Effect of hypertension and type 2 diabetes on heart rate variability in patients undergoing aortic valve replacement
沈诗吟 1许昌海 1林琳 1崔岩 1张誉籍 2陆婧媛
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作者信息
1. 北部战区总医院重症医学科，沈阳 110000
2. 北部战区总医院心血管外科，沈阳 110000
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摘要
目的 探讨高血压与2型糖尿病(T2DM)对行主动脉瓣置换术患者心率变异性的影响。 方法 本研究为回顾性病例对照研究，选取2022年1月至2023年5月北部战区总医院心血管外科收治的138例因主动脉瓣病变行主动脉瓣置换的患者，男96例，女42例，年龄(57.54±11.17)岁，年龄范围为15～77岁。根据患者既往是否患有高血压和(或)T2DM将患者分为无合并症组(n＝62)、T2DM组(n＝14)、高血压组(n＝46)、高血压合并T2DM组(n＝16)。比较四组患者术前及术后7 d的心率变异性指标[全部窦性心搏RR间期的标准差(SDNN)、相邻5 min间隔的心跳间隔的标准差的平均值(SDANN)和相邻心跳间隔的均方根差(rMSSD)]，以评估既往是否患有高血压和(或)T2DM患者心率变异性的早期改变情况。 结果 术后7 d，患者SDNN[73.50(61.00，114.28)ms]、SDANN[54.35(44.00，65.48)ms]和rMSSD[15.30(10.70，21.93)ms]均低于术前[86.50(74.00，127.28)ms、69.50(58.70，99.23)ms、25.00(20.40，31.63)ms]，差异有统计学意义(P<0.05)。术后7 d，无合并症组、T2DM组、高血压组及高血压合并T2DM组患者的SDNN[117.10(96.15，143.85)ms、73.50(73.13，74.25)ms、63.10(56.55，65.88)ms、32.05(24.95，39.48)ms]、SDANN[68.20(60.18，78.65)ms、54.35(52.48，54.90)ms、45.60(42.65，48.93)ms、35.70(32.35，37.43)ms]及rMSSD水平[22.15(19.03，28.60)ms、15.30(15.08，15.75)ms、11.45(9.95，13.22)ms、6.00(4.95，6.90)ms]比较，差异有统计学意义(P<0.05)。术后7 d，无合并症组与T2DM组SDNN差值为(38.00±11.83)ms、无合并症组与高血压组SDNN差值为(68.00±7.78)ms、无合并症组与高血压合并T2DM组SDNN差值为(99.00±11.21)ms、T2DM组与高血压合并T2DM组SDNN差值为(61.00±14.63)ms、高血压合并T2DM组与高血压合并T2DM组SDNN差值为(31.00±11.60)ms，差异有统计学意义(P<0.05)。 结论 行主动脉瓣置换术后早期，患者的心率变异性指标均有所下降，高血压合并T2DM患者的心率变异性指标下降得较为明显。 Objective To explore the effects of hypertension and type 2 diabetes mellitus(T2DM)on heart rate variability in patients undergoing aortic valve replacement. Methods This study was a retrospective case-control study, a total of 138 patients who underwent aortic valve replacement due to aortic valve disease were selected from Cardiovascular Surgery department of the General Hospital of Northern Theater Command from January 2022 to May 2023, including 96 males and 42 females, aged(57.54±11.17)years old, ranging from 15 to 77 years old.According to whether the patients had hypertension and/or T2DM in the past, the patients were divided into no hypertension and T2DM group(n=62), T2DM group(n=14), hypertension group(n=46), and hypertension and T2DM group(n=16).The heart rate variability indexes[standard deviation of the RR intervals of all sinus beats(SDNN), the mean of the standard deviations of the heartbeat intervals of adjacent 5-minute intervals(SDANN)and adjacent Root mean square difference(rMSSD)of heartbeat intervals]to evaluate early changes in heart rate variability in patients with pre-existing hypertension and/or T2DM. Results At 7 days after surgery, the patient′s SDNN[73.50(61.00, 114.28)ms], SDANN[54.35(44.00, 65.48)ms]and rMSSD[15.30(10.70, 21.93)ms]were all lower than those before surgery[86.50(74.00, 127.28))ms, 69.50(58.70, 99.23)ms, 25.00(20.40, 31.63)ms], the differences were statistically significant(P<0.05).At 7 days after surgery, the SDNN of patients in the non-hypertensive T2DM group, T2DM group, hypertension group and hypertension combined with T2DM group[117.10(96.15, 143.85)ms, 73.50(73.13, 74.25)ms, 63.10(56.55, 65.88)ms, 32.05(24.95, 39.48)ms], SDANN[68.20(60.18, 78.65)ms, 54.35(52.48, 54.90)ms, 45.60(42.65, 48.93)ms, 35.70(32.35, 37.43)ms]and rMSSD level[22.15(19.03, 28.60)ms, 15.30(15.08, 15.75)ms, 11.45(9.95, 13.22)ms, 6.00(4.95, 6.90)ms], the differences were statistically significant(P<0.05).At 7 days after surgery, the SDNN difference between the non-hypertension and T2DM group and the T2DM group was(38.00±11.83)ms, the SDNN difference