老年糖尿病患者非心脏手术后心脏自主神经功能的变化

Changes in activity of autonomic nervous system in elderly patients with diabetes mellitus after non-cardiac surgery

目的探讨老年糖尿病患者非心脏手术后心脏自主神经功能的变化。方法择期行非心脏手术老年患者30例,分为糖尿病组(DM组,n=15)和非糖尿病组(NDM组,n=15)。用三通道动态心电图监测仪分别于手术前日(术前)、术后第1天和第2天记录当晚23:00至次日早晨7:00总的心率变异性(HRV),包括总功率(TP)、高频功率(HF)、低频功率(LF)、极低频功率(VLF)及LF/HF。结果术前DM组TP、HF低于NDM组(P<0．05),术后第1天:两组TP、HF、LF、VLF、LF/HF下降,DM组 HF低于NDM组而LF/HF高于NDM组(P<0．05或0．01),术后第2天:DM组TP、HF、LF及VLF较术后第1天进一步降低,亦低于NDM组(P<0．05或0．01)。结论与非糖尿病患者比较,糖尿病患者非心脏手术后发生心脏自主神经功能紊乱更为严重和持久。

Objective To investigate the activity of autonomic nervous system （ANS） in elderly patients with diabetes mellitus （ DM ） after non-cardiac surgery. Mehtods Thirty ASA Ⅰ - Ⅲ patients aged ≥60 yrs undergoing elective abdominal surgery or operation on the lower limbs were assigned to one of 2 groups （ n = 15 each） ： DM group and non-DM group. The patients were monitored with Holter （DMS Co, U. S. A） the day before and on the 1st and 2nd day after operation. Heart-rate variability （HRV） including total power （TP）, high frequency （HF）, low frequency （LF）, very low frequency （VLF） and LF/HF ratio were recorded. Results TP and HF were significantly lower in DM group than in non-DM group before operation （ P 〈 0.05）. On the 1st postoperative day TP, HF, LF, VLF and LF/HF were significantly decreased as compared to the baseline values before operation in both groups; HF was significantly lower while LF/HF ratio significantly higher in DM group than in non-DM group （P 〈 0.05 or 0.01 ）. On the 2nd postoperative day TP, HF, LF and VLF in DM group were further decreased as compared to those on the 1 st postoperative day and were significantly lower than those in non- DM group （ P 〈 0.05 or 0.01 ）. Conclusion The disturbances in the activity of ANS were severer and more persistent in elderly patients with diabetes mellitus after non-cardiac surgery.