脓毒症患者心率变异性与肌钙蛋白Ⅰ和预后关系的研究  

Relationship of heart rate variability and cardiac troponin I with the prognosis in septic patients

作　　者：牛开亚[1] 庞谊[1] 杨帆[1] 杨晓燕[1] 承解静[1] 

机构地区：[1]上海中医药大学附属普陀医院急诊内科,200062

出　　处：《中国急救医学》2011年第6期489-492,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨心率变异性（HRV）和肌钙蛋白Ⅰ（cardiac troponinⅠ，cTnI）在脓毒症患者中的相关性，以及在预后中的应用价值。方法回顾性分析我院急诊监护室（EICU）救治的95例脓毒症患者的临床资料，分析人院后24h内的HRV、cTnI及急性生理和慢性健康状况评分Ⅱ（APACHEⅡ），分别比较死亡组和生存组的HRV、cTnI和APACHEⅡ评分，分析三者的关系，采用受试者工作特征（ROC）曲线确定预测因素的界值。分析该界值对患者死亡的预测价值。结果死亡组HRV较生存组明显下降（P〈0．01），cTnI和APACHEⅡ评分较生存组明显升高（P〈0．01）。HRV与APACHEⅡ评分和cTnI呈负相关，APACHEⅡ评分≥21分、cTnI≥0．30μg／L、SDNN≤60ms、LF≤360ms和TF≤2500ms可预测脓毒症患者28d死亡。结论HRV特别是SDNN、LF和TF，可能是脓毒症患者住院期间死亡的预测因子。Objective To explore the relationship of heart rate variability （HRV） and cardiac troponin I with the prognosis in septic patients. Methods 95 septic patients in EICU were included in this study. Acute physiology and chronic health evaluation II （ APACHE II） was calculated and HRV was analyzed with both time - domain and frequency - domain methods in first 24 - hour in - hospital. Serum cardiac troponin I was measured. Spearman analysis was used to analyze the correlation between APACHE II , cTnI and HRV. Receiver operator characteristic curve （ROC）was used to determine the cutoff values. Results The mean levels of HRV were higher in survivors than in the dead 28 days （P〈0.01）. The mean levels of cTnI and APACHE II were higher in the dead than in survivors respectively（P 〈0.01）. APACHE II ≥21 ,cTnI≥0. 30 μg/L, SDNN ≤60 ms,LF≤360 ms and TF≤ 2500 ms were independent predictors of death. Conclusion Heart rate variability, especially the SDNN, LF and TF, may be used as valuable predictors of in - hospital mortality in the patients with sepsis.

关 键 词：脓毒症 心率变异性 肌钙蛋白Ⅰ 急性生理和慢性健康状况评分Ⅱ 

分 类 号：R[医药卫生]