围手术期多维度数字化监测平台在胃癌患者中的应用价值
Application value of a multi‑dimensional digital monitoring platform for perioperative period in gastric cancer patients
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摘要:目的 探讨围手术期多维度数字化监测平台在胃癌患者中的应用价值。方法 采用回顾性队列研究方法。收集2022年7月至2024年1月南京中医药大学附属医院收治的50例行腹腔镜胃癌根治术患者的临床资料;男35例,女15例;年龄为(64±12)岁。所有患者遵循加速康复外科理念,采用以穿戴式监测设备为基础的围手术期多维度数字化监测平台实施围手术期管理措施。观察指标:(1)心率变异性(HRV)监测结果。(2)血糖和血氧监测结果。(3)运动和睡眠监测结果。(4)人体成分监测结果。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(IQR)表示。重复测量数据采用重复测量方差分析,偏态分布的计量资料通过SPSS转换功能转换为正态分布资料后再进行检验。手术前后比较,正态分布的计量资料采用配对样本t检验,偏态分布的计量资料采用非参数Wilcoxon符号秩和检验。结果 (1)HRV监测结果。HRV指标中,从术前至术后第3天,50例患者NN间期标准差从(103±26)ms变化为(101±36)ms,每5min NN间期标准差的平均值从(45±16)ms变化为(33±12)ms,相邻NN间期之差>50 ms的心搏数占NN间期心搏总数的百分比从6.02% (4.96%)变化为5.79%(4.20%),低频功率从376.78(468.96)ms2变化为742.79(525.20)ms2,高频功率从273.61(273.58)ms2变化为397.48(164.87)ms2,低频功率与高频功率之比从1.6±0.5变化为1.6±0.6,上述指标手术前后比较,差异均有统计学意义(F=34.43,26.15,24.58,5.51,6.11,6.02,P<0.05)。(2)血糖和血氧监测结果。从术前至术后第3天,50例患者血糖从6.75(2.05)mmol/L变化为6.90(2.63)mmol/L,手术前后比较,差异有统计学意义(F=45.84,P<0.05);血氧从97.00%(5.00%)变化为97.5%(3.00%),手术前后比较,差异无统计学意义(F=2.25,P>0.05)。(3)运动和睡眠监测结果。从术前至术后第3天,50例患者运动步数从3 043(1 224)步变化为1 473(767)步,睡眠时长从(8.2±1.1)h变化为(7.3±0.8)h、睡眠评分从(80±10)分变化为(78±5)分,上述指标手术前后比较,差异均有统计学意义(F=716.46,29.02,47.32,P<0.05)。(4)人体成分监测结果。手术前后,50例患者体质量从(63±8)kg变化为(61±8)kg,体脂率从24%±8%变化为22%±9%、肌肉量从43(12)kg变化为41(17)kg,体质量指数从(23.0±2.6)kg/m2变化为(22.1±2.5)kg/m2,手术前后比较,差异均有统计学意义(t=8.19,3.00,Z=-2.78,t=7.34,P<0.05);基础代谢从(1 390±134)kcal变化为(1 379±139)kcal,手术前后比较,差异无统计学意义(t=1.02,P>0.05)。结论 围手术期多维度数字化监测平台应用于胃癌患者能精准监测围手术期应激水平和评估术后康复状态,并呈现可视化结果。Abstract:Objective To investigate the application value of a multi‑dimensional digital moni-toring platform for perioperative period in gastric cancer patients.Methods The retrospective cohort study was conducted. The clinical data of 50 patients who underwent laparoscopic radical gastrec-tomy in The Affiliated Hospital of Nanjing University of Chinese Medicine from July 2022 to January 2024 were collected. There were 35 males and 15 females, aged (64±12)years. All patients followed the concept of enhanced recovery after surgery, and the multi‑dimensional digital monitoring platform based on wearable monitoring equipment was used to implement perioperative management measures. Observation indicators: (1) results of heart rate variability (HRV) monitoring; (2) results of blood glucose and blood oxygen monitoring; (3) results of exercise and sleep monitoring; (4) results of body composition monitoring. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(IQR). Repeated measurement data were analyzed using the repeated ANOVA. Measurement data with skewed distri-bution were transformed to normal distribution by SPSS transformation function before testing. For comparison between pre‑ and postoperation, paired sample t test was used for measurement data with normal distribution, and nonparametric Wilcoxon signed rank sum test was used for measure-ment data with skewed distribution.Results (1) Results of HRV monitoring. From preoperation to the third day after surgery, the standard deviation normal to normal heart beat of 50 patients was changed from(103±26)ms to(101±36)ms, the mean of the standard deviations of normal to normal heart beat calculated per 5 min segment was changed from (45±16)ms to(33±12)ms, the number of pairs of adjacent NN intervals differing by more than 50 ms in the entire recording was changed from 6.02%(4.96%) to 5.79%(4.20%), the low frequency power was changed from 376.78(468.96)ms2 to 742.79(525.20)ms2, the high frequency power was changed from 273.61(273.58)ms2 to 397.48(164.87)ms2, the ratio of low frequency power to high frequency power was changed from 1.6±0.5 to 1.6±0.6, showing significant differences in above indicators before and after operation (F=34.43, 26.15, 24.58, 5.51, 6.11, 6.02, P<0.05). (2) Results of blood glucose and blood oxygen monitoring. From preoperation to the third day after surgery, the blood glucose of 50 patients was changed from 6.75(2.05)mmol/L to 6.90(2.63)mmol/L, showng a significant difference before and after operation (F=45.84, P<0.05). The blood oxygen was changed from 97.00%(5.00%) to 97.50%(3.00%), showing no significant difference before and after operation (F=2.25, P>0.05). (3) Results of exercise and sleep monitoring. From preoperation to the third day after surgery, the number of steps fo 50 pati-ents was changed from 3 043(1 224) to 1 473(767), sleep duration was changed from(8.2±1.1)hours to(7.3±0.8)hours, sleep score was changed from 80±10 to 78±5,showing significant differences in above indicators before and after operation (F=716.46, 29.02, 47.32,P<0.05).(4) Results of body composition monitoring. The body weight of 50 patients was changed from (63±8)kg to(61±8)kg before and after operation, body fat rate was changed from 24%±8% to 22%±9%, muscle mass was changed from 43 (12)kg to 41(17)kg, body mass index was changed from (23.0±2.6)kg/m2 to(22.1±2.5)kg/m2, showing significant differences in above indicators before and after operation (t=8.19, 3.00, Z=-2.78, t=7.34, P<0.05), while there was no significant difference in basal metabolic indicators from (1 390±134)kcal to (1 379±139)kcal before and after operation (t=1.02, P>0.05).Conclusion The multi‑dimensional digital monitoring platform for preoperative period can accurately monitor the perioperative stress level and evaluate the postoperative recovery of gastric cancer patients, which can present the visual results.