中文摘要：

目的观察原发性手汗症患者行胸交感神经调制手术前后心率变异性（HRV）的变化，评估胸交感神经调制术对患者心脏自主神经功能的影响。方法选择2015年1～11月在浙江省嘉兴市第一医院接受胸交感神经调制术的原发性手汗症患者28例（P组）和门诊同期健康体检者22例（C组）。P组患者均在CT引导下经皮T3-4椎间隙穿刺，直至针尖抵达第4肋骨小头上缘。注入含造影剂碘海醇的1％利多卡因2ml，患者双手小指末梢灌注指数（PI）上升5倍以上和双手手掌温度上升3℃以上，即于20min后每侧注入含造影剂碘海醇的无水乙醇2．5ml。P组分别于术前（哟）、术后10min（T1）、24h（他）时刻，C组在1、0时刻检测HRV的低频功率（LF）、高频功率（HF）、总功率频段（TP）、LF的标准化值（LFnu）、HF的标准化值（HFnu）和低频／高频（LF／HF）并进行对比分析。结果28例患者T1时刻双手末梢灌注指数上升了（7．79±0．85）倍，双手温度平均上升了（5．03±0．85）℃，且双手多汗症状完全消失。电话随访结果显示，所有患者疗效均能持续3个月以上，术后无严重并发症发生。与P组T0时刻比较，T1、T2时刻和C组，ID时刻TP、HF、HFnu升高，LF、LFnu、LF／HF降低，差异有统计学意义（P〈0．05）；C组110时刻与P组T1、他时刻各指标比较无明显变化，差异无统计学意义（P〉0．05）。结论胸交感神经调制可安全、有效的治疗原发性手汗症，并可降低患者术后交感神经系统的张力，增高迷走神经系统的张力，改善自主神经系统的平衡。

英文摘要：

Objective To observe the evolution of heart rate variability （HRV） in patients with primary palmar hyperhidrosis after thoracic sympathetic modulation and evaluate the effects of the thoracic sympathetic modulation on the autonomic nerve system. Methods From January, 2015 to November, 2015,28 patients with primary palmar hyperhidrosis who were preparation for thoracic sympathetic modulation（ Group P） and 22 outpatient healthy volunteers （Group C ） in our hospital were enrolled into the study. The puncture of thoracic sympathetic nerve was guided by CT through the gap of T3-4, until the needle tip arrive at the top of the fourth ribs head. 2 ml of 1% lidoeaine（ mixed with Iohexol injection） was injected. The fingertip petfusion index（PI） was elevated more than 5 folds, the temperature of hands increased more than 3℃ （about 20 min later）. Then ,2.5 ml of absolute alcohol was injected adjacently to thoracic sympathetic nerves. LF, HF, TP and LF/HF were recorded at the time points of before the operation （T0）, 10 min （T1） ,24 h （T2） after the opera- tion at Group P. LF, HF, TP, the normalized values of LF （LFnu） , the normalized values of HF （ HFnu ） and LF/HF were recorded at the time points of before the operation（T0） at Group C. Results In Group P, Oximetry-derivcd pcrfusion index and the temperature of hands raised（7.79±0.85 ） times and （ 5.03 ±0.85 ）℃ in average, respectively. All of the patients with palmar hyperhidrosis were cured within 3 months, there were no severe complications. As compared with those at TO in Group P, TP, HF, HFnu at T1,T2 in Group P and TO in Group C was significantly increased, and LF, LFnu, LF/HF was significantly decreased（P 〈 0.05） ;There was no significantly differences between Group P at T1, T2 and Group C at T0 （ P 〉 0.05 ）. Conclusion CT-guided thoracic sympathetic modulation can be used for treating primary palmar hyperhidrosis safely and effectively, which may reduce the tension of the postoperative sympa