【原】【罂粟摘要】可乐定对脊髓麻醉期间心率变异性的影响：随机临床试验

可乐定对脊髓麻醉期间心率变异性的影响：随机临床试验

贵州医科大学          麻醉与心脏电生理课题组

翻译：严旭         编辑：田明德    审校：曹莹

简介：脊髓麻醉包括在蛛网膜下腔可引起感觉、运动和自主神经传导阻滞。目前，脊髓麻醉恢复是通过运动功能来评估的，而不考虑自主神经阻断，这是该技术大多数并发症的原因。心率变异性（HRV）是一种测量自主神经系统的间接方法，可能有助于评估脊髓麻醉后的自主神经恢复。该研究目标是在可乐定用作佐剂时，通过HRV评估接受脊髓麻醉的患者在运动功能恢复时的自主功能。

材料和方法：这是一项随机、双盲临床试验。样本包括64名接受脊髓麻醉的ASA I-II患者，并被分为2组。C组接受20mg布比卡因和75ug可乐定，B组接受20mg布比卡因。在静止（T1）和运动功能恢复（T2）时对HRV进行了评估。使用Polar V800®心率监测器收集数据，然后使用Kubios 3.0®软件进行分析和过滤。

结果：在2个时刻之间的任何一组中，低频/高频（LF/HF）比率、庞加莱图标准差（SD2/SD1）、去趋势波动分析（DFAα1、DFAα2）或相关维度（D2）指数的值都没有差异。在可乐定组中，仅在近似熵（ApEn）方面存在差异，其中P为0.0124，95%置信区间为17.83-141.47。

结论：脊髓麻醉中交感神经阻滞和运动阻滞的持续时间没有显著差异。

原始文献来源：Hermes Melo Teixeira Batista , Solange Kelly Lima Araújo , Galba Matos Cardoso de Alencar Júnior , et，al.Effect of clonidine on heart rate variability during spinal anaesthesia: randomized clinical trial [J].Anaesthesiol Intensive Ther. 2023;55(3):218-222.doi: 10.5114/ait.2023.130821.

Effect of clonidine on heart rate variability during spinal anaesthesia: randomized clinical trial

Abstract

Introduction: Spinal anaesthesia consists of administering a local anaesthetic in the subarachnoid space, thus causing sensory, motor, and autonomic nerve conduction block. Currently, recovery from spinal anaesthesia is evaluated by the return of motor function, without considering the autonomic blockade, which is responsible for most complications of the technique. Heart rate variability (HRV) is an indirect method to measure the autonomic nervous system and may be useful in assessing autonomic recovery after spinal anaesthesia. The study objective was to evaluate the autonomic function, through HRV, at the moment of return of motor function in patients who received spinal anaesthesia when clonidine is used as an adjuvant.

Material and methods: This was a randomised, double-blind clinical trial. The sample consisted of 64 ASA I-II patients who underwent spinal anaesthesia and were divided into 2 groups. Group C received 20 mg of bupivacaine with 75 mcg of clonidine, and group B received 20 mg of bupivacaine. HRV was evaluated at rest (T1) and at the time of motor function recovery (T2). Data were collected using a Polar V800® heart rate monitor and then analysed and filtered using Kubios 3.0® software.

Results: There was no difference in the values of the low-frequency/high-frequency (LF/HF) ratio, Poincaré plot standard deviation (SD2/SD1), detrended fluctuation analysis (DFAα1, DFAα2), or correlation dimension (D2) indices in any of the groups between the 2 moments. In the clonidine group, there was a difference only in approximate entropy (ApEn), where a P of 0.0124 was obtained considering a 95% confidence interval ranging from 17.83 to 141.47.

Conclusions: There was no significant difference between the duration of sympathetic blockade and motor blockade in spinal anaesthesia.