加以及交感神经活动减少。
