高血压和2型糖尿病对心脏搭桥术后早期心率变异性影响程度的探讨

Degree of influence of hypertension and type 2 diabetes on early heart rate variability after cardiac bypass surgery

摘要:

目的 探究行非体外循环下冠状动脉搭桥术（off-pump coronary artery bypass grafting，OPCABG）患者围术期心率变异性（heart rate variability，HRV）的变化趋势，以及高血压和（或）2型糖尿病（type 2 diabetes mellitus，T2DM）因素对这种趋势的影响程度。方法 回顾性研究2020年12月至2022年3月因冠状动脉粥样硬化性心脏病需要行OPCABG的521名患者住院期间的基线资料与围手术期7 d动态心电图记录的相关指标来反映HRV的早期改变。根据患者既往是否患有高血压和（或）T2DM将患者分为A、B、C、D 4组：A组（患有高血压合并T2DM，n=118）、B组（单纯患有高血压，n=183）、C组（单纯患有T2DM，n=81）、D组（既往无高血压且无T2DM，n=139）。对521名患者行独立样本t检验，观察患者行OPCABG围术期全部窦性心搏RR间期的标准差（standard deviation of NN intervals，SDNN）与相邻正常心动周期差值的均方的平方根（root-mean-square of difference-value of adjacent RR interval，rMSSD）的变化，同时对4组患者行单因素ANOVA检验，再行邦弗伦尼事后检验行组间比较观察组间关系，探究高血压、糖尿病与HRV之间的关系。结果 OPCABG围手术期心率变异性的时域指标SDNN与rMSSD较术前降低［SDNN：（89.744±23.350） ms vs. （58.027±13.565） ms，rMSSD：（29.184±13.060） ms vs. （20.132 ± 9.298） ms，均P<0.05］；高血压合并T2DM组术后7 d SDNN指标为（51.258±10.358） ms，低于高血压组的（59.271±11.858） ms（P<0.001），高血压合并T2DM组为（51.258±10.358） ms，低于T2DM组的（55.273±9.538） ms（P=0.182）；OPCABG术后rMSSD指标为20.132±9.298，低于术前的29.184±13.061（P<0.001）。结论 术后早期患者HRV功能受损严重；OPCABG术后既往高血压合并T2DM的患者SDNN指标下降最为明显，T2DM因素对术后早期HRV下降较高血压因素起的作用更大，T2DM对术后早期交感神经与副交感神经协调功能紊乱起较大作用；术后患者迷走神经功能整体下降，高血压和T2DM因素对于术后早期迷走神经功能下降的影响特异性不大。

Abstract:

Objective To investigate the trend of perioperative heart rate variability（HRV） in patients undergoing off-pump coronary artery bypass grafting （OPCABG），and the extent to which hypertension and/or type 2 diabetes mellitus（T2DM） factors influence this trend.Methods A retrospective study was conducted to reflect the early changes in HRV in the hospitalization of 521 patients with OPCABG from December 2020 to March 2022 who needed OPCABG for treating coronary atherosclerotic heart disease during hospitalization. According to whether the patient had previous hypertension or/and T2DM，patients were divided into four groups：A，B，C，and D. Among them，patients in group A had hypertension combined with T2DM（n=118）， patients in group B had simple hypertension （n=183），patients in group C had T2DM alone（n=81），and patients in group D had no previous hypertension and no T2DM（n=139）. An independent-samples t-test was performed on 521 patients to observe the changes of the standard deviation of NN interval（SDNN） and the root-mean-square of difference-value of adjacent RR interval（rMSSD） in the OPCABG perioperative period. At the same time，the univariate ANOVA test was performed with 4 groups of patients，and Bonferroni post hoc test was performed to explore the relationship among hypertension，diabetes and HRV.Results The time-domain indexes SDNN and rMSSD of perioperative HRV of OPCABG decreased compared with those before the operation［SDNN：（89.744±23.350） ms vs. （58.027±13.565） ms；rMSSD：（29.184±13.060） ms vs. （20.132±9.298） ms，all P<0.05）. The SDNN indexes［（51.258±10.358） ms］ in the hypertension combined with T2DM group were lower than those in the hypertension group［（59.271±11.858） ms，P<0.001］，and those were lower in hypertension combined with T2DM group［（51.258±10.358） ms］ than in the T2DM group［（55.273±9.538） ms，P=0.182］. The rMSSD index after OPCABG （20.132±9.298） was lower than that before surgery（29.184±13.061，P<0.001）.Conclusion HRV function is seriously impaired in early postoperative patients. The decline in SDNN index is most obvious in patients with prior hypertension and T2DM after OPCABG， and T2DM factor plays a greater role in the decline of HRV in the early postoperative period than hypertension，and T2DM plays a greater role in the coordination and dysfunction of sympathetic and parasympathetic nerves in the early postoperative period. The overall decline in vagus nerve function in postoperative patients，and the effects of hypertension and T2DM factors on the decline of vagus nerve function in the early postoperative period are not specific