Hirose M, Imai H, Ohmori M, Matsumoto Y, Amaya F, Hosokawa T, Tanaka Y
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Japan.
Anesthesiology. 1998 Sep;89(3):666-70. doi: 10.1097/00000542-199809000-00016.
Chemical thoracic sympathectomy (CTS) resulted in profound bradycardia in a patient with severe post-therapeutic neuralgia. To clarify the cause of this bradycardia, the authors evaluated heart rate variability using a Poincaré plot, which is a scatter diagram of the current R-R interval plotted against the R-R interval immediately preceding it, in this patient and in others scheduled for CTS or mandibular block (MB).
Twenty-three patients were scheduled for CTS (n = 13, CTS group) and for MB (n = 10, MB group). Heart rate and the SD of the R-R interval variabilities spreading along the x axis (SDRR) and perpendicularly along the diagonal line of the Poincaré plot (SDdeltaRR) were evaluated before, just after, and 1 h after the block.
Neither group had significant changes in heart rate. The MB group showed no significant change in the SD(RR):SDdeltaRR ratio. In the CTS group, however, the SD(RR):SDdeltaRR ratio decreased significantly from 1.72+/-0.20 to 1.23+/-0.11 just after CTS. The previous patient, who had a high SD(RR):SDdeltaRR ratio of 3.45 before CTS, exhibited severe bradycardia (22 beats/min).
The SD(RR):SDdeltaRR ratio decreased after CTS without any significant concomitant change in heart rate. The decrease in the SD(RR):SDdeltaRR. ratio indicates a reduction of cardiac sympathetic activity. However, CTS in patients having high SD(RR):SDdeltaRR ratios can result in profound bradycardia.
化学性胸交感神经切除术（CTS）在一名患有严重治疗后神经痛的患者中导致了严重的心动过缓。为了阐明这种心动过缓的原因，作者使用庞加莱图评估了心率变异性，庞加莱图是当前R-R间期相对于紧接其前的R-R间期的散点图，对该患者以及其他计划接受CTS或下颌阻滞（MB）的患者进行了评估。
23例患者计划接受CTS（n = 13，CTS组）和MB（n = 10，MB组）。在阻滞前、刚结束后以及结束后1小时评估心率以及沿庞加莱图x轴分布的R-R间期变异性标准差（SDRR）和沿对角线垂直分布的标准差（SDdeltaRR）。
两组患者心率均无显著变化。MB组的SD（RR）：SDdeltaRR比值无显著变化。然而，在CTS组中，CTS刚结束后，SD（RR）：SDdeltaRR比值从1.72±0.20显著降至1.23±0.11。之前那名患者在CTS前SD（RR）：SDdeltaRR比值高达3.45，出现了严重的心动过缓（22次/分钟）。
CTS后SD（RR）：SDdeltaRR比值降低，而心率没有任何显著的伴随变化。SD（RR）：SDdeltaRR比值的降低表明心脏交感神经活动减少。然而，SD（RR）：SDdeltaRR比值高的患者进行CTS可能会导致严重的心动过缓。
