胃肠肿瘤围术期患者心率变异研究  

Study on heart rate variability of patients with gastrointestinal tumors during perioperative period

作　　者：支梦伟 江志伟 戴新娟[3] 许珊珊[3] ZHI Mengwei;JIANG Zhiwei;DAI Xinjuan;XU Shanshan(School of Nursing,Nanjing University of Chinese Medicine,Jiangsu Province,Nanjing210023,China;Department of General Surgery,Jiangsu Provincial Hospital of Chinese Medicine,Jiangsu Province,Nanjing210029,China;Department of Nursing,Jiangsu Provincial Hospital of Chinese Medicine,Jiangsu Province,Nanjing210029,China)

机构地区：[1]南京中医药大学护理学院,江苏南京210023 [2]江苏省中医院普外科,江苏南京210029 [3]江苏省中医院护理部,江苏南京210029

出　　处：《中国医药导报》2021年第5期93-96,共4页China Medical Herald

基　　金：国家自然科学基金资助项目(81500417);江苏省科技计划重点病种规范化诊疗项目(BE2015687)。

摘　　要：目的观察腹腔镜下胃肠肿瘤切除术患者围术期心率变异度(HRV)变化情况。方法选取2019年4月—10月于江苏省中医院行腹腔镜下胃肠肿瘤切除术的76例患者作为研究对象,于术前1 d至术后第5天进行24 h动态心电监测,记录患者术前1 d(T0)、术后第1天(T1)、术后第2天(T2)、术后第3天(T3)、术后第4天(T4)、术后第5天(T5)的HRV参数[全部窦性心搏RR期间的标准差(SDNN)、三角指数、相邻NN间期之差>50 ms的个数占总窦性心搏个数的百分比(pNN50)、低频功率(LF)、高频功率(HF)、低频功率/高频功率(LF/HF)]变化情况。结果整体分析发现:不同时间点全部窦性心搏RR间期的标准差经对数Ln转换(LnSDNN)、三角指数经对数Ln转换(Ln三角指数)和低频功率/高频功率经对数Ln转换(LnLF/HF)比较,差异有统计学意义(P<0.01),提示手术前后SDNN、三角指数和LF/HF出现变化;进一步两两比较,与T0时比较,LnSDNN在T1~2时下降(P<0.01),Ln三角指数在T1、T2、T5时下降(P<0.05),LnLF/HF在T1~4下降(P<0.01)。整体分析发现:不同时间点相邻NN间期之差>50 ms的个数占总窦性心搏个数的百分比经对数Ln转换(LnpNN50)、低频功率经对数Ln转换(LnLF)和高频功率经对数Ln转换(LnHF)比较,差异无统计学意义(P>0.05),提示手术前后pNN50、LF、HF变化并不明显。结论腹腔镜下胃肠肿瘤切除术患者术后早期HRV下降,自主神经功能受损、平衡失调,于术后第5天基本恢复至术前水平。Objective To observe the changes of heart rate variability(HRV)in patients undergoing laparoscopic gastrointestinal tumor resection.Methods A total of 76 patients underwent laparoscopic gastrointestinal tumor resection at Jiangsu Provincial Hospital of Chinese Medicine from April to October 2019 were selected as research subjects,and 24-hour ambulatory ECG monitoring was performed from one day before surgery to five days after surgery.HRV indexes[standard diviation of NN intervals(SDNN),triangle index,the number of pairs of successive NNs that differ by more than 50 ms(pNN50),low frequency(LF),high frequency(HF),low frequency/high frequency(LF/HF)]were recorded at one day before surgery(T0),one day after surgery(T1),two days after surgery(T2),three days after surgery(T3),four days after surgery(T4),five days after surgery(T5).Results Overall analysis showed that there were significant differences in LnSDNN,Ln triangle index and LnLF/HF at different time points(P<0.01),it was suggested that SDNN,trigonometric index and LF/HF change before and after operation.Further pairwise comparison,compared with T0,LnSDNN decreased at T1-2(P<0.01),Lntriangle index decreased at T1,T2 and T5(P<0.05),and LnLF/HF decreased at T1-4(P<0.01).Overall analysis showed that there were no significant differences in LnpNN50,LnLF and LnHF at different time points(P>0.05),it was suggested that the changes of pNN50,LF and HF before and after operation were not obvious.Conclusion Early postoperative HRV decreases in patients with laparoscopic gastrointestinal tumor resection,the autonomic nerve function is impaired and unbalanced,and returns to the preoperative level on five days after surgery.

关 键 词：胃肠肿瘤 手术 心率变异度 应激反应 

分 类 号：R735.3[医药卫生—肿瘤]