Low SpO2 and myocardial ischemia within two days after operation in diabetic neuropathy patient.

众所周知，糖尿病患者与糖尿病性神经病变的发生率显著相关。近年来，糖尿病性神经病变引起的无症状性心肌缺血已成为一个研究热点。6例非糖尿病患者（对照组）和10例糖尿病患者（糖尿病组）接受全身麻醉参与本研究。麻醉前在手术室进行3项标准的无创自主神经测试（深周期呼吸时心率变化、Valsalva手法和头上倾斜）。自主神经功能障碍患者分为糖尿病自主神经功能障碍组（DM-AD（+）组），术后48小时行动态心电图和动脉血氧饱和度（SpO2）检查。采用动态心电图法研究心率变异性的频谱特征。（结果）本研究无低SpO2或心肌缺血（ST段抑制）患者。但DM-AD（+）组有1例（n=4）至少暂时呈T波阴性。本组患者HF值及LF/HF比值无明显变化。对照组术后第2天（POD） HF值（70.8±63.6 vs . 54.3±46.0ms^2）大于POD 1， DM-AD（+）组相对无变化。对照组POD2的LF/HF比值（2.34±1.02 vs . 3.26±1.78）小于对照组POD1， DM-AD（+）组差异无统计学意义。

It is well known that patients with diabetes are associated with significant rates of diabetic neuropathy. Recently asymptomalic myocardial ischemia induced by diabetic neuropathy is going to be a problem.Six nondiabetic patients (control group) and 10 diabetic patients (diabetic group) were scheduled to receive general anesthesia participated in this study. Three standard noninvasive autonomic tests (heart rate variation during deep period breathing, Valsalva maneuver and head-up tilt) were performed in each patient at operating theater before anesthesia. Patients with autonomic dysfunction by autonomic tests were categorized as diabetic autonomic dysfunction group (DM-AD (+) group) and they were undergoing to check holter-ECG and arterial oxygen saturation (SpO2) after 48 hours after surgery. Spectral characteristics of heart rate variability was investigated by holter-ECG.(Results) There are no patients with low SpO2 or myocardial ischemia (ST depression) in this study. But one patient of DM-AD (+) group (n=4) showed negative T wave at least temporarily. There were no significant change of HF value and LF/HF ratio in this study. HF value on postoperative days (POD) two was larger than that of POD 1 (70.8±63.6 v.s. 54.3±46.0ms^2) at control group, but relatively there was no change in DM-AD (+) group. LF/HF ratio on POD2 was smaller than that of POD1 (2.34±1.02 v.s. 3.26±1.78) at control group, but relatively there was no change in DM-AD (+) group.