Characteristics of heart rate variability can predict impending septic shock in emergency department patients with sepsis
Characteristics of heart rate variability can predict impending septic shock in emergency department patients with sepsis
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DOI：
10.1197/j.aem.2006.12.015
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发表时间：
2007-05-01
影响因子：
4.4
通讯作者：
Kuo, Cheng-Deng
中科院分区：
文献类型：
--
作者：
Chen, Wei-Lung;Kuo, Cheng-Deng
目的：确定心率变异性 (HRV) 测量是否可用于预测急诊科 (ED) 中哪些脓毒症患者将进展为脓毒症休克。方法：作者前瞻性地纳入了符合 2001 年国际脓毒症定义会议脓毒症标准并在六个月内到一所大学教学医院的 ED 就诊的连续患者。除了脓毒症检查外，还同时进行连续 10 分钟的心电图记录。 HRV 测量值是离线计算的，并与患者的结果相关。结果：纳入了 81 名年龄在 30-84 岁且符合纳入标准的患者。根据 6 小时内的结果，将患者分为无感染性休克患者 (n = 60) 和感染性休克患者 (n = 21)。感染性休克组的基线均方根逐次差值、高频功率和归一化高频功率均显着高于非感染性休克组。感染性休克组的低频功率、归一化低频功率、低频/高频功率比均显着低于非感染性休克组。多元逻辑回归分析确定均方根连续差是脓毒症 ED 患者即将发生脓毒性休克的最佳预测因子。结论：HRV 测量可用于识别脓毒症 ED 患者即将发生脓毒性休克。在这些HRV指标中，均方根连续差值似乎是预测感染性休克发生的最佳指标。
Objectives: To determine whether heart rate variability (HRV) measures can be used to predict which septic patients in the emergency department (ED) will progress to septic shock.Methods: The authors prospectively enrolled consecutive patients who met the 2001 International Sepsis Definitions Conference criteria of sepsis and visited the ED of a university teaching hospital over a six-month period. In addition to the septic workup, a continuous 10-minute electrocardiogram recording was performed at the same time. The HRV measures were calculated off-line and correlated with the outcome of the patients.Results: Eighty-one patients aged 30-84 years who met the inclusion criteria were enrolled. The patients were classified as those with no septic shock (n = 60) and those with septic shock (n = 21), according to their outcome within six hours. The baseline root mean square successive difference, high-frequency power, and normalized high-frequency power of the septic shock group were significantly higher than those of the no septic shock group. The low-frequency power, normalized low-frequency power, and low-/high-frequency power ratio of the septic shock group were significantly lower than those of the no septic shock group. Multiple logistic regression analysis identified root mean square successive difference as the best predictor of impending septic shock for septic ED patients.Conclusions: HRV measures may be used to identify septic ED patients with impending septic shock. Among those HRV measures, root mean square successive difference seems to be the best indicator to predict the occurrence of septic shock.