Hogue C W, Stein P K, Apostolidou I, Lappas D G, Kleiger R E
Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110-1093.
Anesthesiology. 1994 Dec;81(6):1356-64. doi: 10.1097/00000542-199412000-00009.
Preliminary studies have indicated that autonomic nervous system dysfunction may be present in patients after cardiac surgery. The purpose of this study was to evaluate cardiac autonomic nervous system function, as assessed by analysis of heart rate variability (HRV), in adult patients undergoing uncomplicated coronary artery bypass graft surgery.
Longitudinal changes in HRV were determined perioperatively by continuous electrocardiographic monitoring in 40 adult patients undergoing elective coronary artery bypass graft surgery and were compared with HRV in two groups of control subjects: 15 patients undergoing nonthoracic major vascular surgery and 19 healthy volunteers. Exclusion criteria were diabetes, renal failure, recent or perioperative myocardial infarction, or use of inotropic drugs. HRV data during electrocardiographically documented episodes of myocardial ischemia were omitted.
There were no differences in any measurement of preoperative HRV between groups during the day, but HRV was greater at night (12:00 AM to 5:00 AM) in volunteers than in patients in either surgical group. In the hour after induction of anesthesia (before cardiopulmonary bypass), the components of HRV were decreased compared with those in the preoperative daytime but were similar in the two surgical groups. After surgery, HRV in the group undergoing nonthoracic vascular surgery remained at about the same level as that observed after induction of anesthesia, whereas in the group undergoing coronary artery bypass graft surgery, HRV was further reduced and was approximately 40-50% less than that in the vascular surgery group (P < 0.05). In the coronary artery bypass group, the reduction in HRV compared with the preoperative daytime measurements persisted on postoperative day 5.
HRV is reduced after uncomplicated coronary artery bypass graft surgery. Although we cannot exclude the effects of uncontrolled variables in this reduction of postoperative HRV, the observed changes in HRV did not appear to result from general anesthesia, perioperative stress responses, and other factors associated with the early postoperative period. These data are consistent with the supposition that cardiac autonomic nervous system function is impaired after cardiac surgery.
初步研究表明，心脏手术后患者可能存在自主神经系统功能障碍。本研究的目的是通过分析心率变异性（HRV）来评估接受非复杂性冠状动脉旁路移植术的成年患者的心脏自主神经系统功能。
通过连续心电图监测，对40例接受择期冠状动脉旁路移植术的成年患者围手术期HRV的纵向变化进行测定，并与两组对照组的HRV进行比较：15例接受非胸部大血管手术的患者和19名健康志愿者。排除标准为糖尿病、肾衰竭、近期或围手术期心肌梗死或使用正性肌力药物。心电图记录的心肌缺血发作期间的HRV数据被排除。
各组白天术前HRV的任何测量值均无差异，但志愿者夜间（上午12:00至上午5:00）的HRV高于任一手术组的患者。在麻醉诱导后（体外循环前）的1小时内，HRV的各成分与术前白天相比有所降低，但在两个手术组中相似。术后，接受非胸部血管手术的组的HRV保持在与麻醉诱导后观察到的水平大致相同，而接受冠状动脉旁路移植术的组的HRV进一步降低，比血管手术组低约40%-50%（P<0.05）。在冠状动脉旁路移植组中，与术前白天测量值相比，HRV的降低在术后第5天仍然存在。
非复杂性冠状动脉旁路移植术后HRV降低。虽然我们不能排除在这种术后HRV降低中未控制变量的影响，但观察到的HRV变化似乎不是由全身麻醉、围手术期应激反应和与术后早期相关的其他因素引起的。这些数据与心脏手术后心脏自主神经系统功能受损的假设一致。
