摘要
目的:通过监测心率变异度(heart rate variability,HRV)各指标评估结直肠癌患者围手术期自主神经功能的变化,并探讨其与营养、康复之间的关系。方法:将28例结直肠癌患者通过营养风险筛查分为无营养风险组(A组)和高营养风险组(B组),并对患者HRV、机体组成及血清营养指标进行检测,探讨组间与组内营养指标的差异性及其与HRV各指标之间的相关性。结果:A组术日与术前HRV比较,HRV时域指标PNN50明显上升(P<0.05),低频功率(LF)、高频功率(HF)也明显上升(P<0.05),LF/HF明显下降(P<0.05);B组术日与术前比较,3个指标也呈同样的趋势;A、B两组术日HRV比较显示,PNN50、HF差异有统计学意义(P<0.05)。A组术后与术前HRV比较,PNN50、LF、HF、LF/HF差异均无统计学意义(P>0.05);B组术后与术前HRV比较,PNN50、LF、HF明显升高(P<0.05);两组术后PNN50、HF比较,B组比A组明显升高(P<0.05)。HRV与营养指标相关性分析提示,PNN50与体质量、脂肪群、白蛋白、转铁蛋白相关(均r≠0,P<0.05),HF与体质量、体质量指数(BMI)、脂肪群、转铁蛋白相关(均r≠0,P<0.05),LF/HF与体质量、身体总水分、肌肉群、总蛋白相关(均r≠0,P<0.05)。结论:自主神经功能,尤其是迷走神经功能,与围手术期营养状况及康复具有相关性,HRV的监测为肿瘤患者的营养评估和营养支持提供了新的思路。
Objective:To assess perioperative autonomic nervous function by monitoring heart rate variability(HRV)in patients with colorectal cancer to explored its relationship with nutrition and rehabilitation.Methods:28 patients with colorectal cancer were divided into no nutritional risk group(A group)and high nutritional risk group(B group)based on comprehensive nutritional risk assessment.The changes of body composition,HRV and serum nutritional indicators were monitored,and the differences and correlation of indexes between and within groups of nutritional indexes and HRV indexes were explored.Results:Compared with preoperative HRV,PNN50 increased significantly on operative day in group A(P<0.05),LF and HF also increased significantly(P<0.05),and LF/HF decreased significantly(P<0.05).In group B,the comparison of operative day and preoperative day showed the same trend.There was a statistical difference in PNN50 and HF between group A and group B(P<0.05).In group A,there were no significant differences in PNN50,LF,HF and LF/HF between preoperative and postoperative HRV(P>0.05).In group B,PNN50,LF and HF of group B were significantly higher than those before operation(P<0.05).Postoperative PNN50 and HF of group B were significantly higher those in group A(P<0.05).Correlation analysis of HRV and nutritional indexes showed that PNN50 was significantly correlated with body weight,fat group,albumin and transferrin(all r≠0,P<0.05),HF was significantly correlated with body weight,BMI,fat group and transferrin(all r≠0,P<0.05),and LF/HF was significantly correlated with body weight,total body moisture,muscle group and total protein(all r≠0,P<0.05).Conclusion:Autonomic nervous function,especially vagus nerve function,is correlated with perioperative nutritional status and rehabilitation.HRV monitoring provides a new idea for nutritional evaluation and nutritional support of tumor patients.
作者
龚冠闻
江志伟
孙辰华
马朝群
朱永康
潘华峰
程双
成汇
GONG Guanwen;JIANG Zhiwei;SUN Chenhua;MA Chaoqun;ZHU Yongkang;PAN Huafeng;CHENG Shuang;CHENG Hui(Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China)
出处
《东南大学学报（医学版）》
CAS
2022年第3期358-363,共6页
Journal of Southeast University(Medical Science Edition)
基金
江苏省中医药管理局重点项目(ZD201903)。
关键词
自主神经功能
迷走神经
心率变异度
结直肠癌
加速康复外科
营养支持
autonomic nervous function
vagus nerve
heart rate variability
colorectal cancer
enhanced recovery after surgery
nutritional support
