Journal of Shandong University (Health Sciences) ›› 2020, Vol. 58 ›› Issue (11): 85-91.doi: 10.6040/j.issn.1671-7554.0.2020.0113

Previous Articles     Next Articles

Clinical observation of heart rate variability in patients with gastric cancer during perioperative period under the guidance of enhanced recovery after surgery

ZHI Mengwei1, JIANG Zhiwei2, DAI Xinjuan3, WANG Gang2, CHENG Wei2   

  1. 1. School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu, China;
    2. Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu, China;
    3. Department of Nursing, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu, China
  • Published:2020-11-04

PDF (PC)

235

Abstract: Objective To explore the changes of heart rate variability(HRV)in patients undergoing laparoscopic radical gastrectomy under the guidance of enhanced recovery after surgery(ERAS). Methods The clinical data of 50 patients who received laparoscopic radical gastrectomy during Jan. 2019 and Dec. 2019 were retrospectively analyzed. According to whether ERAS concept was adopted, the patients were divided into the control group(n=25)and ERAS group(n=25). Patients in the control group received traditional perioperative management, while patients in the ERAS group received multimodal health education, fluid management, multimodal analgesia, early enteral nutrition, early ambulation and so on. Perioperative HRV parameters were compared between the two groups, including standard deviation of NN intervals(SDNN), triangle index, number of pairs of successive NNs that differ by more than 50ms(pNN50), low frequency(LF), high frequency(HF), low frequency/high frequency(LF/HF). The serum hypersensitive C-reactive protein level in the two groups were also observed. Results In postoperative days 1-4, SDNN was significantly higher in the ERAS group than in the control group(P<0.05). In postoperative days 1, 2, 3 and 5, triangle index was significantly higher in the ERAS group than in the control group(P<0.05). In postoperative days 2-4, LF/HF was significantly higher in the ERAS group than in the control group(P<0.05). In postoperative days 1-5, there were no differences in LF, HF and LF/HF between the two groups(P>0.05). In postoperative days 1 and 3, C-reactive protein was significantly lower in the ERAS group than in the control group(P<0.05). Conclusion ERAS improves HRV, reduces surgical stress and inflammatory response, and promotes recovery in patients undergoing laparoscopic radical gastrectomy.

Key words: Enhanced recovery after surgery, Gastric cancer, Heart rate variability, Autonomic nervous system, Stress response

CLC Number: 

