An Easy and Reliable Way to Prevent Electrocardiographic Deteriorations of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: Preoperative Anxiolytic Treatment

Abstract Objective: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. Methods: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. Results: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). Conclusion: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.

摘要：
研究目的：探讨术前抗焦虑干预对非体外循环冠状动脉旁路移植术患者电生理变化的影响。
方法：本研究共纳入61例美国麻醉医师协会（ASA）Ⅲ级风险、年龄18~65岁的患者，采用随机分组法分为两组。S组（镇静组）于术前口服0.04mg/kg劳拉西泮，每日2次；C组（对照组）未给予任何抗焦虑术前用药。采用状态-特质焦虑量表（State Trait Anxiety Inventory, STAI-I）与贝克焦虑量表（Beck Anxiety Inventory, BAI）评估患者焦虑水平；所有患者均接受心电图（Electrocardiography, ECG）、脉搏血氧饱和度监测及常规生命体征监测，并计算所有心电图各导联的QT离散度与P波离散度。
结果：镇静组术前STAI-I评分显著低于对照组。相较于对照组，镇静组在麻醉诱导前、诱导后第1分钟、气管插管后30秒及气管插管后第4分钟测得的QT离散度均值均显著降低（分别为P=0.024、P=0.027、P=0.001、P=0.033）；同时，镇静组在麻醉诱导前、诱导后第3分钟、气管插管后30秒及气管插管后第4分钟测得的P波离散度均值亦显著低于对照组（分别为P=0.001、P=0.020、P=0.023、P=0.005）。
结论：冠状动脉旁路移植术患者术前焦虑水平升高可通过延长QT与P波离散度产生不良影响。术前抗焦虑治疗可通过降低QT及P波离散度时长，有助于预防室性与房性心律失常及相关并发症。