胸内手术患者心率变异性与呼吸功能及住院时间的关系

Relationship between heart rate variability and respiratory function or stay at hospital in patients undergoing thoracic surgery

目的 探讨胸内手术患者心率变异性与呼吸功能及住院时间的关系。方法 以动态心电图监测 45例择期胸内手术病人 ,术前监测至少 12小时 ,术后 2 4小时 ,求得每例手术前后平均每小时的心率变异性总功率 (TP)、高频 (HF)、低频 (LF)、极低频 (VLF)、LF/HF比和平均R R间期(RRmean)。根据术后呼吸功能情况分为呼吸功能障碍组 (Ⅰ组 )和呼吸功能正常组 (Ⅱ组 )。结果 术后Ⅰ组术前HF低于Ⅱ组 (P <0 0 5 )、而LF/HF比却显著高于Ⅱ组 (P <0 0 1)。Ⅰ组术后的TP、HF、LF、RRmean明显低于Ⅱ组 (P <0 0 5 )。患者总住院时间与术前心率变异性 (HRV)和术后LF/HF无明显相关性 (P >0 0 5 ) ,但与术后TP、HF、LF、VLF、RRmean呈明显负相关 (P值均 <0 0 1)。结论 (1)胸内手术后呼吸功能不全与HRV下降有关 :(2 )术前HF、LF/HF比的异常可能是患者术后呼吸功能障碍者的预测因素 ;(3)术后 2 4小时内TP、HF、LF、VLF。

Objective To determine the relation ship between heart rate variability (HRV) and respiratory function or stay at hospital in patients undergoing thoracic surgery.Methods Forty five patients scheduled for elective thoracotomy were monitered with dynamic electrocardiogram for at least 12 hours before surgery and 24 hours after surgery.The single,hourly determined values of HRV,including total-power (TP),high-frequency (HF),low-frequency(LF),very-low-frequency (VLF),LF/HF and mean RR intervals,were summed and averaged hourly before or after surgery.Results Patients with postoperative respiratory dysfunction (group Ⅰ) had lower preoperative HF(P<0.05)and higher preoperative LF/HF(P<0.01)than the patients with normal postoperative respiratory function (group Ⅱ).During 24 hours after surgery,TP,HF,LF,RRmean in group Ⅰwere lower than those in group Ⅱ.No correlation between preoperative HRV and the length of hospitalisation was found.Postoperative TP,HF,LF,VLF and RRmean were significantly negatively correlated with the length of stay in hospital (P<0.01).Conclusion Respiratory dysfunction after thoracotomy is associated with decreased HRV.Preoperative abnormal HF?LF/HF could be taken as the prognostic indicators of postoperative respiratory dysfunction.Decreased postoperative TP,HF,LF,VLF,RRmean might be associated with severe complications and longer stay at hospital.