  • R619
[1] 陈秋磊. 加速康复外科对肠功能及自主神经调控的研究[D]. 南京: 南京大学, 2016.
[2] Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology[J]. Eur Heart J, 1996, 17(3): 354-381.
[3] 刘慧, 王新利, 关育红, 等. 妊娠期合并糖代谢异常对新生儿胰岛素敏感性的影响[J]. 中国新生儿科杂志, 2012, 27(4): 228-232. LIU Hui, WANG Xinli, GUAN Yuhong, et al. Effects of pregnancy complicated with abnormal glycometabolism on the offspring insulin sensitivity[J]. Chinese Journal of Neonatology, 2012, 27(4): 228-232.
[4] 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.
[5] 张静, 王晰程, 曹彦硕, 等. 二代测序在家族遗传性高危胃肠肿瘤筛查中的应用[J]. 中国肿瘤临床, 2018, 45(19): 1000-1004. ZHANG Jing, WANG Xicheng, CAO Yanshuo, et al. Application of next-generation sequencing for the screening of hereditary gastrointestinal cancer[J]. Chinese Journal of Clinical Oncology, 2018, 45(19): 1000-1004.
[6] Goudman L, Brouns R, Linderoth B, et al. Effects of spinal cord stimulation on heart rate variability in patients with failed back surgery syndrome: comparison between a 2-lead ECG and a wearable device[J]. Neuromodulation, 2019. doi:10.1111/ner.13091.
[7] Batchinsky AI, Cooke WH, Kuusela T, et al. Loss of complexity characterizes the heart rate response to experimental hemorrhagic shock in swine[J]. Crit Care Med, 2007, 35(2): 519-525.
[8] Salom(~overa)o E Jr, Otsuki DA, Correa AL, et al. Heart rate variability analysis in an experimental model of hemorrhagic shock and resuscitation in pigs[J]. PLoS One,2015,10(8): e0134387. doi: 10.1371/journal.pone.0134387.
[9] Hu S, Lou J, Zhang Y, et al. Low heart rate variability relates to the progression of gastric cancer[J]. World J Surg Oncol, 2018, 16(1): 49. doi:10.1186/s12957-018-1348-z.
[10] Carli F. Physiologic considerations of enhanced recovery after surgery(ERAS)programs: implications of the stress response[J]. Can J Anaesth, 2015, 62(2): 110-119.
[11] 林雪梅, 符梅华, 黄丽娜, 等. 药枕联合耳穴贴压缓解胃肠道恶性肿瘤患者围手术期焦虑、抑郁的临床研究[J]. 北京中医药, 2019, 38(10): 968-973. LIN Xuemei, FU Meihua, HUANG Lina, et al. Application of medicinal pillow combined with auricular acupoint pressing in relieving perioperative anxiety and depression of patients with gastrointestinal malignancy[J]. Beijing Journal of Traditional Chinese Medicine, 2019, 38(10): 968-973.
[12] Fiol-Veny A, Balle M, De la Torre-Luque, et al. Negative cognitive emotion regulation as a predictor of adolescent heart rate variability and entropy under social stress[J]. Anxiety Stress Coping, 2019, 32(6): 641-653.
[13] Usui H, Nishida Y. The very low-frequency band of heart rate variability represents the slow recovery component after a mental stress task[J]. PLoS One, 2017, 12(8): e0182611. doi: 10.1371/journal.pone.0182611.
[14] Borys M, Zyzak K, Hanych A, et al. Survey of postoperative pain control in different types of hospitals: a multicenter observational study[J]. BMC Anesthesiol, 2018, 18(1): 83.
[15] Karri J, Zhang L, Li S, et al. Heart rate variability: a novel modality for diagnosing neuropathic pain after spinal cord Injury[J]. Front Physiol, 2017, 8: 495. doi: 10.3389/fphys.2017.00495.
[16] Léonard G, Chalaye P, Goffaux P, et al. Altered autonomic nervous system reactivity to pain in trigeminal neuralgia[J]. Can J Neurol Sci, 2015, 42(2): 125-131.
[17] 房怿, 申岱. 相位整序信号平均技术用于全麻术中自主神经功能的评价[J]. 临床麻醉学杂志, 2017, 33(1): 15-18. FANG Yi, SHEN Dai. Phase-rectified signal averaging for the assessment of automatic nervous system activity in surgery during general anesthesia[J]. Journal of Clinical Anesthesiology, 2017, 33(1): 15-18.
[18] 房怿, 张婷婷, 张文静, 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. FANG Yi, ZHANG Tingting, ZHANG Wenjing, et al. Conservation of vagus nerve during perioperative period[J]. International Journal of Anesthesiology and Resuscitation, 2017, 38(12): 1128-1132.
[19] 王刚, 江志伟. 加速康复外科推广过程中面临的挑战与对策[J]. 山东大学学报(医学版), 2019, 57(9): 24-27, 37. WANG Gang, JIANG Zhiwei. Challenges and countermeasures in the spread of enhanced recovery after surgery[J]. Journal of Shandong University(Health Sciences), 2019, 57(9): 24-27,37.
[20] Haase O, Langelotz C, Scharfenberg M, et al. Reduction of heart rate variability after colorectal resections[J]. Langenbecks Arch Surg, 2012, 397(5): 793-799.
[21] 程康文, 王贵和, 束宽山, 等. 加速康复外科在腹腔镜辅助胃癌根治术中的应用及其对患者术后恢复、营养及应激的影响[J]. 中国普通外科杂志, 2019, 28(10): 1228-1236. CHENG Kangwen, WANG Guihe, SHU Kuanshan, et al.Application of enhanced recovery after surgery in laparoscopic assisted radical resection for gastric cancer and its influence on postoperative recovery, nutrition status and stress of the patients[J]. Chinese Journal of General Surgery, 2019, 28(10): 1228-1236.
[22] 赵健, 韩晓玲, 王刚, 等. 多模式止痛对机器人45例远端胃切除术后肠功能的影响[J]. 山东大学学报(医学版), 2019, 57(9): 43-47. ZHAO Jian, HAN Xiaoling, WANG Gang, et al. Effects of multimodal analgesia on the intestinal function of 45 patients who received robotic distal gastrectomy[J]. Journal of Shandong University(Health Sciences), 2019, 57(9): 43-47.