between the non-hypertension and T2DM group and the hypertension group was(68.00±7.78)ms, the SDNN difference between the T2DM group and the hypertension combined T2DM group was(99.00±11.21)ms, the SDNN difference between the T2DM group and the hypertension combined T2DM group was(61.00±14.63)ms, the SDNN difference between the hypertension combined T2DM group and the hypertension combined T2DM group was(31.00±11.60)ms, and the differences were statistically significant(P<0.05). Conclusions In the early stage after aortic valve replacement, the heart rate variability indexes of all patients decreased, and the heart rate variability indexes of patients with hypertension and T2DM decreased more significantly.
Abstract
Objective To explore the effects of hypertension and type 2 diabetes mellitus(T2DM)on heart rate variability in patients undergoing aortic valve replacement. Methods This study was a retrospective case-control study, a total of 138 patients who underwent aortic valve replacement due to aortic valve disease were selected from Cardiovascular Surgery department of the General Hospital of Northern Theater Command from January 2022 to May 2023, including 96 males and 42 females, aged(57.54±11.17)years old, ranging from 15 to 77 years old.According to whether the patients had hypertension and/or T2DM in the past, the patients were divided into no hypertension and T2DM group(n=62), T2DM group(n=14), hypertension group(n=46), and hypertension and T2DM group(n=16).The heart rate variability indexes[standard deviation of the RR intervals of all sinus beats(SDNN), the mean of the standard deviations of the heartbeat intervals of adjacent 5-minute intervals(SDANN)and adjacent Root mean square difference(rMSSD)of heartbeat intervals]to evaluate early changes in heart rate variability in patients with pre-existing hypertension and/or T2DM. Results At 7 days after surgery, the patient′s SDNN[73.50(61.00, 114.28)ms], SDANN[54.35(44.00, 65.48)ms]and rMSSD[15.30(10.70, 21.93)ms]were all lower than those before surgery[86.50(74.00, 127.28))ms, 69.50(58.70, 99.23)ms, 25.00(20.40, 31.63)ms], the differences were statistically significant(P<0.05).At 7 days after surgery, the SDNN of patients in the non-hypertensive T2DM group, T2DM group, hypertension group and hypertension combined with T2DM group[117.10(96.15, 143.85)ms, 73.50(73.13, 74.25)ms, 63.10(56.55, 65.88)ms, 32.05(24.95, 39.48)ms], SDANN[68.20(60.18, 78.65)ms, 54.35(52.48, 54.90)ms, 45.60(42.65, 48.93)ms, 35.70(32.35, 37.43)ms]and rMSSD level[22.15(19.03, 28.60)ms, 15.30(15.08, 15.75)ms, 11.45(9.95, 13.22)ms, 6.00(4.95, 6.90)ms], the differences were statistically significant(P<0.05).At 7 days after surgery, the SDNN difference between the non-hypertension and T2DM group and the T2DM group was(38.00±11.83)ms, the SDNN difference between the non-hypertension and T2DM group and the hypertension group was(68.00±7.78)ms, the SDNN difference between the T2DM group and the hypertension combined T2DM group was(99.00±11.21)ms, the SDNN difference between the T2DM group and the hypertension combined T2DM group was(61.00±14.63)ms, the SDNN difference between the hypertension combined T2DM group and the hypertension combined T2DM group was(31.00±11.60)ms, and the differences were statistically significant(P<0.05). Conclusions In the early stage after aortic valve replacement, the heart rate variability indexes of all patients decreased, and the heart rate variability indexes of patients with hypertension and T2DM decreased more significantly.
万方数据