目的：通过监测飞秒激光小切口角膜基质透镜取出术(SMILE)手术中不同时机心率的变化趋势，探究术中心率变化的影响因素。

方法：前瞻性队列研究。选取2024-04/05在西安市第一医院激光近视治疗中心接受SMILE的手术患者69例(均取右眼数据)，术前邀请患者填写状态焦虑问卷S-AI(1-20题)，收集患者应对次日手术的焦虑评分。使用医用脉搏血氧仪记录患者术前基础心率，同时记录接受SMILE手术时患者在摆放体位、透镜扫描、透镜分离取出、术毕点眼的实时心率。

结果：患者摆放体位时心率为83.61±13.87次/分，与基础心率(77.52±10.88次/分)、透镜分离取出时心率(75.54±12.52次/分)、术毕点眼时心率(76.65±10.54次/分)相比有差异(均P<0.001)。根据年龄中位数分层后比较术中心率变化，年龄较大组(>26岁)患者透镜分离取出时心率为76.27±9.93次/分，与摆放体位时心率(84.82±14.10次/分)、透镜扫描时心率(82.76±13.72次/分)相比有差异(均P<0.005)。根据性别分层后比较心率变化，男性患者摆放体位时心率(85.31±16.61次/分)最高，与基础心率(78.26±12.63次/分)、透镜分离取出时心率(77.14±14.59次/分)、术毕点眼时心率(77.11±12.49次/分)相比有差异(均P<0.005)。术中摆放体位心率与术前状态焦虑评分结果无相关性(r=0.124，P=0.418)。

结论：SMILE术中患者随着不同手术操作进程呈现不同的心率变化，心率在摆放体位时最高，透镜分离取出时最低。年龄较大组患者在摆放体位时心率较高，男性患者在摆放体位时心率较高。

METHODS: Prospective cohort study. A total of 69 patients who underwent SMILE surgery at the Laser Vision Correction Center of Xi'an No.1 Hospital from April to May 2024 were enrolled. Before the surgery, patients completed the State Anxiety Inventory(S-AI, questions 1-20)to assess their preoperative anxiety scores related to the next day's surgery. Baseline HR was recorded using medical pulse oximeter, and real-time HR was recorded during patient positioning, lenticule scanning, lenticule separation and extraction, and the application of postoperative eye drops.

RESULTS: The HR during patient positioning was 83.61±13.87 bpm, which was significantly different from the baseline HR(77.52±10.88 bpm), HR during lenticule separation and extraction(75.54±12.52 bpm), and HR during postoperative eye drop application(76.65±10.54 bpm; all P<0.001). When stratified by median age, older patients(>26 years)had the HR during lenticule separation and extraction 76.27±9.93 bpm, which differed from the HR at positioning(84.82±14.10 bpm)and at lens scanning(82.76±13.72 bpm; all P<0.005). Stratified by gender, the HR of male patients at positioning was the highest(85.31±16.61 bpm), which differed significantly from the baseline HR(78.26±12.63 bpm), HR during lenticule separation and extraction(77.14±14.59 bpm), and HR during postoperative eye drop application(77.11±12.49 bpm; all P<0.005). There was no correlation between HR during positioning and preoperative anxiety scores(r=0.124, P=0.418).

CONCLUSION: HR changes during SMILE surgery vary with different procedural stages, peaking during patient positioning and reaching the lowest point during lenticule separation and extraction. Older patients showed higher HR during positioning, and male patients exhibited higher HR during positioning.