加速康复外科指导下胃癌患者围手术期心率变异度的临床观察

Clinical observation of heart rate variability in patients with gastric cancer during perioperative period under the guidance of enhanced recovery after surgery

目的探讨加速康复外科(ERAS)指导下腹腔镜辅助胃癌根治术患者围手术期心率变异度(HRV)的变化情况。方法回顾性分析2019年1月至12月50例行腹腔镜辅助胃癌根治术的胃癌患者,根据围手术期是否采用加速康复外科理念,分为对照组(n=25)和ERAS组(n=25)。对照组实施传统围手术期处理措施,ERAS组围手术期处理措施包括多模式健康宣教、液体管理、多模式止痛、早期肠内营养、早期下床活动等。观察比较两组手术前后心率变异度参数[全部窦性心搏RR期间的标准差(SDNN)、NN间期总个数除以NN间期直方图的高度(三角指数)、相邻NN间期之差>50 ms的个数占总窦性心搏个数的百分比(pNN50)、低频功率(LF)、高频功率(HF)、低频功率/高频功率(LF/HF)]及血清C反应蛋白(CRP)变化情况。结果ERAS组术后1~4 d SDNN均高于对照组,差异有统计学意义(P<0.05);ERAS组术后第1、2、3、5天三角指数均高于对照组,差异有统计学意义(P<0.05);ERAS组术后2~4 d LF/HF均高于对照组,差异有统计学意义(P<0.05);两组术后1~5 d pNN50、LF、HF相比较,差异无统计学意义(P>0.05)。ERAS组术后第1、3天CRP均低于对照组,差异有统计学意义(P<0.05)。结论加速康复外科提高了腹腔镜辅助胃癌根治术后患者心率变异度,减轻了手术应激和炎症反应,促进了术后快速恢复。

Objective To explore the changes of heart rate variability(HRV)in patients undergoing laparoscopic radical gastrectomy under the guidance of enhanced recovery after surgery(ERAS).Methods The clinical data of 50 patients who received laparoscopic radical gastrectomy during Jan.2019 and Dec.2019 were retrospectively analyzed.According to whether ERAS concept was adopted,the patients were divided into the control group(n=25)and ERAS group(n=25).Patients in the control group received traditional perioperative management,while patients in the ERAS group received multimodal health education,fluid management,multimodal analgesia,early enteral nutrition,early ambulation and so on.Perioperative HRV parameters were compared between the two groups,including standard deviation of NN intervals(SDNN),triangle index,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).The serum hypersensitive C-reactive protein level in the two groups were also observed.Results In postoperative days 1-4,SDNN was significantly higher in the ERAS group than in the control group(P<0.05).In postoperative days 1,2,3 and 5,triangle index was significantly higher in the ERAS group than in the control group(P<0.05).In postoperative days 2-4,LF/HF was significantly higher in the ERAS group than in the control group(P<0.05).In postoperative days 1-5,there were no differences in LF,HF and LF/HF between the two groups(P>0.05).In postoperative days 1 and 3,C-reactive protein was significantly lower in the ERAS group than in the control group(P<0.05).Conclusion ERAS improves HRV,reduces surgical stress and inflammatory response,and promotes recovery in patients undergoing laparoscopic radical gastrectomy.