心率变异性与脓毒血症病情严重程度的相关性分析  

Correlation analysis between heart rate variability and severity of sepsis

作　　者：张泽奎[1] 龙江超 张晓勤 ZHANG Zekui;LONG Jiangchao;ZHANG Xiaoqin(Department of Critical Medicine,People′s Hospital of Aba Tibetan and Qiang Autonomous Prefecture,Sichuan Province,Maerkang 624000,China;Department of Critical Medicine,Sichuan Academy of Medical Sciences Sichuan People′s Hospital,Sichuan Province,Chengdu 610072,China)

机构地区：[1]阿坝藏族羌族自治州人民医院重症医学科,四川马尔康624000 [2]四川省医学科学院四川省人民医院重症医学科,四川成都610072

出　　处：《中国医药导报》2020年第16期16-19,23,共5页China Medical Herald

基　　金：四川省干部保健科研课题项目(川干研2019-219)。

摘　　要：目的探讨心率变异性与脓毒血症病情严重程度以及预后的相关性。方法选择阿坝藏族羌族自治州人民医院2017年1月~2019年1月收治的98例脓毒症患者(观察组),根据急性生理学与慢性健康状况(APACHEⅡ)评分结果将观察组分为脓毒症组(0~10分,39例)、严重脓毒症组(11~20分,32例)和脓毒症休克组(>20分,27例)。并选择同期50名健康体检者(对照组)进行动态心电图检测,记录心率变异性参数[总体标准差(SDNN)、均值标准差(SDANN)、差值均方根(rrMSSD)、差值>50 ms百分比(PNN50)、低频功率(LF)、高频功率(HF)、LF/HF]。分析心率变异性参数与APACHEⅡ评分和预后相关性。结果观察组SDNN、LF、LF/HF低于对照组(P<0.05)。严重脓毒症组、脓毒性休克组SDNN、LF、LF/HF低于脓毒症组,且脓毒性休克组低于严重脓毒症组,差异有统计学意义(P<0.05)。SDNN、LF、LF/HF与APACHEⅡ评分呈负相关(r=-0.459、-0.367、-0.405,P<0.05)。SDNN、LF、LF/HF预测脓毒症患者预后的曲线下面积(AUC)分别为0.817、0.802、0.937。最佳截断值分别为95.21 ms、5.13 ms、0.41,灵敏度、特异性分别为0.807、0.895;0.645、0.881;0.871、0.940。结论心率变异性参数SDNN、LF、LF/HF与脓毒症病情严重程度和预后密切相关,可作为其预后预测的敏感指标。Objective To explore the correlation between heart rate variability and severity and prognosis of sepsis.Methods A total of 98 sepsis patients(observation group)admitted to People′s Hospital of Aba Tibetan and Qiang Autonomous Prefecture from January 2017 to January 2019 were selected,while according to acute physiology and chronic health evaluation(APACHEⅡ)score,the observation group was divided into sepsis group(0-10 scores,39 cases),severe sepsis group(11-20 scores,32 cases)and sepsis shock group(>20 scores,27 cases).A total of 50 healthy patients(control group)in the same period were selected for dynamic electrocardiogram.Heart rate variability parameters(standard deviation of normal-to-normal intervals[SDNN],standard deviation of averaged normal-to-normal intervals[SDANN],root of the mean square of successive differences[rMSSD],percentage of adjacent normal-to-normal intervals differing by more than 50 ms[PNN50],low frequency[LF],high frequency[HF],LF/HF)were recorded.The heart rate variability parameters,APACHEⅡscore and prognosis were analyzed.Results The SDNN,LF,LF/HF in the observation group were lower than those in the control group(P<0.05).The SDNN,LF,LF/HF in the severe sepsis group and septic shock group were lower than those in the sepsis group,while those in the septic shock group were lower than those in the severe sepsis group,and the differences were statistically significant(P<0.05).SDNN,LF,LF/HF were negatively correlated with APACHEⅡscore(r=-0.459,-0.367,-0.405,P<0.05).The area under the curve(AUC)of SDNN,LF,LF/HF to predict the prognosis of sepsis patients were 0.817,0.802,and 0.937,respectively.The best cutoff values were 95.21 ms,5.13 ms,and 0.41,while the sensitivity and specificity were 0.807 and 0.895;0.645 and 0.881;0.871 and 0.940,respectively.Conclusion Heart rate variability parameters SDNN,LF,LF/HF are closely related to the severity and prognosis of sepsis,which can be used as sensitive indicators for prognosis prediction.

关 键 词：心率变异性 脓毒血症 急性生理学与慢性健康状况评分 总体标准差 均值标准差 

分 类 号：R631[医药卫生—外科学]