Padley James R, Ben-Menachem Erez
Department of Anaesthesia, St Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia.
Notre Dame School of Medicine, Darlinghurst, NSW, Australia.
J Clin Monit Comput. 2018 Apr;32(2):245-252. doi: 10.1007/s10877-017-0012-4. Epub 2017 Mar 14.
Significant hypotension after induction of general anesthesia is common and has the potential for serious complications. This study aimed to determine if pre-operative heart rate variability (HRV) was associated with post-induction hypotension in patients undergoing major abdominal surgery. Patients undergoing semi-elective major abdominal surgery were consecutively recruited during pre-admission clinic assessment. Exclusion criteria included cardiac conduction disease, arrhythmias or severe liver or renal disease. Ten minutes of electrocardiogram at 1024 Hz were recorded a median of 3 days pre-operatively. Pre-operative HRV parameters were compared in patients who experienced significant hypotension (fall in systolic and mean arterial pressure (MAP) >30% baseline and MAP ≤60 mmHg) versus those who remained haemodynamically stable after induction of general anesthesia with propofol and fentanyl. Patients who experienced hypotension after general anesthesia induction had significantly lower pre-operative HRV (SDNN 16 vs. 37 ms, p < 0.001), reduced spectral power (total power 262 vs. 1236 ms, p = 0.002) and reduced correlation dimension, a measure of signal complexity (0.11 vs. 2.13, p < 0.001). Hypotension occurred relatively frequently in our cohort and was associated with a higher ASA grade (36 vs. 6% ASA 3, p = 0.036), hence post-induction hypotension and lower HRV may be associated with severity of illness or poor physiological reserve. Pre-operative HRV was a useful screening tool in identifying patients undergoing major abdominal surgery who were at risk of haemodynamic instability after anesthesia induction.
全身麻醉诱导后出现显著低血压很常见，且有可能引发严重并发症。本研究旨在确定术前心率变异性（HRV）是否与接受大型腹部手术患者诱导后低血压相关。在入院前门诊评估期间，连续招募接受半择期大型腹部手术的患者。排除标准包括心脏传导疾病、心律失常或严重肝或肾疾病。术前3天的中位数时间记录10分钟1024Hz的心电图。比较经历显著低血压（收缩压和平均动脉压（MAP）下降>30%基线且MAP≤60mmHg）的患者与使用丙泊酚和芬太尼诱导全身麻醉后血流动力学保持稳定的患者的术前HRV参数。全身麻醉诱导后出现低血压的患者术前HRV显著更低（标准差NN间期16对37ms，p<0.001）、频谱功率降低（总功率262对1236ms，p=0.002）以及关联维数降低，关联维数是信号复杂性的一种度量（0.11对2.13，p<0.001）。低血压在我们的队列中相对频繁发生，且与更高的美国麻醉医师协会（ASA）分级相关（36%对6%为ASA 3级，p=0.036），因此诱导后低血压和更低的HRV可能与疾病严重程度或生理储备不佳相关。术前HRV是一种有用的筛查工具，可用于识别接受大型腹部手术且麻醉诱导后有血流动力学不稳定风险的患者。
