Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Heart Rate and ECG Changes after Endoscopic Thoracic Sympathectomy in Patients with Primary Hyperhidrosis

원발성 다한증 환자에서 흉부 교감 신경 차단술 후의 심박동수 및 심전도 변화

  • Kim, Jae-Jun (Department of Thoracic and Cardiovascular Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Young-Du (Department of Thoracic and Cardiovascular Surgery, Holy Family Hospital, The Catholic University of Korea College of Medicine) ;
  • Park, Chan-Beom (Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, The Catholic University of Korea College of Medicine) ;
  • Moon, Seok-Whan (Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, The Catholic University of Korea College of Medicine) ;
  • Cho, Deog-Gon (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Sa, Young-Jo (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Seo, Jong-Hee (Department of Thoracic and Cardiovascular Surgery, Ujeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Chi-Kyeong (Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, The Catholic University of Korea College of Medicine)
  • 김재준 (가톨릭대학교 의과대학 강남성모병원 흉부외과학교실) ;
  • 김영두 (가톨릭대학교 의과대학 성가병원 흉부외과학교실) ;
  • 박찬범 (가톨릭대학교 의과대학 성바오로병원 흉부외과학교실) ;
  • 문석환 (가톨릭대학교 의과대학 성바오로병원 흉부외과학교실) ;
  • 조덕곤 (가톨릭대학교 의과대학 성빈센트병원 흉부외과학교실) ;
  • 사영조 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 서종희 (가톨릭대학교 의과대학 의정부성모병원 흉부외과학교실) ;
  • 김치경 (가톨릭대학교 의과대학 성바오로병원 흉부외과학교실)
  • Published : 2009.04.05
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Abstract

Background: Primary focal hyperhidrosis is characterized by overactivity of the sympathetic nervous function, and this has been effectively treated with endoscopic thoracic sympathetic denervation (ESD). The imbalance of sympathetic and parasympathetic nervous system that's created by ESD may affect the heart, lung and other thoracic organs. We analyzed the heart rate and ECG changes after performing ESD at our hospital, and this is the first such study that has been conducted on this. Material and Method: Of the 263 patients who underwent ESD between October 1996 and October 2006, 130 had ECG before and after ESD, and they were classified into 3 groups according to the level of ESD: Group I (n=40) patients underwent ESD at the 2nd rib (T2ESD), Group II (n=80) at the 3rd rib (T3ESD) and Group III (n=10) at the 4th rib (T4ESD). Result: There was no mortality or major morbidity. Heart rate (HR) was significantly decreased from $71.6{\pm}10.6/min\;to\;66.8{\pm}10.2/min$ after ESD (p<0.01); however, the PR (from $148.6{\pm}21.2$ msec to $152.8{\pm}20.5$ msec) and QTc (from $399.2{\pm}15.4$ msec to $404.0{\pm}15.1$ msec) intervals were significantly increased after ESD in the patients who suffered with primary hyperhidrosis (p<0.01). According to the level of ESD, there were significant changes in the HR and QTc interval in group I (T2ESD), the HR and PR interval in group II and the QTc interval in Group III. Conclusion: There were significant changes in the heart rate and ECG findings after ESD. The thoracic sympathetic denervation of T2, T3 and T4 affected the electrical activity of the heart at the resting state.

배경: 일차성 다한증은 교감신경의 과도한 활성을 특징으로 하고 흉강경을 통한 흉부 교감신경차단 술은 효과적, 안정적으로 시행되고 있다. 수술로 인한 교감신경과 부교감 신경의 불균형은 심장, 폐, 그 외 다른 여러 흉부장기에 영향을 준다. 저자들은 수술 후 나타나는 심박수와 심전도 변화를 분석하였다. 대상 및 방법: 우리는 1996년 10월부터 2006년 10월까지 수술 받은 263 명의 환자 중에 130명의 환자를 분석하였고 주된 수술부위에 따라 1, 2, 3군(1군: T2, 2군: T3, 3군: T4)으로 나누었고 수술 전과 후의 심전도를 비교하였다. 결과: 수술후 사망과 큰 합병증이 있는 환자는 없었고 심박수는 $71.6{\pm}10.6$회/분에서 $66.8{\pm}10.2$회/분으로 수술 후 감소하였고 PR 간격은 $148.6{\pm}21.2$ msec에서 $152.8{\pm}20.5$ msec으로 QTc 간격은 $399.2{\pm}15.4$ msec에서 $404.0{\pm}15.1$ msec으로 증가하였다. 흉부교감신경 차단부위에 따라 제1군에서는 심박동수와 QTc 간격이, 제2군에서는 심박동수와 PR간격이, 그리고 제 3군에서는 단지 QTc 간격이 수술전후에 의미 있게 변화하였다. 결론: 수술후 심박수와 심전도에 변화가 있었고 T2, T3, T4의 차단에 의하여 안정시 심장의 전기적 활성에 영향이 있었다.

Keywords

References

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