二尖瓣置换术后患者新发心房颤动与心脏迷走神经功能变化的相关性研究  

Study on the correlation between new-onset atrial fibrillation and changes in cardiac vagal function in the patients after mitral valve replacement

作　　者：王镜涵 李保银 张誉籍 张丹阳 韩劲松 Wang Jinghan;Li Baoyin;Zhang Yuji;Zhang Danyang;Han Jinsong(Graduate School of China Medical University,Shenyang 110122,China;Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]中国医科大学研究生院,沈阳110122 [2]北部战区总医院心血管外科,沈阳110016

出　　处：《中国临床实用医学》2024年第1期12-15,共4页China Clinical Practical Medicine

基　　金：辽宁省科学技术计划项目(2022JH2/101300085)。

摘　　要：目的探讨因单纯二尖瓣关闭不全行二尖瓣置换术(MVR)发生术后心房颤动(POAF)与心脏迷走神经功能变化的关系。方法本研究为病例对照研究,选取2020年3月至2023年7月北部战区总医院心血管外科收治的290例因二尖瓣关闭不全需行MVR出现POAF的患者,男160例,女130例,年龄(58.20±10.53)岁,年龄范围为48~77岁。根据术后心脏相邻RR间期差值的平方根(RMSSD)指标将患者分为迷走神经功能减低组(RMSSD<15 ms,n=78)、迷走神经功能正常组(RMSSD为15~39 ms,n=182)和迷走神经功能亢进组(RMSSD>39 ms,n=30)。观察患者MVR围术期RMSSD变化趋势,分析围术期迷走神经功能改变和MVR发生POAF的关系。结果290例患者术前7 d的RMSSD指标[(26.48±13.81)ms]高于术后7 d[(23.73±12.79)ms],差异有统计学意义(P<0.05)。迷走神经功能减低组术后RMSSD指标[(12.15±1.91)ms]低于术前[(13.39±1.35)ms],迷走神经功能正常组术后RMSSD指标[(23.97±6.39)ms]低于术前[(24.15±5.90)ms],迷走神经功能亢进组术后RMSSD指标[(52.36±12.53)ms]低于术前[(56.34±20.29)ms],差异均有统计学意义(P<0.05)。迷走神经功能减低组患者的POAF发生率[34.6%(27/78)]低于迷走神经功能正常组[52.2%(95/182)],差异有统计学意义(P<0.05);迷走神经功能亢进组的POAF发生率[43.3%(13/30)]低于迷走神经功能正常组,差异无统计学意义(P>0.05);迷走神经功能亢进组的POAF发生率高于迷走神经功能减低组,差异无统计学意义(P>0.05)。结论MVR术后患者心脏迷走神经功能变化和POAF的关系是非线性的,术后迷走神经功能正常时心房颤动发生率更高.Objective To investigate the relationship between postoperative atrial fibrillation(POAF)and vagal nerve function after mitral valve replacement(MVR)due to simple mitral valve insufficiency.Methods This study was a case-control study,a total of 290 patients with POAF due to MVR who were selected from the department of Cardiovascular Surgery of General Hospital of Northern Theater Command from March 2020 to July 2023,including 160 males and 130 females,aged(58.20±10.53)years old,ranging form 48 to 77 years old.Patients were divided into reduced vagus function group[root mean square of difference-value of adjacent RR interval(RMSSD)<15 ms,n=78],normal vagus function group(RMSSD 15 to 39 ms,n=182)and hypervagus function group(RMSSD>39 ms,n=30)according to the RMSSD.To observe the change trend of RMSSD in patients with MVR during perioperative period,and analyze the relationship between the change of vagus nerve function and POAF in MVR.Results The RMSSD index of 290 patients 7 days before surgery[(26.48±13.81)ms]was higher than that 7 days after surgery[(23.73±12.79)ms],and the difference was statistically significant(P<0.05).The RMSSD indexes of the three groups were lower after surgery than before surgery.The postoperative RMSSD index[(12.15±1.91)ms]in the vagus nerve reduction group was lower than that before operation[(13.39±1.35)ms],the postoperative RMSSD index[(23.97±6.39)ms]in the normal vagus nerve function group was lower than that before operation[(24.15±5.90)ms],and the postoperative RMSSD index[(52.36±12.53)ms]in the vagus hyperfunction group was lower than that before surgery[(56.34±20.29)ms],the difference was statistically significant(P<0.05).The incidence of POAF in the reduced vagus nerve function group[34.6%(27/78)]was significantly lower than that in the normal vagus nerve function group[52.2%(95/182)],and the difference was statistically significant(P<0.05).The incidence of POAF in hypervagus group[43.3%(13/30)]was lower than that in normal vagus group,and the difference was not statist

关 键 词：二尖瓣置换术 术后心房颤动 相邻RR间期差值的平方根 心脏迷走神经 

分 类 号：R654.2[医药卫生—外科学]