心率变异性预警恶性肿瘤患者术后室性心律失常的价值

Prognostic value of heart rate variability and other related indicators for postoperative ventricular arrhythmias in patients with malignant tumors

目的 探讨心率变异性等相关指标对恶性肿瘤患者术后发生室性心律失常(VA)的预测价值。方法纳入需要手术治疗的恶性肿瘤患者150例,根据术后是否发生心律失常分为无心律失常组(正常组,n=108)和室性心律失常组(室性早搏、室性心动过速)(n=42)。所有研究对象术前均行24小时动态心电图监测,对比各组患者治疗前一般临床资料(年龄、性别、吸烟史、糖尿病史、高血压史、Hb、TC、TG、HDL-C、LDL-C、K+、Na+、Ca2+),分析和测量患者术前心率变异性(heart rate variability, HRV)各项指标值(24小时正常心房开始除极至心室开始除极时间RR间期标准差、24小时连续5分钟正常RR间期标准差、24小时连续5分钟正常RR间期标准差均值),通过相关性分析及受试者工作曲线(ROC)分析心率变异性等相关指标对恶性肿瘤患者术后发生室性心律失常的预测价值。结果 室性心律失常组的SDNN、SDANN-index、SDNN-index均显著低于正常组(P<0.05),Spearman相关性分析表明,SDNN、SDANN-index及SDNN-index均与恶性肿瘤患者术后发生室性心律失常具有显著正相关性(P<0.05);ROC曲线分析表明:SDNN、SDANN-index、SDNN-index单独和联合预测恶性肿瘤患者术后发生室性心律失常的曲线下面积分别为0.641、0.605、0.604、0.897,SDNN、SDANN-index、SDNN-index联合预测恶性肿瘤患者术后发生室性心律失常的曲线下面积显著高于SDNN、SDANN-index、SDNN-index的单独预测。结论 恶性肿瘤患者术后发生室性心律失常者SDNN、SDANN-index、SDNN-index显著降低;SDNN、SDANN-index、SDNN-index对恶性肿瘤患者术后发生室性心律失常均有一定预测价值,三者联合预测价值更高。可应用于临床评估恶性肿瘤患者发生室性心律失常的风险,为患者及早预防、治疗提供理论依据。

Objective To investigate the predictive value of heart rate variability and other related indicators for postoperative ventricular arrhythmia(VA)in patients with malignant tumors.Methods One hundred and fifty patients with malignant tumor requiring surgical treatment were included and divided into non-arrhythmic group(normal group,n=108)and ventricular arrhythmia group(premature ventricular beats,ventricular tachycardia)(n=42)according to the occurrence of postoperative arrhythmias.All subjects underwent 24 h dynamic electrocardiogram monitoring before surgery,and the general clinical dataage,gender,smoking history,diabetes history,hypertension history,Hb,TC,TG,HDL-C,LDL-C,K^(+),Na^(+),Ca^(2+)of each group before treatment were compared.Preoperative heart rate variability(heart rate variability)was analyzed and measured.HRV all index values(standard deviation of RR interval when normal atrium began to depolarize to ventricle began to depolarize at 24h,standard deviation of normal RR interval at 24h continuous 5min<SDANN-index>,mean standard deviation of normal RR interval at 24h continuous 5min<SDNN-index>)to analyze the predictive value of heart rate variability and other relevant indicators for postoperative ventricular arrhythmias in patients with malignant tumors by correlation analysis and receiver operating curve(ROC).Results SDNN,SDANN-index and SDNN-index in ventricular arrhythmia group were significantly lower than those in normal group,Spearman correlation analysis showed that,SDNN,SDANN-index and SDNN-index were positively correlated with postoperative ventricular arrhythmia in patients with malignant tumors,ROC curve analysis showed that SDNN,SDANN-index and SDNN-index alone and combined predicted the area under the curve of postoperative ventricular arrhythmia in patients with malignant tumor were 0.641,0.605,0.604 and 0.897,respectively.The area under the curve predicted by the combination of SDNN,SDANN-index and SDNN-index was significantly higher than that predicted by SDNN,SDANN-index and SDNN-index alone.Conclusions SDNN,SDANN-index and SDNN-index decreased significantly in patients with ventricular arrhythmia after surgery.SDNN,SDANN-index and SDNN-index all have certain predictive value for postoperative ventricular arrhythmias in patients with malignant tumors,and their combined predictive value is higher.It can be used to evaluate the risk of ventricular arrhythmia in patients with malignant tumors,and provide theoretical basis for early prevention and treatment.