围术期老年糖尿病患者心率变异性的监测及临床意义

目的探讨围术期老年糖尿病患者非心脏手术后心脏自主神经功能的变化及意义。方法选择择期非心脏手术的老年患者160例分为糖尿病组（DM组，78例）和非糖尿病组（NDM组，82例）。用动态心电图监测仪分别记录术前（患者入院后）、术后第1天（从手术开始记录）、术后第2天（第2个24h）的心率变异性（HRV），包括SDNN、SDANN和RMSSD。结果术前与NDM组比较，DM组SDNN、SDANN降低（P〈0．01），RMSSD差异无统计学意义；术后第1天DM组SDNN、SDANN、RMSSD均低于术前（P〈0．05），NDM组SDNN、SDANN低于术前（P〈0．05），RMSSD与术前相比差异无统计学意义；术后第2天两组各指标均低于术前及术后第1天（P〈0．01）；DM组低于NDM组。结论麻醉、手术创伤及术后疼痛对患者的自主神经功能有显著的影响。与非糖尿病患者相比，糖尿病患者手术后发生自主神经功能紊乱更为严重。

The change of heart rate variability(HRV)in elderly diabetic with perioperative period

Objective To investigate the activity and relationship of autonomic nervous system （ANS） in elderly patients with diabetes mellitus （DM） after non-cardiac surgery. Mehtods 160 patients with ASA Ⅰ -Ⅲ aged 1〉 65 yrs undergoing elective abdominal surgery or operation on the lower limbs were assigned to one of 2 groups： DM group（n=78） and non-DM group（n=82）. The patients were monitored with Halter the day before and on the 1st and 2nd day after operation. Heart-rate variability （HRV） including SDNN, SDANN and RMSSD were analyzed. Results SDNN, SDANN were significantly lower in DM group than in non-DM group before operation （P〈0.01）, RMSSD was no significant difference. On the 1st postoperative day, SDNN, SDANN, RMSSD in DM group were significantly lower than operation before（P〈0.05 ）, SDNN, SDANN in non-DM group were significantly lower than operation before （P〈0.05）, RMSSD was no significant difference. On the 2th postoperative day two group Index were significantly lower than operation before and the 1st postoperative day （P〈0.01）, DM group was significantly lower than non-DM group. Conclusion The disturbances in the activity of ANS are severer and more persistent in elderly diabetic after non-cardiac surgery.