危重症患者心率变异的预后价值  

Prognostic values of heart rate variations and their predictions on outcomes in critical severe cases

作　　者：柴艳芬[1] 寿松涛[1] 崔书章[1] 刘洪斌[1] 王鑫[1] 张云强[1] 

机构地区：[1]天津医科大学总医院急救中心,300052

出　　处：《医师进修杂志》2005年第1期12-14,29,共4页Journal of Postgraduates of Medicine

摘　　要：目的　了解危重症患者心率变异 (HRV) ,分析其对预后的指导价值。方法　 12 3例患者住院 2 4h内行动态心电图检查 ,计算 5min短程和 2 4h长程HRV指数。按APACHEⅡ评分分为 0～ 9、10～ 19和 >2 0分三组。计算预测住院病死几率 (R) ,将病人分为R >0 .5组和R <0 .5组。比较各组间HRV指数差异 ,应用Logistic回归分析 ,了解HRV指数与预后关系。结果　APACHEⅡ>2 0分组、R >0 .5组、死亡组的VLF、LF、LF HF、RR5和SDNN、SDANN均显著降低 ,死亡组rMSSD5也降低 ,三组 2 4h平均心率明显升高。应用Logistic回归方程计算新的预测病死几率 (Pr)。以Pr>0 .5为病死风险增加标准 ,其预测敏感性高于R >0 .5组 ,预测特异性与R >0 .5组无差异 ,但高于APACHEⅡ >2 0分组。结论　危重症患者HRV指数变化和病情严重程度与预后有关。HRV分析与APACHEⅡ评分系统相结合可提高预测预后的敏感性和特异性。Objective To use heart rate variations (HRV) in analysing and judging critically ill patient′s prognosis. Methods All the patients were divided into three groups based on APACHEⅡ,score 0～9,10～19,>20.Computed predicted death rates (R),the R>0.5 was belong to one group,R<0.5 fall to another.The 24-hour holter were recorded within 24 hours.To compute 5-minute short-term and 24-hour long-term HRV and to compare the deference among the groups.Logistic regression was used to observe the relation between the indexes of HRV and prognosis of the patients. Results VLF,LF,LF/HF,RR 5 and SDNN,SDANN were significantly decreased in the patients with APACHEⅡ score>20,R>0.5 and death group.The mean HR was higher in the patients with APACHEⅡ score>20 or R>0.5.Besides the indexes above-mentioned,rMSSD 5 was also decreased in death group. To compute the risk (Pr) of fatality with the logistic regress equation.In the evaluation of prognosis,the sensitivity of Pr>0.5 and APACHEⅡ score>20 were higher than R>0.5,the specificity of Pr>0.5 and R>0.5 were higher than APACHEⅡ score>20. Conclusion When the APACHEⅡ score>20 or R>0.5, VLF,LF,LF/HF,RR 5 and SDNN,SDANN significantly decreased.The indexes of above significantly decreased in the deaths than that in survivors,rMSSD 5 decreased too.The mean HR is higher in the patients with APACHEⅡ score>20, R>0.5 and the deaths. In the indexes of HRV,HR and LF/HF have closely relation to prognosis,which combined with APACHEⅡsystem can improve the sensitivity and specificity of their prognosis evaluation.

关 键 词：HRV 危重症患者 心率变异 预后价值 APACHEⅡ评分 住院 死亡 差异 分组 增加 

分 类 号：R541[医药卫生—心血管疾病] R542[医药卫生—内科学]