相位整序信号平均技术用于全麻术中自主神经功能的评价

Phase-rectified signal averaging for the assessment of automatic nervous system activity in surgery during general anesthesia

中文关键词: 心率变异性  相位整序信号平均技术  心率减速力  全身麻醉  自主神经系统

英文关键词: Heart rate variability  Phase rectified signal averaging  Deceleration capacity  General anesthesia  Automatic nervous system

中文摘要:

      目的 将相位整序信号平均技术(phase rectified signal averaging, PRSA)应用于全麻术中,观察其评价自主神经活动变化的可行性。方法 选择口腔颌面外科择期手术患者110例,男63例,女47例,年龄18～65岁,ASA Ⅰ或Ⅱ级。手术全程采集心电信号。从连续的心电信号中截取三个5 min时段:术前(T0):患者麻醉前的清醒状态;术中(T1):手术开始25～30 min;术后(T2):手术结束,患者意识恢复。计算三个时间段心率变异性(heart rate variability,HRV)各项指标：心率减速力(deceleration capacity of heart rate, DC)、RR间期差值的均方根(RMSSD)、RR间期的标准差(SDNN)、散点图短轴(SD1)、散点图长轴(SD2)、总功率(total power, TP)、低频功率(low frequency power, LF)、高频功率(high frequency power, HF)。结果 与T0时比较,T1、T2时DC、RMSSD、SDNN、SD1、SD2明显缩短，logTP、logLF和logHF明显减小(P＜0.05);与T1时比较,T2时DC、RMSSD、SDNN、SD1、SD2明显延长，logTP、logLF和logHF明显增大(P＜0.05);DC与RMSSD、SD1、logHF呈正相关 (r=0.905、0.909、0.932, P＜0.01)。结论 基于PRSA技术5分钟的DC值,与迷走神经活动性具有较好的相关性,用于术中观察自主神经活动是可行的。

英文摘要:

      Objective To observe the feasibility of phase rectified signal averaging applied for the evaluation of automatic nervous system activity in general anesthesia. MethodsForty seven females and 63 males aged 18 65 years, ASA falling into category Ⅰ or Ⅱ, scheduled for oral maxillofacial surgery under general anesthesia were selected. The heart rate variability(HRV) signal was recorded by Powerlab throughout the operation,and then it was sectioned into three segments with 5 minutes: pre anesthesia(T0), means the waking state before the operation; intra anesthesia(T1), the period of operation in 25 30 min; post anesthesia(T2), the consciousness recovery state in the end of the operation. All indicators of HRV analysis was calculated in the time domain. SpO2, MAP and BIS were recorded synchronously in the three periods. ResultsCompared with T0, DC, RMSSD, SDNN, SD1, SD2, logTP, logLF, logHF were significantly lower at T1 and T2(P＜005). In contrast to T1, HR, MAP and BIS were significantly higher at T2(P＜005), DC, RMSSD, SDNN, SD1, SD2, logTP, logLF, logHF were significantly increased at T2(P＜005). There was positive relation between DC and RMSSD, SD1, logHF (r=0905, 0909, 0932, respectively, P＜001). ConclusionAs 5 min DC could indicate the character of PRSA, especially its specificity in showing vagus nerves activities, it is feasible that DC is used to observe the autonomic nerve activity intra operation.