目的 探讨不同麻醉深度对接受腹腔镜下胆囊切除术（laparoscopic cholecystectomy,LC）的中老年患者心率变异性（heart rate variability,HRV）和血流动力学的影响。方法 纳入2020年1月至2024年12月在山西省运城市中心医院接受LC的中老年患者164例,根据麻醉深度分为轻度麻醉组（BIS：50~59,n=55）、中度麻醉组（BIS：40~49,n=55）和深度麻醉组（BIS：30~39,n=54）。观察各组麻醉诱导前（T1）、插管后（T2）、插管后3 min（T3）、拔管后6 min（T4）HRV及血流动力学的动态变化。比较各组麻醉恢复时间、疼痛应激因子水平、认知功能及不良反应发生率。结果 组间同一时间点（T2~T4）,三组患者HRV（HFP、LFP/HFP及TP）及血流动力学（HR、MAP、DBP及SBP）相关指标的比较差异均有统计学意义。相较于轻度麻醉和深度麻醉组,中度麻醉组HRV及血流动力学相关指标的波动较小。相较于轻度和深度麻醉组,中度麻醉组患者自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间及出复苏室的时间明显缩短,认知功能评分明显升高,中度麻醉组患者疼痛应激因子（AD、NE、Cor）水平明显降低。三组患者麻醉过程中的不良反应发生率无显著差异。结论 BIS维持在40~49对接受LC的中老年患者围术期HRV和血流动力学影响不大,与麻醉后恢复相关,提示在本研究条件下BIS 40~49可能有益,但仍需前瞻性、多中心研究验证。
Abstract
Objective To investigate the impacts of different depth of anesthesia on heart rate variability (HRV) and hemodynamics in middle-aged and elderly patients undergoing laparoscopic cholecystectomy (LC). Methods A total of 164 middle-aged and elderly patients who underwent LC in Yuncheng Central Hospital of Shanxi Province from January 2020 to December 2024 were enrolled. According to the bispectral index (BIS), patients were divided into three groups: mild anesthesia (BIS: 50-59, n=55), moderate anesthesia (BIS: 40-49, n=55), and deep anesthesia (BIS: 30-39, n=54). HRV and hemodynamic parameters were recorded at four time points: before anesthesia induction (T1), immediately after intubation (T2), 3 min after intubation (T3) and 6 min after extubation (T4). Anesthesia recovery time, levels of pain-related stress markers, cognitive function and the incidence of adverse reactions were compared among all groups. Results Significant differences were observed among the three groups in HRV indices (HFP, LFP/HFP and TP) and hemodynamic parameters (HR, MAP, DBP and SBP) at T2 to T4. The moderate anesthesia group showed smaller fluctuations in HRV and hemodynamic measures compared to the mild and deep anesthesia groups. In addition, patients in the moderate anesthesia group had significantly shorter recovery times (spontaneous respiration, eye opening, extubation, orientation recovery, and post-anesthesia care unit discharge), higher cognitive function scores, and lower levels of pain-related stress markers (AD, NE, and Cor) than those in the other two groups. There were no significant differences in the incidence of adverse reactions among the three groups. Conclusion Maintaining BIS within 40-49 during surgery has little impact on perioperative HRV and hemodynamics in middle-aged and elderly patients undergoing LC, and is associated with postoperative recovery. This suggests that under the conditions of this study, a BIS range of 40-49 may be beneficial, though prospective or multicenter validation is still required.
关键词
麻醉深度 /
心率变异性 /
血流动力学 /
腹腔镜胆囊切除术 /
围手术期
Key words
anesthesia depth /
heart rate variability /
hemodynamics /
laparoscopic cholecystectomy /
perioperative period
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基金
山西省卫健委四个一批科技兴医创新计划团队项目“加速康复外科青年团队”（2020TD22）
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