胸交感神经射频热凝术后原发性多汗症的自主神经功能变化

Changes of autonomic function in primary hyperhidrosis after radiofrequency thermocoagulation of thoracic sympathetic ganglia

摘要:

目的：探讨原发性多汗症患者行CT引导下胸交感神经射频热凝术后的自主神经功能变化以及心率变异性与预后的关系。 方法：对嘉兴学院附属医院疼痛科自2019年11月至2021年1月收治的50例原发性头、手多汗症患者行CT引导下胸交感神经射频热凝治疗,收集患者术前及术后24小时的心率变异性数据,并于术后第24个月随访以探究心率变异性与结局(复发与代偿性出汗)的关系。 结果：术后50例患者的多汗症状明显改善,术后24小时心率变异性频域指标中低频功率和总功率明显下降,高频功率无明显改变,其中术前低频功率(P=0.0113)和手术前后低频功率的差值(P=0.0231)与结局是否发生代偿性出汗显著相关。 结论：胸交感神经射频热凝术可降低多汗症患者交感神经的张力,但未对自主神经系统平衡造成影响。心率变异性有可能成为评判交感神经射频热凝术疗效与预后的有用指标。

Abstract:

Objective: To investigate the autonomic function changes and the relationship between heart rate variability and prognosis after CT-guided radiofrequency thermocoagulation of thoracic sympathetic ganglia in patients with primary hyperhidrosis. Methods: Fifty patients with primary hyperhidrosis of heads and palms admitted to our hospital from November 2019 to January 2021 underwent CT-guided thoracic sympathetic nerve radiofrequency thermocoagulation. Data on heart rate variability were collected preoperatively and 24 hours postoperatively, and followed up were conducted at 24 months postoperatively to investigate the relationship between heart rate variability and outcome (recurrence and compensatory hyperhidrosis). Results: The symptoms of hyperhidrosis improved significantly in 50 patients after procedure, and the low-frequency power and total power in the frequency domain index of heart rate variability decreased significantly in postoperative 24 hours, while the high-frequency power did not change remarkably. Of all, preoperative low-frequency power (P=0.0113) and the difference in pre-postoperative low-frequency power (P=0.0231) were significantly associated with whether compensatory hyperhidrosis occurred. Conclusion: Radiofrequency thermocoagulation of thoracic sympathetic ganglia lowers sympathetic tension in patients with hyperhidrosis, but does not affect autonomic nervous system homeostasis. Heart rate variability has the potential to be a useful indicator for judging the efficacy and prognosis of sympathetic nerve radiofrequency thermocoagulation.