2型糖尿病与高血压对因退行性二尖瓣关闭不全行二尖瓣置换术患者围术期心率变异性的影响

Effect of type 2 diabetes mellitus and hypertension on perioperative heart rate variability in patients with degenerative mitral regurgitation undergoing mitral valve replacement

目的探讨2型糖尿病(T2DM)与高血压对因退行性二尖瓣关闭不全行二尖瓣置换术(MVR)患者围术期心率变异性(HRV)的影响。方法本研究为回顾性病例对照研究,选取2021年1月至2022年12月北部战区总医院心血管外科收治的150例因退行性二尖瓣关闭不全行MVR的患者,男76例,女74例,年龄60.23(54.00,64.50)岁,年龄范围为43~76岁。根据患者既往是否患有高血压和(或)T2DM将患者分为对照组(未患有高血压及T2DM,n=42)、单纯高血压组(n=51)、单纯T2DM组(n=28)及合并组(高血压合并T2DM,n=29)。比较手术前后7 d及术后7 d四组间HRV[相邻NN间隔的标准差(SDNN)、每5 min的均值的标准差(SDANN)和相邻NN间隔的平方差的均值的平方根(rMSSD)]水平。结果术后7 d,患者SDANN[49.30(38.40,65.30)ms]、SDNN[54.00(43.10,69.90)ms]及rMSSD[14.90(12.50,33.10)ms]水平低于术前[63.80(51.30,81.50)ms、76.00(60.00,94.00)ms、22.70(17.70,28.20)ms],差异有统计学意义(P<0.05)。对照组、单纯高血压组、单纯T2DM组及合并组患者术后SDANN[75.30(69.00,81.55)ms、57.35(53.20,62.80)ms、44.60(40.65,47.65)ms、30.50(27.50,34.20)ms]、SDNN[80.70(75.20,87.50)ms、62.55(57.95,66.73)ms、48.70(44.45,51.55)ms、33.30(31.00,36.90)ms]和rMSSD[47.40(42.70,57.15)ms、24.65(18.65,29.43)ms、13.40(12.80,14.05)ms、10.60(8.80,11.50)ms]水平比较,差异有统计学意义(P<0.05)。术后7 d,对照组与单纯高血压组SDNN差值为(33.50±9.56)ms;对照组与单纯T2DM组SDNN差值为(71.00±9.15)ms;对照组与合并组SDNN差值为(105.00±10.15)ms;单纯高血压组与单纯T2DM组SDNN差值为(37.50±9.07)ms;单纯高血压组与合并组SDNN差值为(71.50±10.08)ms,差异有统计学意义(P<0.05)。结论高血压和T2DM对二尖瓣置换患者HRV有不利影响,T2DM影响更大。

Objective To investigate the effect of type 2 diabetes mellitus(T2DM)and hypertension on perioperative heart rate variability(HRV)in patients with degenerative mitral regurgitation undergoing mitral valve replacement(MVR).Methods This study was a retrospective case-control study,a total of 150 patients who underwent MVR due to degenerative mitral insufficiency admitted to the department of Cardiovascular Surgery of the Northern Theater General Hospital from January 2021 to December 2022,including 76 males and 74 females,aged 60.23(54.00,64.50)years old,ranging from 43 to 76 years old.Patients were divided into control group(no hypertension and T2DM,n=42),simple hypertension group(n=51),simple T2DM group(n=28)and merge group(both hypertension and T2DM,n=29)according to whether they had previous hypertension and/or T2DM.The levels of HRV[standard deviation of adjacent NN intervals(SDNN),standard deviation of mean values every 5 min(SDANN)and square root of mean squared squared values of adjacent NN intervals(rMSSD)]were compared between the four groups at 7 days before surgery and 7 days after surgery.Results At 7 days after surgery,the levels of SDANN[49.30(38.40,65.30)ms],SDNN[54.00(43.10,69.90)ms]and rMSSD[14.90(12.50,33.10)ms]in the patient were lower than those before surgery[63.80(51.30,81.50)ms,76.00(60.00,94.00)ms,22.70(17.70,28.20)ms],the differences were statistically significant(P<0.05).Patients in control group,simple hypertension group,simple T2DM group and merge group had SDANN[75.30(69.00,81.55)ms,57.35(53.20,62.80)ms,44.60(40.65,47.65)ms,30.50(27.50,34.20)ms],SDNN[80.70(75.20,87.50)ms,62.55(57.95,66.73)ms,48.70(44.45,51.55)ms,33.30(31.00,36.90)ms]and rMSSD[47.40(42.70,57.15)ms,24.65(18.65,29.43)ms,13.40(12.80,14.05)ms,10.60(8.80,11.50)ms],the differences were statistically significant(P<0.05).At 7 days after surgery,the difference of SDNN between control group and simple hypertension group was(33.50±9.56)ms.The difference of SDNN between control group and simple T2DM group was(71.00±9.15)ms.The difference of SDNN between control group and merge group was(105.00±10.15)ms.The difference of SDNN between simple hypertension group and simple T2DM group was(37.50±9.07)ms.The difference of SDNN between the simple hypertension group and the merge group was(71.50±10.08)ms,and the differences were statistically significant(P<0.05).Conclusions Hypertension and T2DM have adverse effects on HRV in mitral valve replacement patients,and T2DM has a greater effect.