结直肠癌患者围手术期自主神经功能变化及其与营养状况的相关性分析-东南大学学报医学版

结直肠癌患者围手术期自主神经功能变化及其与营养状况的相关性分析

单位：南京中医药大学附属医院, 江苏南京 210029

分类号：R735.3

出版年·卷·期（页码）：2022·41·第三期（358-363）

摘要：

目的：通过监测心率变异度（heart rate variability，HRV）各指标评估结直肠癌患者围手术期自主神经功能的变化，并探讨其与营养、康复之间的关系。方法：将28例结直肠癌患者通过营养风险筛查分为无营养风险组（A组）和高营养风险组（B组），并对患者HRV、机体组成及血清营养指标进行检测，探讨组间与组内营养指标的差异性及其与HRV各指标之间的相关性。结果：A组术日与术前HRV比较，HRV时域指标PNN50明显上升（P<0.05），低频功率（LF）、高频功率（HF）也明显上升（P<0.05），LF/HF明显下降（P<0.05）；B组术日与术前比较，3个指标也呈同样的趋势；A、B两组术日HRV比较显示，PNN50、HF差异有统计学意义（P<0.05）。A组术后与术前HRV比较，PNN50、LF、HF、LF/HF差异均无统计学意义（P>0.05）；B组术后与术前HRV比较，PNN50、LF、HF明显升高（P<0.05）；两组术后PNN50、HF比较，B组比A组明显升高（P<0.05）。HRV与营养指标相关性分析提示，PNN50与体质量、脂肪群、白蛋白、转铁蛋白相关（均r≠0，P<0.05），HF与体质量、体质量指数（BMI）、脂肪群、转铁蛋白相关（均r≠0，P<0.05），LF/HF与体质量、身体总水分、肌肉群、总蛋白相关（均r≠0，P<0.05）。结论：自主神经功能，尤其是迷走神经功能，与围手术期营养状况及康复具有相关性，HRV的监测为肿瘤患者的营养评估和营养支持提供了新的思路。

Objective: To assess perioperative autonomic nervous function by monitoring heart rate variability(HRV)in patients with colorectal cancer to explored its relationship with nutrition and rehabilitation. Methods: 28 patients with colorectal cancer were divided into no nutritional risk group(A group) and high nutritional risk group(B group) based on comprehensive nutritional risk assessment. The changes of body composition, HRV and serum nutritional indicators were monitored, and the differences and correlation of indexes between and within groups of nutritional indexes and HRV indexes were explored. Results: Compared with preoperative HRV, PNN50 increased significantly on operative day in group A(P<0.05), LF and HF also increased significantly(P<0.05), and LF/HF decreased significantly(P<0.05). In group B, the comparison of operative day and preoperative day showed the same trend. There was a statistical difference in PNN50 and HF between group A and group B(P<0.05). In group A, there were no significant differences in PNN50, LF, HF and LF/HF between preoperative and postoperative HRV(P>0.05). In group B, PNN50, LF and HF of group B were significantly higher than those before operation(P<0.05). Postoperative PNN50 and HF of group B were significantly higher those in group A(P<0.05). Correlation analysis of HRV and nutritional indexes showed that PNN50 was significantly correlated with body weight, fat group, albumin and transferrin(all r≠0, P<0.05), HF was significantly correlated with body weight, BMI, fat group and transferrin(all r≠0, P<0.05), and LF/HF was significantly correlated with body weight, total body moisture, muscle group and total protein(all r≠0, P<0.05). Conclusion: Autonomic nervous function, especially vagus nerve function, is correlated with perioperative nutritional status and rehabilitation. HRV monitoring provides a new idea for nutritional evaluation and nutritional support of tumor patients.

