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題 名 | Power Spectral Analysis of Arterial Blood Pressure after Spinal Anesthesia=脊髓麻醉對動脈壓訊號頻譜成份之影響 |
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作 者 | 楊敏文; 郭博昭; 林素滿; 陳慶鏗; | 書刊名 | 麻醉學雜誌 |
卷 期 | 36:1 1998.03[民87.03] |
頁 次 | 頁3-10 |
分類號 | 416.54 |
關鍵詞 | 脊髓麻醉; 局部麻醉劑:bupivacaine; 動脈壓訊號頻譜分析; 自主神經系統; Anesthesia:Spinal; Anesthetics, Local:bupivacaine; Spectral analysis:systemic arterial pressure; Autonomic nervous system; |
語 文 | 英文(English) |
中文摘要 | 背景:動脈壓訊號和心跳變異頻譜分析最近成為一種非侵襲性觀測自主神經系 統強度指標;脊髓麻醉會經由節前神經阻斷作用產生動脈壓降低和心跳變緩慢等變化。本實 驗目的在脊髓麻醉後的病人,利用動脈壓訊號頻譜分析測得自主神經系統強度變化,和動脈 壓降低和心跳變緩慢等變化作比較,驗證動脈壓訊號頻譜分析可視為一種監測脊麻醉後生理 變化之臨床生理檢測儀器。 方法:在 10 位病人接受常規鼠蹊部疝氣修補手術,麻醉體位評議為壹或貳級,年紀分 別有 17 到 75 歲不等。脊髓麻醉方式採用 bupivacaine 0.5% 劑量為 13-15 毫克。利用 傳利葉轉換函數分析動脈壓訊號?:極低頻( BVLF,0.01-0.08Hz ), 低頻( BLF, 0.09-0.15Hz )和高頻( BHF,0.16-0.25Hz ),比較脊髓麻醉後生理變化和動脈壓訊號頻 譜成份改變之間是否有密切關係存在。 結果:在脊髓麻醉後,15 分鐘 S2 階段動脈壓訊號頻譜分析之極低頻和低頻強度減弱 ;同時發現動脈壓訊號頻譜主要成份中,由低頻移位到高頻外;不管動脈壓降低和心跳變緩 慢等變化程度大小,每位病人皆有相同的動脈壓訊號頻譜變化;而且脊髓麻醉後發生動脈壓 訊號譜變化早於動脈壓降低和心跳變緩慢等生理變化。 結論:在脊髓麻醉後 15 分鐘 S2 階段,動脈壓訊號頻譜分析之極低頻和低頻強度減弱 ,證實脊髓麻醉減弱交感神經強度。有些病人脊髓麻醉後,雖然動脈壓降低和心跳變緩慢等 變化程度不明顯,但是交感神經強度減弱很多,更需要注意後續變化,我們認為動脈壓訊號 頻譜分析,可細部檢測病人脊髓麻醉後心臟循環系統之神經調節能力。 |
英文摘要 | Background: The continuous, on-line and real-time analysis of the power spectrum (CORAPS) of systemic arterial pressure (SAP) and heart rate (HR) signals is one of the current progresses in the development of non-invasive indexes for autonomic nervous system. It might be a useful clinical tool to monitor the progress of preganglionic block of sympathetic nervous system and the homeostatsis of cardiac neuroregulation after spinal anesthesia. The purpose of this study is to examine the relationship between the hypotensive response and the changes of components in CORAPS throughout the course of spinal anesthesia. Methods: In 10ASA class I-II patients (aged from 17 to 75 years) scheduled for elective surgery, we analyzed the changes of spectrum of systemic arterial blood pressure signals during spinal anesthesia. Spinal anesthesia was performed with 0.5% bupivacaine (dosage at 13-15mg). For CORAPS, SAP signals were simultaneously relayed to an analog-digital converter connected to a computer. Power spectral density of the data was computed using a fast Fourier transform. The areas of the spectral peaks within each me asurement were calculated as the follows: very low (BVLF, 0.01-0.08HZ), low (BLF, 0.09-0.15Hz), and high (BHF, 0.16-0.25Hz). Results: During the time interval (S2 period) when spinal anesthesia was initiated and 15 min thereafter the power density of low frequency (BLF), (1.2vs. 2.3), and very low frequency (BVLF) components decreased, (3.4vs.7.8), in comparison with that at the baseline level (SI period). We also found the shift of dominance between low frequency (BLF) and high frequency (BHF) in S2 period. The effects of intrathoracic pressure on the venous return may contribute to the increase of power density of BHF component s (1.7vs.1.1). We also found that even in patients with stable hemodynamic variability, the decrease of BLF and BVLF components, and the shift of dominance were the same as in patients with unstable hemodynamic variability. Conclusions: It might prove that the cephalic spread of spinal block abolished the sympathetic tone of the autonomic nervous system. These results validated previous speculations of a sympathetic block during spinal anesthesia. More importantly, patients with stable hemodynamic variability still have profoundly sympathetic block with decreased power density of BLF and BVLF. The CORAPS is a good clinical monitoring tool to evaluate the homeostatsis of cardiac neuroregulation after spinal anesthesia |
本系統中英文摘要資訊取自各篇刊載內容。