Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies.
Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies.
复制标题
DOI：
10.1016/s0140-6736(10)62226-x
复制
发表时间：
2011-03-19
期刊：
影响因子：
168.9
通讯作者：
Mant, David
中科院分区：
文献类型：
--
作者：
Fleming, Susannah;Thompson, Matthew;Stevens, Richard;Heneghan, Carl;Plueddemann, Annette;Maconochie, Ian;Tarassenko, Lionel;Mant, David
虽然心率和呼吸率是在急性环境中对儿童进行常规测量的，但目前的参考范围并没有证据。本研究的目的是使用现有研究的系统综述数据推导出心率和呼吸率的新百分位数图表，并将其与现有的国际范围进行比较。我们检索了MEDLINE、EMBASE和CINAHL（截止2009年4月）以及参考文献列表，以确定测量出生至18岁正常儿童心率和/或呼吸率的研究。我们使用非参数核回归方法来创建心率和呼吸率随年龄变化的百分位数图表。我们比较了现有的参考范围与百分位数图表得出的参考范围。我们纳入了69项研究，其中59项提供了143，346名儿童的心率数据，20项提供了3，881名儿童的呼吸率数据。我们新的百分位数图表显示了从出生到青春期早期的呼吸频率下降，两岁以下的婴儿下降最明显;从出生时的中位数44次/分钟下降到两岁时的26次/分钟。心率百分位数图显示在一个月龄时出现一个小峰值。平均心率从出生时的127次/分钟增加到大约一个月大时的145次/分钟，然后在两岁时下降到113次/分钟。将百分位数图表与现有已发表的心率和呼吸率参考范围进行比较，结果显示与百分位数图表存在显著差异，已发表范围的限值经常超过第99和第1百分位数，或超过中位数。我们的回顾表明，现有的儿童心率和呼吸率的国际指南并没有证据为基础。我们已经创建了一个新的百分位数图表的基础上，系统审查的研究，测量这些生命体征在正常儿童。临床和复苏指南应根据这些循证参考范围进行更新。由国家卫生研究所资助的研究项目为应用研究“初级保健中新诊断程序和技术的开发和实施”提供赠款。SF由工程和物理科学研究理事会和国家卫生研究所生物医学研究中心方案资助。
Although heart rate and respiratory rate are routinely measured in children in acute settings, current reference ranges are not evidence-based. The aim of this study is to derive new centile charts for heart rate and respiratory rate using systematic review data from existing studies, and to compare these with existing international ranges. We searched MEDLINE, EMBASE, and CINAHL to April 2009, and reference lists to identify studies which had measured heart rate and/or respiratory rate in normal children between birth and 18 years of age. We used a non-parametric kernel regression method to create centile charts for heart rate and respiratory rate with respect to age. We compared existing reference ranges with those derived from the centile charts. We included 69 studies, 59 of which provided data on the heart rate of 143,346 children, and 20 on the respiratory rate of 3,881 children. Our new centile charts demonstrate the decline in respiratory rate from birth to early adolescence, with the steepest decline apparent in infants under two years; decreasing from a median of 44 breaths/minutes at birth to 26 breaths/minute at the age of two. The heart rate centile chart demonstrates a small peak at one month of age. The median heart rate increases from 127 beats/minute at birth to a maximum of 145 beats/minute at approximately one month of age, before decreasing to 113 beats/minute by the age of two. Comparison of the centile charts with existing published reference ranges for heart rate and respiratory rate show marked disagreement with the centile charts, with limits from published ranges frequently exceeding the 99th and 1st centiles, or crossing the median. Our review shows that existing international guidelines for heart rate and respiratory rate in children are not based on evidence. We have created new centile charts based on a systematic review of studies which have measured these vital signs in normal children. Clinical and resuscitation guidelines should be updated in the light of these evidence-based reference ranges. Research funded by the National Institute for Health Research programme grant for applied research ‘Development and implementation of new diagnostic processes and technologies in primary care’. SF was funded by the Engineering and Physical Sciences Research Council and the National Institute for Health Research Biomedical Research Centre Programme.