Study on heart rate variability of patients with gastrointestinal tumors during perioperative period
ZHI Mengwei1 JIANG Zhiwei2 DAI Xinjuan3 XU Shanshan3
1.School of Nursing, Nanjing University of Chinese Medicine, Jiangsu Province, Nanjing 210023, China;
2.Department of General Surgery, Jiangsu Provincial Hospital of Chinese Medicine, Jiangsu Province, Nanjing 210029, China;
3.Department of Nursing, Jiangsu Provincial Hospital of Chinese Medicine, Jiangsu Province, Nanjing 210029, China
Abstract: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.
[1] Bray F,Ferlay J,Soerjomataram I,et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin,2018,68(6):394-424.
[2] 张静,王晰程,曹彦硕,等.二代测序在家族遗传性高危胃肠肿瘤筛查中的应用[J].中国肿瘤临床,2018,45(19):1000-1004.
[3] 陈秋磊.加速康复外科对肠功能及自主神经调控的研究[D].南京:南京大学,2016.
[4] Anderson TA. Heart rate variability:implications for perioperative anesthesia care [J]. Curr Opin Anaesthesiol,2017, 30(6):691-697.
[5] Okugawa Y,Grady WM,Goel A. Epigenetic alterations in colorectal cancer:emerging biomarkers [J]. Gastroenterology,2015,149(5):1204-1225.
[6] Ren L,Zhu D,Wei Y,et al. Enhanced recovery after surgery(ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer:a prospective randomized controlled trial [J]. World J Surg,2012,36(2):407-414.
[7] Padley JR,Ben-Menachem E. Low pre-operative heart rate variability and complexity are associated with hypotension after anesthesia induction in major abdominal surgery [J]. J Clin Monit Comput,2018,32(2):245-252.
[8] Heart rate variability. Standards of measurement,physiological interpretation,and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology [J]. Eur Heart J,1996,17(3):354-381.
[9] Tan C,Saito N,Miyawaki I. Changes in heart rate and autonomic nervous activity after orthopedic surgery in elderly japanese patients [J]. Kobe J Med Sci,2017,62(5):E129-E135.
[10] Restan AZ,Camacho AA,Cerqueira JA,et al. Effect of a lactate-guided conditioning program on heart rate variability obtained using 24-Holter electrocardiography in Beagle dogs [J]. PLoS One,2020,15(6):e0233264.
[11] Honami K,Noriko M,Saori Y,et al. Heart rate variability in the course of chemotherapy and haematopoietic stem cell transplantation for peadiatric patients with haematological malignancies [J]. Cardiol Young,2020,30(7):967-974.
[12] 薛鹏,李林潞,徐芃芃,等.心率变异检测在肿瘤患者中的研究进展[J].癌症进展,2019,17(5):497-502,506.
[13] Zygulska AL,Furgala A,Krzemieniecki K,et al. Association between gastric myoelectric activity disturbances and dyspeptic symptoms in gastrointestinal cancer patients [J]. Adv Med Sci,2019,64(1):44-53.
[14] Carli F. Physiologic considerations of enhanced recovery after surgery (ERAS) programs:implications of the stress response [J]. Can J Anaesth,2015,62(2):110-119.
[15] Haase O,Langelotz C,Scharfenberg M,et al. Reduction of heart rate variability after colorectal resections [J]. Langenbecks Arch Surg,2012,397(5):793-799.
[16] Fiol-Veny A,Balle M,De la Torre-Luque A,et al. Negative cognitive emotion regulation as a predictor of adolescent heart rate variability and entropy under social stress [J]. Anxiety Stress Coping,2019,32(6):641-653.
[17] Usui H,Nishida Y. The very low-frequency band of heart rate variability represents the slow recovery component after a mental stress task [J]. PLoS One,2017,12(8):e0182611.
[18] Nenna A,Lusini M,Spadaccio C,et al. Heart rate variability:a new tool to predict complications in adult cardiac surgery [J]. J Geriatr Cardiol,2017,14(11):662-668.
[19] 房怿,申岱.相位整序信号平均技术用于全麻术中自主神经功能的评价[J].临床麻醉学杂志,2017,33(1):15-18.
[20] Sesay M,Robin G,Tauzin-Fin P,et al. Responses of heart rate variability to acute pain after minor spinal surgery:optimal thresholds and correlation with the numeric rating scale [J]. J Neurosurg Anesthesiol,2015,27(2):148-154.
[21] Amalan S,Vaishali B,SP P,et al. Pre-surgery stress monitoring using heart rate variability measures [J]. Annu Int Conf IEEE Eng Med Biol Soc,2019,2019:4592-4595.
[22] Farbood A,Sahmeddini MA,Bayat S,et al. The effect of preoperative depression and anxiety on heart rate variability in women with breast cancer [J]. Breast Cancer,2020,27(5):912-918.
[23] 房怿,张婷婷,张文静,等.围手术期迷走神经保护[J].国际麻醉学与复苏杂志,2017,38(12):1128-1132.
[24] Ardissino M,Nicolaou N,Vizcaychipi M. Non-invasive real-time autonomic function characterization during surgery via continuous Poincaré quantification of heart rate variability [J]. J Clin Monit Comput,2019,33(4):627-635.
[25] Desborough JP. The stress response to trauma and surgery [J]. Br J Anaesth,2000,85(1):109-117.
[26] Reimer P,Máca J,Szturz P,et al. Role of heart-rate variability in preoperative assessment of physiological reserves in patients undergoing major abdominal surgery [J]. Ther Clin Risk Manag,2017,13:1223-1231.
[27] Ushiyama T,Mizushige K,Wakabayashi H,et al. Analysis of heart rate variability as an index of noncardiac surgical stress [J]. Heart Vessels,2008,23(1):53-59.