年龄及术后心房颤动对主动脉瓣置换术后患者心率变异性的影响探究  

Effects of age and postoperative atrial fibrillation on heart rate variability in patients after aortic valve replacement

作　　者：秦娜娜 武文军 祝岩 任文璞 刘方绪 Qin Nana;Wu Wenjun;Zhu Yan;Ren Wenpu;Liu Fangxu(Graduate College,Liaoning University of Traditional Chinese Medicine,Shenyang 110016,Liaoning Province,China)

机构地区：[1]辽中医药大学研究生学院,沈阳110016 [2]解放军北部战区总医院心血管外科

出　　处：《中华老年心脑血管病杂志》2025年第4期454-458,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：辽宁省科学技术计划项目(2024JH2/102600275)。

摘　　要：目的探究行体外循环下主动脉瓣置换术(aortic valve replacement,AVR)患者围术期心率变异性(heart rate variability,HRV)的变化趋势,以及年龄和(或)术后心房颤动(perioperativeatrial fibrillation,POAF)对这种趋势的影响程度。方法回顾性研究2021年1月至2023年1月在解放军北部战区总医院心血管外科行AVR的134例中、重度主动脉瓣疾病患者住院期间的基线资料,根据患者年龄和(或)是否并发POAF将患者分为A组(年龄<60岁、无POAF,49例)、B组(年龄<60岁并发POAF,21例)、C组(年龄≥60岁、无POAF,30例)、D组(年龄≥60岁并发POAF,34例),收集患者术前7 d与术后7 d动态心电图指标。观察患者围术期HRV变化。结果AVR术后7 d窦性心搏RR间期的标准差、24 h记录的所有5 min段中NN间隔的标准偏差的平均值(average of the standard deviations of NN intervals across all 5-minute segments recorded over a 24-hour period,SDNN_(idx))、R波时间间隔的方均根、连续RR间隔相差大于50 ms的百分比明显低于术前7 d,差异有统计学意义[(61.172±17.449)ms vs(804.567±230.518)ms、(20.284±9.432)ms vs(42.933±12.876)ms、(1.307±0.196)ms vs(1.412±0.148)ms,3.00(1.30,7.23)ms vs 5.30(3.00,10.40)ms,P<0.01];D组术后7 d SDNN_(idx)明显低于A组,差异有统计学意义[(42.568±14.749)ms vs(46.467±11.754)ms,P<0.05]。结论AVR术后早期自主神经功能紊乱,年龄≥60岁并伴POAF患者HRV指标显著下降,迷走神经功能受损加剧,两者协同作用加重紊乱。Objective To explore the perioperative trend of heart rate variability(HRV)in patients undergoing aortic valve replacement(AVR)under cardiopulmonary bypass and investigate the influence of age and/or postoperative atrial fibrillation(POAF)on this trend.Methods Baseline and clinical data of 134 patients undergoing AVR due to aortic valve disease in Department of Cardiovascular Surgery of Northern Theater General Hospital of PLA from January 2021 to January 2023 were collected and retrospectively studied.According to the age and/or POAF,they were divided into group A(aged<60 years,no POAF,49 cases),group B(aged<60 years,complicated with POAF,21 cases),group C(aged≥60 years,no POAF,30 cases)and group D(aged≥60 years,with POAF,34 cases).The dynamic electrocardiogram indicators were collected in 7 d before and 7 d after operation.The changes in perioperative HRV were also observed.Results After operation,the standard deviation of sinus heart beat RR intervals,average of the standard deviations of NN intervals for each 5 min segment of a 24 h HRV recording(SDNN_(idx)),root mean square of successive RR interval differences,and percentage of successive RR intervals that differ by more than 50 ms were significantly lower than those in 7 d before operation[61.172±17.449 ms vs 804.567±230.518 ms,20.284±9.432 ms vs 42.933±12.876 ms,1.307±0.196 ms vs 1.412±0.148 ms,3.00(1.30,7.23)ms vs 5.30(3.00,10.40)ms,P<0.01].The group D had obviously lower SDNN_(idx)than the group A in 7 d after surgery(42.568±14.749 ms vs 46.467±11.754 ms,P<0.05).Conclusion Autonomic dysfunction is observed in the early stage after AVR.For the patients aged≥60 years with POAF,the HRV indicators are significantly decreased,the dysfunction of the vagus nerve is aggravated,and the disorder is exacerbated because of their synergistic effect.

关 键 词：心房颤动 心率 迷走神经 主动脉瓣置换术 

分 类 号：R54[医药卫生—心血管疾病]