参考文献：

[1] BRAY F,FERLAY J,SOERJOMATARAM I,et al.Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2018,68(6):394-424.
[2] CSCO肿瘤营养治疗专家委员会.恶性肿瘤患者的营养治疗专家共识[J].临床肿瘤学杂志,2012,17(1):59-73.
[3] 中华医学会肠外肠内营养学分会,中国医药教育协会加速康复外科专业委员会.加速康复外科围术期营养支持中国专家共识(2019版)[J].中华消化外科杂志,2019,18(10):897-902.
[4] DOCKRAY G J,BURDYGA G.Plasticity in vagal afferent neurones during feeding and fasting:mechanisms and significance[J].Acta Physiol(Oxf),2011,201(3):313-321.
[5] BISWAS S,MANDAL S,MITRA T,et al.A prospective randomized comparative study to compare the homodynamic and metabolic stress respone due to endotracheal intubation and igelusage during laparoscopic cholecystectomy[J].Middle East J Anaesthesiol,2015,23(3):315-320.
[6] PRIEBE H J.Pharmacological modification of the perioperative stress response in noncardiac surgery[J].Best Pract Res Clin Anaesthesiol,2016,30(2):171-189.
[7] 房怿,张婷婷,张文敬,等.围手术期迷走神经保护[J].国际麻醉学与复苏杂志,2017,38(12):1128-1132.
[8] 邓春花,孙美娟,张娟娟,等.NRS2002在老年髋部骨折患者术前营养筛查和预测临床转归中的应用[J].现代医学,2021,49(3):321-325.
[9] 中华医学会肠外肠内营养学分会加速康复外科协作组.结直肠手术应用加速康复外科中国专家共识(2015版)[J].中华消化外科杂志,2015,14(8):606-608.
[10] LYELL N J,KITANO M,SMITH B,et al.The effect of preoperative nutritional status on postoperative complications and overall survival in patients undergoing pelvic exenteration:a multi-disciplinary,multi-institutional cohort study[J].Am J Surg,2019,218(2):275-280.
[11] NA B G,HAN S S,CHO Y A,et al.Nutritional status of patients with cancer:a prospective cohort study of 1,588 hospitalized patients[J].Nutr Cancer,2018,70(8):1228-1236.
[12] BERTHOUD H R,NEUHUBER W L.Functional and chemical anatomy of the afferent vagal system[J].Auton Neurosci,2000,85(1-3):1-17.
[13] DOCKRAY G J,BURDYGA G.Plasticity in vagal afferent neurones during feeding and fasting:mechanisms and significance[J].Acta Physiol(Oxf),2011,201(3):313-321.
[14] DE LARTIGUE G,DIMALINE R,VARRO A,et al.Cocaine- and amphetamine-regulated transcript:stimulation of expression in rat vagal afferent neurons by cholecystokinin and suppression by ghrelin[J].J Neurosci,2007,27(11):2876-2882.
[15] DE LARTIGUE G.Putative roles of neuropeptides in vagal afferent signaling[J].Physiol Behav,2014,136:155-169.
[16] 洪必莹,何森,陈晓平.心率变异性研究进展[J].华西医学,2013,28(4):614-618.
[17] WILLIAMS D L,BASKIN D G,SCHWARTZ M W.Evidence that intestinal glucagon-like peptide-1 plays a physiological role in satiety[J].Endocrinology,2009,150(4):1680-1687.
[18] 胡永奎,凌刘.老年2型糖尿病合并冠心病患者的心率变异性研究[J].河北医学,2016,22(2):236-238.
[19] 李静,王邦茂.心率变异与肠易激综合征研究进展[J].国际消化病杂志,2010,30(4):213-216.
[20] 沈仲元,刘仁光,SHIN L,等.夜间呼吸时相的周期及形态特点与心率变异的关系[J].江苏实用心电学杂志,2012,21(3):157-161.
[21] 曾莲,秦聪.糖尿病合并无症状冠心病的心率变异分析[J].实用心电学杂志,2010,19(2):124.
[22] 王骏扬,邹永波,张明威,等.胃肠道恶性肿瘤术后早期肠内营养与肠外营养对照研究[J].中国实验诊断学,2013,17(3):524-526.
[23] DE LA SERRE C B,DE LARTIGUE G,RAYBOULD H E.Chronic exposure to low dose bacterial lipopolysaccharide inhibits leptin signaling in vagal afferent neurons[J].Physiol Behav,2015,139:188-194.

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