| 摘要: |
| ［摘要］ 目的 分析自主神经功能对胃癌患者术后康复的影响。方法 回顾性分析2022年11月至2024年5月在南京中医药大学附属医院（江苏省中医院）普外科接受腹腔镜胃癌根治术的72例胃癌患者的临床资料。于患者入院后检测正常窦性心搏间期的标准差（SDNN）值以评估患者自主神经功能。根据术前第1天SDNN值将患者分为SDNN低值组（SDNN<102 ms，32例）和SDNN正常组（SDNN为102～180 ms，40例）。比较两组术后恢复情况和炎症指标。结果 SDNN正常组首次排气时间、首次进食流质饮食时间、术后拔除引流管时间早于SDNN低值组，术后住院天数少于SDNN低值组，差异有统计学意义（P<0.05）。两组术后第2天、第3天视觉模拟量表（VAS）评分低于术后第1天，SDNN正常组术后第3天VAS评分低于术后第2天，差异有统计学意义（P<0.05）。不同时间点两组VAS评分比较差异无统计学意义（P>0.05）。两组术后第1天和第3天白细胞（WBC）、超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）水平高于术前，两组术后第3天WBC水平低于术后第1天，差异有统计学意义（P<0.05）。术后第3天SDNN正常组WBC水平显著低于SDNN低值组（P<0.05）。结论 良好的自主神经功能有助于胃癌患者抵御手术应激，促进术后胃肠功能恢复，改善术后疼痛情况和炎症状态。SDNN有望成为一个术前预康复指标，评估患者术后康复状态，指导临床实践。 |
| 关键词: 胃癌 围术期 心率变异性 自主神经功能 加速康复外科 |
| DOI：10.3969/j.issn.1674-3806.2025.06.13 |
| 分类号: |
| 基金项目:中国医药教育协会“2022重大科学攻关问题和医药技术难题”课题（编号：2022KTZ005）；江苏省医学重点学科/实验室建设项目 |
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| Effect of autonomic nervous function on postoperative rehabilitation of gastric cancer patients |
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XU Pengyan, NAN Haiou, CAI Yuling, LI Jiayu, GE Miaomiao, WANG Gang, JIANG Zhiwei
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Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Province Hospital of Chinese Medicine), Nanjing 210009, China
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| Abstract: |
| ［Abstract］ Objective To analyze the effect of autonomic nervous function on postoperative rehabilitation of gastric cancer patients. Methods The clinical data of 72 patients with gastric cancer who received laparoscopic radical gastrectomy in Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Province Hospital of Chinese Medicine) from November 2022 to May 2024 were retrospectively analyzed. After admission, the standard deviation of normal-to-normal intervals(SDNN) values were detected to evaluate the patients′ autonomic nervous function. According to SDNN values on the first day before surgery, the patients were divided into low SDNN group(SDNN<102 ms, 32 patients) and normal SDNN group(SDNN: 102-180 ms, 40 patients). The postoperative recovery and inflammatory indicators were compared between the two groups. Results The time of first exhaust, the time of first consumption of liquid food, and the time of postoperative removal of drainage tube in the normal SDNN group was earlier than that in the low SDNN group, and the postoperative hospitalization days in the normal SDNN group were less than those in the low SDNN group, with statistically significant differences between the two groups(P<0.05). The Visual Analogue Scale(VAS) scores on the 2nd day and the 3rd day after surgery were lower than those on the 1st day after surgery in both groups, and the VAS scores on the 3rd day after surgery were lower than those on the 2nd day after surgery in the normal SDNN group, with statistically significant differences(P<0.05). There were no statistically significant differences in VAS scores between the two groups at different time points(P>0.05). The levels of white blood cell(WBC), high-sensitivity C-reactive protein(hs-CRP) and interleukin-6(IL-6) on the 1st day and the 3rd day after surgery were higher than those before surgery in both groups, and the levels of WBC on the 3rd day after surgery were lower than those on the 1st day after surgery in both groups, with statistically significant differences(P<0.05). The level of WBC on the 3rd day after surgery in the normal SDNN group was significantly lower than that in the low SDNN group(P<0.05). Conclusion Good autonomic nervous function helps gastric cancer patients resist surgical stress, promotes postoperative gastrointestinal function recovery, and improves postoperative pain and inflammatory state. SDNN is expected to become a preoperative pre-rehabilitation indicator to assess the postoperative rehabilitation status of the patients and guide clinical practice. |
| Key words: Gastric cancer Perioperative period Heart rate variability Autonomic nervous function Enhanced recovery after surgery |
