年龄对二尖瓣置换术后心脏自主神经功能影响

Effect of age on cardiac autonomic nerve function after mitral valve replacement

目的探讨不同年龄段因退行性二尖瓣关闭不全行二尖瓣置换术后患者的心率变异性(HRV)的数据,评估年龄对术后心脏自主神经功能的影响。方法回顾性分析自2020年4月至2023年6月在北部战区总医院住院因退行性二尖瓣关闭不全行二尖瓣置换的391例患者的临床资料。根据患者的年龄将其分为A组(年龄50~59岁,n=146)、B组(年龄60~69岁,n=196)及C组(年龄70~79岁,n=49)。比较各组患者术前7 d及术后7 d动态心电图HRV的指标,包括均值标准差(SDANN)、总体标准差(SDNN)、标准差均值(SDNNindex)、相邻两个RR间期差值>50 ms(PNN50)、差值的均方根(rMSSD)。比较各组患者心脏超声参数指标,包括左室舒张末内径(LVIDD)、左室后壁厚度(LVPWT)、室间隔厚度(IVST)、左房内径(LA)。结果术后,A组患者心功能指标LVIDD高于B组、C组,LVPWT、IVST、LA均低于B组、C组,且B组IVST低于C组,差异均有统计学意义(P<0.05)。术前,3组患者HRV相关指标比较,差异均无统计学意义(P>0.05);术后,各组SDNN、SDANN、SDNNindex均低于各组术前,且A组的SDNN、SDANN、SDNNindex、rMSSD、PNN50均高于B组、C组,B组各指标均高于C组,差异均有统计学意义(P<0.05)。结论退行性二尖瓣关闭不全患者行二尖瓣置换术后,随着年龄的增加,自主神经功能受损、心脏储备力减退,对其术后恢复及生存质量均有影响。

Objective To investigate the heart rate variability(HRV)of patients undergoing mitral valve replacement due to degenerative mitral insufficiency in different age groups,and to evaluate the effect of age on cardiac autonomic nerve.Methods The clinical data of 391 patients admitted to General Hospital of Northern Theater Command from April 2020 to June 2023 for mitral valve replacement due to degenerative mitral insufficiency were retrospectively analyzed.According to the age of the patients,they were divided into group A(age 50-59,n=146),group B(age 60-69,n=196)and group C(age 70-79,n=49).The indexes of holter electrocardiogram HRV at 7 days before and 7 days after surgery were compared in all groups,including standard deviation of NN intervals(SDANN),standard deviation of sinus heart beat RR interval(SDNN),the average of the standard deviations of NN intervals across all 5-minute segments recorded over a 24-hour period(SDNNindex),percentage of successive RR intervals that difer by more than 50 ms(PNN50),and root mean square of successive ifferences(rMSSD).Cardiac ultrasound parameters of all groups were compared,including left ventricular end-diastolic diameter(LVIDD),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST)and left atrial diameter(LA).Results After surgery,the cardiac function index LVIDD in group A was higher than that in group B and Group C,LVPWT,IVST and LA were lower than those in group B and group C,and IVST in group B was lower than that in group C,with statistical significance(P<0.05).Before surgery,there was no statistical significance in HRV related indexes among 3 groups(P>0.05).After operation,SDNN,SDANN and SDNNindex in all groups were lower than before operation,and SDNN,SDANN,SDNNindex,rMSSD and PNN50 in group A were higher than those in group B and C,and all indexes in group B were higher than those in group C,with statistical significance(P<0.05).Conclusion After mitral valve replacement,with the increase of age,autonomic nervous function is impaired and cardiac reserve strength is decreased,which has an impact on postoperative recovery and life quality.