[23] 程黎阳, 谢正勇, 戴观荣, 等. 快速康复外科应用于胃肠手术的安全性评估及个体化原则[J]. 实用医学杂志, 2012, 28(1): 14-17. CHENG Liyang, XIE Zhengyong, DAI Guanrong, et al. The safety and individuation principle of fast-track surgery applied in gastrointestinal surgery[J]. The Journal of Practical Medicine, 2012, 28(1): 14-17.
[24] Gögenur I. Postoperative circadian disturbances[J]. Dan Med Bull, 2010, 57(12): B4205.
[25] Luo X, Gao H, Yu X, et al. Spectral analysis of heart rate variability for trauma outcome prediction: an analysis of 210 ICU multiple trauma patients[J]. Eur J Trauma Emerg Surg, 2019. doi: 10.1007/s00068-019-01175-5.
[26] Ushiyama T, Mizushige K, Wakabayashi H, et al. Analysis of heart rate variability as an index of noncardiac surgical stress[J]. Heart Vessels, 2008, 23(1): 53-59.
[1] WANG Ye, WANG Gang, NAN Haiou, CAI Yuling, LI Jiayu, WANG Haifeng, YAN Yingjie, JIANG Zhiwei. Correlation between perioperative heart rate variability and inflammatory indicators in gastric cancer patients [J]. Journal of Shandong University (Health Sciences), 2026, 64(4): 23-30.
[2] HU Bingtao, ZHANG Wencan, WANG Chongyi, LIN Xiangyu, WANG Kaibin, FENG Yunze, LIU Chen, XU Wanlong, LI Le, SI Haipeng. Clinical analysis of one-hole split endoscope for lumbar spinal stenosis based on enhanced recovery after surgery [J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 1-7.
[3] MA Zhihu, YU Xiaofeng, SUN Yuliang, WANG Gang, PEI Yantao, CHEN Bin, SHI Anhao, QIAO Li, ZHU Lei. Application of enhanced recovery after surgery comprehensive treatment in the perioperative period of patients with triangular fibrocartilage complex injuries [J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 28-35.
[4] ZHANG Jie, ZHAO Yinghui, DONG Yaqi, LI Juan, LI Peilong, DU Lutao. Role of GPR133 gene methylation in predicting lymph node metastasis in early gastric cancer [J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 76-84.
[5] WANG Gang, XU Pengyan, ZHAO Xuan, WANG Haifeng, GE Miaomiao, PAN Huafeng, JIANG Zhiwei. Effect of ω-3 polyunsaturated fatty acids on recovery of autonomic nervous system and intestinal function after laparoscopic colorectal cancer surgery [J]. Journal of Shandong University (Health Sciences), 2025, 63(2): 36-42.
[6] CHEN Wenliang, WANG Huanhuan, HAO Jinjin, GONG Rui, ZHAO Qiang, ZHANG Fei, GAO Lei, DONG Jingxun. The role of lncRNA PVT1 in prognostic assessment and malignant progression of gastric cancer: a study based on nomogram model and functional cellular experiments [J]. Journal of Shandong University (Health Sciences), 2025, 63(10): 61-71.
[7] GUO Zhenjiang, WANG Ning, ZHAO Guangyuan, DU Liqiang, CUI Zhaobo, LIU Fangzhen. Development of preoperative models for predicting positive esophageal margin in proximal gastric cancer based on machine learning [J]. Journal of Shandong University (Health Sciences), 2024, 62(7): 78-83.
[8] BAI Xiaoliang, SUN Panpan, WANG Hongli, GONG Shunzhi, SUN Yunqi, SHU Meng, QI Xiaoliang. Animal experiment of medical thoracoscopic splanchnotomy [J]. Journal of Shandong University (Health Sciences), 2024, 62(4): 9-13.
[9] GUO Xin, MENG Jun, ZHENG Shiliang, DONG Xiuhong. Correlation between frailty and body composition in elderly patients with gastric cancer [J]. Journal of Shandong University (Health Sciences), 2024, 62(4): 40-47.
[10] SI Haipeng, WANG Chongyi, GONG Guiqing, ZHANG Wencan, GUO Yingjun, WANG Kaibin,FENG Yunze, XU Wanlong, LI Le. Application progress of enhanced recovery after surgery in spine surgery [J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 8-17.
[11] ZHANG Yang, LI Xiaoxu. Research progress of enhanced recovery after surgery for fracture treatment [J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 18-25.
[12] FENG Chang, GUO Yan, ZHAO Jie, ZHAO Xin. Research progress in ultrasound-guided regional block in orthopaedic surgery under the concept of ERAS [J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 26-35.
[13] JIANG Rendong, ZHAO Jianli, SHI Chao, HE Yeteng, YUAN Zhen. Clinical outcomes comparison of total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis under the concept of enhanced recovery after surgery [J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 62-67.
[14] LI Xue, ZHANG Zengzhen, LIU Jisong, LI Deqiang, YANG Shaozhong. Effect of ultrasound-guided genicular nerve block on postoperative pain in patients undergoing total knee arthroplasty [J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 68-75.
[15] LYU Longfei, LI Jiru, ZHAI Yunpeng, ZHAO Huashan, GUO Rui, XU Hongxiu, HUANG Sai, ZHANG Shisong. Early clinical application of “single-surgeon double-incision method” in video-assisted thoracoscopic surgery in the treatment of the children with extralobar sequestration [J]. Journal of Shandong University (Health Sciences), 2024, 62(1): 57-62.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd