术前心率变异性参数预测机器人胃癌术后中重度疼痛的效果  

Efficacy of preoperative heart rate variability parameters in predicting postoperative moderate-to-severe pain on robotic radical gastrectomy

作　　者：邓正明 刘丰铭 周玉弟[2] 黄礼兵[2] 邵明月 江志伟 DENG Zhengming;LIU Fengming;ZHOU Yudi;HUANG Libing;SHAO Mingyue;JIANG Zhiwei(Department of General Surgery,the Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院普外科,210029 [2]南京中医药大学附属医院麻醉科,210029

出　　处：《临床麻醉学杂志》2023年第9期934-938,共5页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(82074432);江苏省中医药管理局重点项目(ZD201903);江苏省中医院人才引进项目(grjj0250)。

摘　　要：目的探讨术前心率变异性(HRV)参数用于预测机器人胃癌术后中重度疼痛(NRS评分>3分)的效果。方法选择2019年12月至2022年08月行机器人胃癌根治术的患者125例,男80例,女45例,年龄≥18岁,BMI≥18 kg/m^(2),ASAⅠ—Ⅲ级。应用穿戴式动态心电记录仪观察术前24 h HRV参数:正常RR间期的标准差(SDNN)、每5分钟平均RR间期的标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、每5分钟NN间期标准差的平均值(SDNNIDX)、相邻RR间期相差>50 ms的个数占总心跳次数的百分比(pNN50)、低频功率(LF)、高频功率(HF)、LF/HF,并收集一般资料、术中指标和术后第1天白细胞计数(WBC)、血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)浓度。根据术后72 h内数字评分量表(NRS)的疼痛评分的最大值将患者为两组:NRS评分≤3分组和NRS评分>3分组。筛选术后中重度疼痛发生的预测因素,采用受试者工作特征(ROC)曲线评估HRV参数预测机器人胃癌术后中重度疼痛的效能。结果有48例(38.4%)患者术后72 h内至少出现一次中重度疼痛。多因素Logistic回归分析显示:HF升高(OR=0.991,95%CI 0.985~0.996)是术后发生中重度疼痛的独立预测因素。其预测术后中重度疼痛发生的AUC为0.928(95%CI 0.885~0.971),最佳截断值为455.55 ms 2,敏感性79.2%,特异性93.7%。结论术前自主神经功能状态与机器人胃癌术后中重度疼痛的发生密切相关,HRV参数中的HF对术后中重度疼痛发生具有一定预测价值。Objective To investigate the efficacy of preoperative heart rate variability(HRV)parameters in predicting postoperative moderate-to-severe pain(NRS>3 scores)on robotic radical gastrectomy.Methods A total of 125 patients with gastric cancer underwent robotic radical gastrectomy from December 2019 to August 2022 were collected,80 males and 45 females,aged≥18 years,ASA physical statusⅠ-Ⅲ.The wearable electrocardiographic recorder was applied to observe the preoperative 24-hour HRV parameters:standard deviation of normal RR intervals(SDNN),standard deviation of average RR intervals per 5 minutes(SDANN),root mean square of the difference between neighboring RR intervals(RMSSD),mean of standard deviations of NN intervals per 5 minutes(SDNNIDX),percentage of the total number of heartbeats with a difference of>50 ms between adjacent RR intervals(pNN50),low-frequency power(LF),high-frequency power(HF),and LF/HF.The patients general data,intraoperative indexes and white blood cell count(WBC),serum C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)1 day after surgery were recorded.According to the maximum pain NRS score within 72 hours after surgery,the patients were divided two groups:NRS≤3 scores group and NRS>3 scores group.Predictive factors for moderate-to-severe postoperative pain were analysed.The efficacy of preoperative HRV parameters predicting the occurrence of postoperative moderate-to-severe pain was assessed by using the receiver operating characteristic curves(ROC).Results Forty-eight pationts(38.4%)in this study had at least one episode of moderate-to-severe pain within 72 hours postoperatively.Multivariate logistic regression analysis showed that the elevated value of HF(OR=0.991,95%CI 0.985-0.996)was an independent predictive factor for the occurrence of moderate-to-severe pain after surgery,and the AUC for predicting the occurrence of moderate-to-severe pain after surgery was 0.928(95%CI 0.885-0.971),with an optimal cut-off value of 455.55 ms 2,a sensitivity of 79.2%,

关 键 词：胃癌根治术 自主神经功能 术后急性疼痛 心率变异性 机器人手术 

分 类 号：R735.2[医药卫生—肿瘤]