Heart-Rate Complexity for Prediction of Prehospital Lifesaving Interventions in Trauma Patients
Heart-Rate Complexity for Prediction of Prehospital Lifesaving Interventions in Trauma Patients
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DOI：
10.1097/ta.0b013e3181848241
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发表时间：
2008-10-01
影响因子：
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通讯作者：
Holcomb, John B.
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文献类型：
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作者：
Cancio, Leopoldo C.;Batchinsky, Andriy I.;Holcomb, John B.
背景：传统的生命体征往往不能及时识别重伤患者，不能及时进行干预。为了提高我们预测院前救生干预(LSI)需求的能力，我们将心率复杂性(HRC)分析应用于前往创伤中心的患者的心电(ECG)。方法：对374名乘坐直升机前往3个城市I级创伤中心的患者的心电和临床数据进行分析。182例患者的波形被排除(由于异位、噪声或长度不足)。在其余192例患者中，54例在现场接受了66例LSI(LSI组)：插管(n=52)、心肺复苏(n=5)、环甲切开(n=2)和气胸减压术(n=7)；138例未接受LSI(非LSI组)。在野外记录心率、血压、格拉斯哥昏迷量表评分(GCS(总))及其运动成分(GCS(运动))。在飞行过程中记录心电图。结果：LSI患者的心率和血压与非LSI患者无明显差异。LSI组SampEn(0.88±-0.03vs.1.11+/-0.03)、DFA(1.09+/-0.05vs.1.33+/-0.03)和GCS(3.40+/-0.4vs.5.7+/-0.1)均低于非LSI组(P均<0.000)。经Logistic回归分析，SampEn、DFA和GCS(运动)与LSIS(受试者工作特征曲线下面积，0.897)独立相关。结论：院前创伤患者HRC降低与LSIS有关。HRC可作为一种新的生命体征用于严重伤者的鉴定。
Background: Traditional vital signs often fail to identify critically injured patients soon enough to permit timely intervention. To improve our ability to forecast the need for prehospital lifesaving interventions (LSIs), we applied heart-rate complexity (HRC) analysis to the electrocardiogram (ECG) of patients en route to trauma centers.Methods: Analysis of ECG and clinical data from 374 patients en route by helicopter to three urban Level I trauma centers was conducted. Waveforms from 182 patients were excluded (because of ectopy, noise, or inadequate length). Of the remaining 192 patients, 54 received 66 LSIs in the field (LSI group): intubation (n = 52), cardiopulmonary resuscitation (n = 5), cricothyroidotomy (n = 2), and pneumothorax decompression (n = 7); 138 patients did not (non-LSI group). In the field, heart rate, blood pressure, and the Glasgow Coma Scale score (GCS(TOTAL)) and its motor component (GCS(MOTOR)) were recorded. ECG was recorded during flight. Ectopy-free, 800-beat sections of ECG were identified off-line and analyzed by HRC methods including Sample Entropy (SampEn) and Detrended Fluctuations Analysis (DFA).Results: There was no difference between LSI and non-LSI patients in heart rate or blood pressure. SampEn was lower in LSI than in non-LSI (0.88 +/- 0.03 vs. 1.11 +/- 0.03), as was DFA (1.09 +/- 0.05 vs. 1.33 +/- 0.03) and GCS(MOTOR) (3.4 +/- 0.4 vs. 5.7 +/- 0.1) (all p < 0.000 1). By logistic regression, SampEn, DFA, and GCS(MOTOR) were independently associated with LSIs (area under the receiver operating characteristic curve, 0.897).Conclusions: Decreased HRC is associated with LSIs in prehospital trauma patients. HRC may be useful as a new vital sign for identification of the severely injured.