ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2020, 5(4): 222–228
Clinical Medicine

Vegetative Status in Extrahepatic Cholestasis in Patients with Cholelitiasis according to the Results of Heart Rate Variability Analysis (PRECISE Diagnostics)

Shevchenko B.F., Zeleniuk O.V., Zyhalo E.V., Prolom N.V., Babii O.M.

The purpose of the study was to assess the autonomic status, adaptive potential and level of stress resistance in terms of heart rate variability in extrahepatic cholestasis in patients with complications of cholelithiasis. Material and methods. We examined 46 patients with extrahepatic cholestasis who were treated in the Department of Surgery of the Digestive System of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine for the period from 2013 to 2019. There were the following complications of cholelithiasis: chronic calculous cholecystitis in 4 patients, chronic calculous cholecystitis with choledocholitis in 12 patients, calculous cholecystitis with stenotic papillitis (stages 1, 2, 3) in 30 patients. Manifestations of extrahepatic cholestasis were established with the help of biochemical studies, ultrasound, and MRCP data. Depending on the nature of the extrahepatic cholestasis, patients were divided into groups. Group I consisted of 16 patients with extrahepatic cholestasis on the background of functional biliary disorders with Oddi sphincter dysfunction; group II included 30 patients with extrahepatic cholestasis on the background of stenotic papillitis (stages 1, 2, 3) with choledocholithiasis in 12 patients. Extrahepatic cholestasis was evaluated based on the results of PRECIZE diagnostics (cloud automated interpretation technology) using a CONTECT 8000GW electrocardiograph (China) with a bluetooth connection and software. To interpret the ECG results, a connection was made to the AMAZON web service. The following indicators were analyzed: sympathetic-vagal balance HF / LF to determine autonomic tone, stress index, RMSSD – the square root of the mean square of the difference of the values of successive pairs of intervals NN, which estimates the level of adaptation (quantification of depletion of adaptation reserves); stress index. Results and discussion. In the examined patients, the average values of the RMSSD index characterizing the adaptive capacity of the organism were within norm, but with a probable decrease in this indicator in patients of group II it was (35.1±4.6) m/s compared with the patients of group I (51.5±5.3) m / s (p <0.05). The analysis of the obtained data revealed that the first group was dominated by patients with normal adaptation (62.5%). The majority of patients in group II (83.3%) showed signs of maladaptation (failure of adaptation) with a decrease in RMSSD to (7.8±2.9) m / s (p <0.05), which indicated a weakening of parasympathetic effects on heart rhythm with possible subsequent complications of the disease in these patients. Our studies showed that most patients with extrahepatic cholestasis and functional biliary disorders (dysfunction) activation of the sympathetic autonomic nervous system, in contrast to patients with extrahepatic cholestasis with stenotic papillitis, who in the spectrum of identified autonomic nervous system disorders, had vagotonia (50.0%) with a decrease in sympatho-vagal balance by 0.48±0.14, and moderate sympathicotonia in 43.3% of patients with an increase in the ratio of LF / HF by 2.1±0.7 (p <0.05). Conclusion. Assessment of heart rate variability using PRECIZE diagnostics is a highly informative, convenient method, which allows assessing the state of the autonomic nervous system, adaptive capacity of the body in surgical patients, including the severity of stress, and can be recommended for use in screening differential diagnosis of functional and organic disorders in surgical patients with extrahepatic cholestasis on the background of complications of cholelithiasis.

Keywords: biliary tract, diagnosis, dysfunction, stenotic papillitis, gallstone disease

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