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Abstract：
Introduction This study aimed to evaluate hemodynamic changes using heart rate variability (HRV) measurements in diabetic and nondiabetic patients who will undergo laparoscopic cholecystectomy and to provide our preoperative measurements to guide us for better perioperative anesthesia management. Materials and methods The study included 143 patients aged 40 years and older who would undergo elective laparoscopic surgery, did not have any comorbidities other than diabetes mellitus (DM) type II, and were in the American Society of Anesthesiologists (ASA) class I-III risk group. Patients were divided into two groups: the control group (n = 77) and the DM group (n = 66). The preoperative glycated hemoglobin (HbA1C) level was measured. Peripheral oxygen saturation (SpO2) and hemodynamic parameters such as systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and HRV parameters were measured preoperatively, perioperatively, and postoperatively. Intra-abdominal pressure (IAP) was administered at 10-12 mmHg. Results Even though SAP, DAP, MAP, and HR decreased with induction, they increased with insufflation, and an overall decrease was seen at the postoperative 24th hour for all parameters. When the groups were evaluated, no difference was observed except that the DAP was significantly lower in the DM group (p = 0.029) at insufflation and the HR was higher in the DM group at induction, and the difference was significant (p = 0.001). Preoperative HRV parameters were significantly lower in the DM group. According to the HRV parameters, although a decrease was observed after induction and insufflation, conversely, an increase was observed postoperatively. When the postoperative and preoperative values were compared, the standard deviation of the NN (R-R) intervals (SDNN), SDNN index, high frequency (HF), low frequency (LF), and LF/HF parameters were found to be significantly lower in the DM group than in the control group. Conclusion Diabetic patients are more sensitive to increased intra-abdominal pressure (IAP) in laparoscopic surgery, and the effects on cardiac autonomic functions can be determined by HRV measurements without clinically reflecting on hemodynamic data. Additionally, in diabetic patients with preoperative LF and/or HF values less than 100, we believe that careful follow-up in terms of autonomic neuropathy complications and anesthesia management should be done more meticulously in these patients.
摘要：
简介本研究旨在使用心率变异性（HRV）测量来评估将接受腹腔镜胆囊切除术的糖尿病和非糖尿病患者的血液动力学变化，并提供我们的术前测量结果，以指导我们更好的围手术期麻醉管理。材料和方法该研究包括143例40岁及以上的患者，这些患者将接受择期腹腔镜手术，除II型糖尿病（DM）外，没有任何合并症，并且属于美国麻醉医师协会（ASA）I-III级风险组。将患者分为两组：对照组（n=77）和DM组（n=66）。测量术前糖化血红蛋白（HbA1C）水平。外周血氧饱和度（SpO2）和血流动力学参数，如收缩压（SAP），舒张压（DAP），平均动脉压(MAP),心率(HR),术前测量HRV参数，围手术期，和术后。腹内压(IAP)以10-12mmHg施用。结果即使SAP，DAP,MAP,HR随着诱导而下降，它们随着吹气而增加，术后24小时观察到所有参数的总体下降。当小组被评估时，没有观察到的差异，除了DAP显着降低DM组（p=0.029）在吹入和HR在DM组更高，在诱导。差异显著(p=0.001)。DM组术前HRV参数显著降低。根据HRV参数，虽然在诱导和吹气后观察到下降，相反,术后观察到增加。当术后和术前的值进行比较时，NN(R-R)间隔(SDNN)的标准偏差，SDNN索引,高频(HF),低频（LF），发现DM组的LF/HF参数显着低于对照组。结论糖尿病患者在腹腔镜手术中对腹内压升高更为敏感,对心脏自主神经功能的影响可以通过HRV测量来确定，而无需临床反映血液动力学数据。此外,对于术前LF和/或HF值小于100的糖尿病患者,我们认为,在自主神经病变并发症和麻醉管理方面,应更细致地进行仔细随访.
