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Received:September 10, 2022 Published Online:February 20, 2023
Received:September 10, 2022 Published Online:February 20, 2023
中文摘要: 目的 寻找一种量化围术期创伤应激的智能方法,将围术期患者的应激状态及恢复过程数字化、可视化,从自主神经系统(ANS)角度分析加速康复外科(ERAS)策略促进患者快速康复的机制。方法 回顾性分析2020年2月至2022年5月在江苏省中医院行腹腔镜结直肠癌根治术的125例患者的临床资料,根据治疗方式分为ERAS组和对照组。应用倾向性评分匹配法(PSM)均衡组间协变量后共66例患者纳入本研究,各33例。对比两组住院天数、超敏C反应蛋白(hs-CRP)、心率变异度(HRV)各参数(SDNN、pNN50、LF/HF)及心率变异曲线变化情况。结果 两组入院当天hs-CRP、HRV各参数比较,差异无统计学意义(P>0.05);ERAS组住院天数及术后hs-CRP均低于对照组 (P<0.05)。手术当天至术后4 d HRV各参数两组对比差异有统计学意义(P<0.05);ERAS组术后第4天HRV各参数与入院时对比差异无统计学意义(P>0.05);对照组HRV各参数术后4 d与入院时对比差异有统计学意义(P<0.05)。结论 ERAS策略可降低围术期应激水平,保护迷走神经功能;HRV是围术期创伤应激监测的可靠手段,无创、实时动态、可视化、可穿戴。
Abstract:ObjectiveTo find an intelligent method to quantify perioperative trauma stress, digitize and visualize perioperative patients stress status and recovery process, and analyze the mechanism of enhanced recovery after surgery (ERAS) strategy to promote rapid recovery of patients from the perspective of autonomic nervous system (ANS). MethodsThe clinical data of 125 patients received laparoscopic radical resection of colorectal cancer in Jiangsu Province Hospital of Chinese Medicine from February 2020 to May 2022 were retrospectively analyzed. According to the treatment methods, they were divided into ERAS group and control group. A total of 66 patients were included in this study after propensity score matching (PSM) was used to equalize covariates between groups, with 33 patients in each group. The hospital stay, high-sensitivity C-reactive protein (hs-CRP), HRV parameters (SDNN, pNN50, LF/HF) and the variation of heart rate curve were compared between two groups. ResultsThere was no significant difference in hs-CRP and HRV parameters between the two groups on admission day (P>0.05). The hospital stay and postoperative hs-CRP in ERAS group were lower than those in control group (P<0.05). There were significant differences in HRV parameters between two groups from the day of operation to 4 days after operation (P<0.05). There was no significant difference between 4th day after operation and admission at parameters of HRV in ERAS group (P>0.05). The difference between 4th day after operation and admission was significant at parameters of HRV in control group (P<0.05). ConclusionERAS can reduce perioperative traumatic stress and protect vagal nerve function. HRV is a reliable means of perioperative traumatic stress monitoring, which is non-invasive, real-time dynamic, visual and wearable.
keywords: Enhanced recovery after surgery Perioperative period Traumatic stress response Colorectal cancer Heart rate variability Autonomic nervous system
文章编号: 中图分类号: 文献标志码:A
基金项目:江苏省中医药管理局重点项目(ZD201903);江苏省中医院科技项目(Y20011)
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