【摘要】 目的探讨老年糖尿病(DM)患者手术前后心脏自主神经功能变化与无症状性心肌缺血(SMI)的关系。方法选择择期非心脏手术老年患者54例,其中非DM患者18例(NDM组),DM患者16例(DM组),DM合并SMI患者20例(SMI组)。监测3组患者心率变异性的变化,包括总功率(TP)、高频功率(HF)、低频功率(LF)、极低频功率(VLF)及LF/HF。结果与NDM组比较,DM组及SMI组术前TP、HF显著降低(P<0.05)。3组术后TP、HF、LF及VLF总的趋势是降低,其中SMI组下降最为明显。术后1天,SMI组TP、HF及VLF与术前比较明显降低,TP、HF、LF及VLF与NDM组差异明显(P<0.01,P<0.05),HF和VLF与DM组差异明显(P<0.05)。术后2天,除DM组LF外,3组TP、HF、LF及VLF分别与术前形成明显差异(P<0.05,P<0.01)。结论DM患者合并有心脏自主神经病变,手术应激引起机体自主神经调节心脏功能的进一步紊乱,是造成DM患者围手术期SMI高发的重要原因。更多还原

【Abstract】 Objective To investigate the relationship between pre-and post-operative cardiac autonomic nervous functions and silent myocardial ischemia(SMI) in elderly patients with diabetes mellitus.Methods Fifty-four elderly patients undergoing elective non-cardiac surgery were assigned to three groups:non-diabetes group(NDM,n=18),diabetes mellitus without myocardial ischemia group(DM,n=16) and diabetes mellitus with SMI group(SMI,n=20).Heart rate variability of the three groups was observed,including total power(TP),high frequency power(HF),low frequency power(LF),very low frequency power(VLF) and LF/HF.Results Compared with NDM group,TP and HF were significantly decreased(P<0.05) in DM group and SMI group in the preoperative period.After surgery,TP,HF,LF and VLF in three groups tended to decrease and the SMI group was most significant.On the first postoperative day,TP,HF and VLF in SMI group were significantly decreased as compared with the preoperative values(P< 0.05);TP,HF,LF and VLF were significantly lower(P< 0.01 and <0.05,respectively) in SMI group than in NDM group;HF and VLF was significantly lower(P<0.05) in SMI group than in DM group.On the second postoperative day,except LF in DM group,TP,HF,LF and VLF in three groups decreased significantly as compared with preoperative values(P<0.05 or P< 0.01).Conclusion The cardiac autonomic nervous function was impaired in diabetic patients,anesthesia and surgery aggravate the disturbances.This is an important cause of perioperative SMI in diabetic patients.更多还原