库欣病患者围手术期测定心率变异性用于评价血浆促肾上腺皮质激素和血清皮质醇的初探  

Heart rate variability for evaluation of ACTH and serum cortisol associated with Cushing's disease during perioperative period

作　　者：钱雯君 孙昱皓[3] 唐莲 景峰[4] 朱大乔[1] Qian Wenjun;Sun Yuhao;TangLian;Jin Feng;Zhu Daqiao(School of Nursing,Shanghai Jiao Tong University,Shanghai,200001,China;Nursing Department,Ruijin Hospital,Shanghai,200001,China;Department of Neurosurgery,Ruijin Hospital,Shanghai,200001,China;Department of Emergency,Ruijin Hospital,Shanghai,200001,China)

机构地区：[1]上海交通大学护理学院,上海200001 [2]上海交通大学医学院附属瑞金医院护理部,上海200001 [3]上海交通大学医学院附属瑞金医院神经外科,上海200001 [4]上海交通大学医学院附属瑞金医院急诊科,上海200001

出　　处：《立体定向和功能性神经外科杂志》2024年第4期193-198,204,共7页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨库欣病(cushing's disease,CD)患者围手术期激素水平与心率变异性(heart rate variability,HRV)波动的相关性。方法采用前瞻性病例对照研究设计,选取拟行“内镜下经鼻蝶入路垂体瘤切除术”的CD患者30例作为观察组,同期选取无功能性垂体腺瘤(nonfunctioning pituitary adenoma,NFPA)患者28例作为对照组。术前评估两组患者焦虑、抑郁及觉知压力水平,术后分别于术前及术后首日采集患者8:00血清皮质醇、血浆促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)水平,以及术前一日、术日夜间睡眠状态的HRV指标。比较分析两组患者激素水平变化与HRV的变化差异。结果CD患者均在接受“内镜下经鼻蝶入路垂体瘤切除术”后达到“生化缓解”,血清皮质醇与ACTH较术前显著下降(P<0.05),HRV参数的低频功率(Low frequency power,LF)和RR间期标准差(standard deviation of normal RR interval,SDNN)较术前增高(P<0.05);NFPA患者皮质醇、ACTH和HRV参数手术前后均无显著变化(P>0.05)。结论HRV指标中LF和SDNN是反映库欣病患者术后“生化缓解”的一个潜在临床指标。Objective To investigate the correlation effect of changes in Heart Rate variability(HRV)and hormone associated with Cushing's Disease during perioperative period.To explore a credible,effective and convenient monitoring indicator for patients with Cushing's Disease after the endoscopic endonasal surgery.Methods 30 patients with CD and 28 age,gender,BMI,blood pressure,fasting blood glucose and course of disease matched patients with nonfunctioning pituitary adenoma(NFPA)participated in the study.All the patients were investigated by using the Hospital Anxiety and Depression Scale(HADS)and Chinese perceived stress scale(CPSS)before operation.During perioperative period,All the patients were obtained the level of plasma ACTH and cortisol.HRV assessment was made in both time and frequency domain using the extracted RR interval data when patients in sleep.Results All the patients with CD achievedbiochemical remission.The low frequency(LF)and SD of all the RR intervals(SDNN)of patients with CD after operation were significantly(P<0.05)higher than those before operation.There were no significant changes in HRV and hormone of patients with NFPA during perioperative period.Conclusion The LF and SDNN may be an effective indicator on patients with CD who attained biochemical remission after the endoscopic endonasal surgery.

关 键 词：库欣病 心率变异性 皮质醇 促肾上腺皮质激素 

分 类 号：R741[医药卫生—神经病学与精神病学]