全身炎症反应综合征患者心率变异与预后的关系  

Relationship between heart rate variability and prognosis in patients with systemic inflammatory response syndrome

作　　者：许丽[1] 李春盛[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京100020

出　　处：《中华急诊医学杂志》2006年第10期917-920,共4页Chinese Journal of Emergency Medicine

摘　　要：目的评价全身炎症反应综合征(SIRS)患者的自主神经活动,了解心率变异(HRV)与SIRS患者病情严重程度、脏器受损程度以及预后的关系。方法用24h动态心电图监测分析100例SIRS组患者和30例非SIRS组患者及30例正常对照组患者的HRV时域指标及频域指标。结果①SIRS组与非SIRS组相比,APACHEⅡ评分、MODS评分明显升高(P＜0．01),HRV下降(P＜0．05)。②SIRS亚组中生存组与死亡组相比,后者APACHEⅡ评分、MODS评分明显升高(P＜0．01),HRV下降(P＜0．01)。③患者预后与SDNN呈负相关,相关系数r=-4．68,P＜0．01；SDNN＜55ms预测SIRS患者的敏感性、特异性、阳性预测值和阴性预测值最高(分别为76．2%、76．7%、90．4%、52．6%)。结论①SIRS患者HRV明显降低,且与疾病严重程度,及脏器功能受损程度呈负相关,与预后呈负相关。②HRV可以作为评价SIRS患者预后的有用指标。Objective To study the autonomic nervous regulation function, and to study relationship between heart rate variability and severity, organ dysfunction and prognosis in patients with systemic inflammatory response syndrome （SIRS）. Methods All the patients were divided into two groups： SIRS and non-SIRS according to the criteria of SIRS. The SIRS group included 100 patients and the non-SIRS group 30 patients, and the control group included 30 heathy adults. SIRS group was further divided into two subgroups： survivor and succumbed. Heart rate variability （HRV） was analyzed with the two methods of time-domain and frequency-domain. Results The SIRS group had significantly higher APACHEⅡ scores and MODS scores （ P 〈 0.01） and lower HRV when compared with the non-SIRS group （ P 〈 0.05）. In the SIRS group, the succumbed groupallad statistically higher APACHEII and MODS scores and lower HRV than the survivor group （ P 〈 0.01 ）. There was a negative correlation between the prognosis of the patients and SDNN （ r = - 4.68, P 〈 0.01 ）, SDNN 〈 55 ms was the most sensitive （76.2%）, and specific （76.7%）, with positive predictive value （90.4%） and negative predictive value （52.6%）. Conlusion The SIRS patients had lower HRV, and there was a negative correlations with the severity of disease, organ dysfunction and prognosis. HRV （SDNN） were the useful index to evaluate the prognosis of critically ill patients.

关 键 词：全身炎症反应综合症 多脏器功能障碍综合症 心率变异 

分 类 号：R459.7[医药卫生—急诊医学]