So Vincent, Klar Gregory, Leitch Jordan, McGillion Michael, Devereaux P J, Arellano Ramiro, Parlow Joel, Gilron Ian
Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
BMJ Open. 2021 Apr 13;11(4):e044949. doi: 10.1136/bmjopen-2020-044949.
Surgical interventions can elicit neuroendocrine responses and sympathovagal imbalance, ultimately affecting cardiac autonomic function. Cardiac complications account for 30% of postoperative complications and are the leading cause of morbidity and mortality following non-cardiac surgery. One cardiovascular parameter, heart rate variability (HRV), has been found to be predictive of postoperative morbidity and mortality. HRV is defined as variation in time intervals between heartbeats and is affected by cardiac autonomic balance. Furthermore, altered HRV has been shown to predict cardiovascular events in non-surgical settings. In multiple studies, experimentally induced pain in healthy humans leads to reduced HRV suggesting a causal relationship. In a different studies, chronic pain has been associated with altered HRV, however, in the setting of clinical pain conditions, it remains unclear how much HRV impairment is due to pain itself versus autonomic changes related to analgesia. We aim to review the available evidence describing the association between postsurgical pain and HRV alterations in the early postoperative period.
We will conduct a scoping review of relevant studies using detailed searches of MEDLINE and EMBASE, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Included studies will involve participants undergoing non-cardiac surgery and investigate outcomes of (1) measures of pain intensity; (2) measures of HRV and (3) statistical assessment of association between #1 and #2. As secondary review outcomes included studies will also be examined for other cardiovascular events and for their attempts to control for analgesic treatment and presurgical HRV differences among treatment groups in the analysis. This work aims to synthesise available evidence to inform future research questions related to postsurgical pain and cardiac complications.
Ethics review and approval is not required for this review. The results will be submitted for publication in peer-reviewed journals.
外科手术干预可引发神经内分泌反应和交感迷走神经失衡，最终影响心脏自主神经功能。心脏并发症占术后并发症的30%，是非心脏手术发病和死亡的主要原因。已发现一个心血管参数，即心率变异性（HRV），可预测术后发病和死亡情况。HRV定义为心跳之间时间间隔的变化，受心脏自主神经平衡影响。此外，HRV改变已被证明可预测非手术环境中的心血管事件。在多项研究中，健康人实验性诱导的疼痛会导致HRV降低，提示存在因果关系。在另一项研究中，慢性疼痛与HRV改变有关，然而，在临床疼痛情况下，尚不清楚HRV损害有多少是由于疼痛本身， versus与镇痛相关的自主神经变化。我们旨在综述现有证据，描述术后早期手术疼痛与HRV改变之间的关联。
我们将根据系统评价和Meta分析的首选报告项目，对MEDLINE和EMBASE进行详细检索，对相关研究进行范围综述。纳入的研究将涉及接受非心脏手术的参与者，并调查以下结果：（1）疼痛强度测量；（2）HRV测量；（3）对（1）和（2）之间关联的统计评估。作为次要综述结果，纳入的研究还将检查其他心血管事件，以及它们在分析中控制镇痛治疗和治疗组术前HRV差异的尝试。这项工作旨在综合现有证据，为未来与术后疼痛和心脏并发症相关的研究问题提供信息。
本综述无需伦理审查和批准。结果将提交至同行评审期刊发表。
