心臟手術對心率變異的影響及其與生活品質的相關性

目的：本前瞻性研究探討心率變異在心臟手術前後的改變及其與生活品質之相關性。方法：本研究於某區域醫院收集心臟手術21位個案，於手術前、後及手術一個月後測量心電圖，並於第三次測量同時填寫生活品質問卷。取得之心電圖以藍芽上傳後分析三次測量中心率變異指標之R-R間隔標準差（SDNN）、高頻功率（HF）、低頻功率（LF）、低頻功率比（LF%）及低高頻比值（LF/HF）之差異，同時分析心率變異與生活品質之相關性。結果：心臟手術後心率變異之SDNN、LF、LF%有顯著下降；手術一個月後SDNN有顯著上升，但與手術前比較則無顯著差異；術後一個月之SDNN、LF、LF%、LF/HF與生活品質之心理範疇有顯著正相關。結論：心臟手術後整體心率變異下降，而在一個月後心率變異略有恢復主要來自交感神經的復原。手術後心理範疇得分最低，與手術後副交感神經活性未恢復可能有關。心率變異分析的客觀數據也可以反映心臟手術後病患心理層面之主觀感受。

關鍵字

心臟手術；心率變異性；生活品質；心理範疇

並列摘要

Objectives: The purpose of this study is to explore the changes in HRV before and after cardiac surgery and the relationship between HRV and quality of life. Methods: A total of 21 patients who received cardiac surgery were included in this study. All cases were conducted with a five-minute ECG uploaded by a Bluetooth signal three times. The ECGs were measured before the operation (1st), after the operation (2nd), and one month after the operation (3rd). The parameters of HRV included: standard deviation of normal to normal (SDNN), low frequency (LF), high frequency (HF), normalized low frequency (LF %), and LF/HF. In the third ECG measurement, the patients were also required to answer the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) in the concise Taiwanese version. The parameters of HRV were analyzed with Wilcoxon signed ranked test. The Spearman correlation test analyzed the correlations between the parameters of HRV and quality of life. Results: Compared with the 1st ECG measurement, the SDNN, LF, and LF% decreased significantly in the 2nd ECG. There was a significant increase in SDNN in the 3rd ECG, but there was no significant difference compared with the 1st ECG. There was a significant positive correlation between HRV and the psychological category of quality of life. Conclusions: Heart rate variability decreased after cardiac surgery, and the slight recovery of heart rate variability one month after surgery was mainly due to the recovery of sympathetic nerves. The psychological category of quality of life after surgery received the lowest score, which may be related to the incomplete recovery of parasympathetic nerve activity after surgery. The objective data of heart rate variability analysis can reflect the subjective psychological category of patients after heart surgery.

並列關鍵字

cardiac surgery ； heart rate variability ； quality of life ； psychological category

參考文獻

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