Novel method to quantify loss of heart rate variability in pediatric multiple organ failure*
Novel method to quantify loss of heart rate variability in pediatric multiple organ failure*
复制标题
量化小儿多器官衰竭心率变异性损失的新方法*
作者：
S. Tibby;H. Frndova;A. Durward;P. Cox
目的建立一个测量心率变异性（HRV）的幂律模型，并与已建立的测量一组器官衰竭（OF）儿童HRV的方法进行比较。设计前瞻性、观察性研究。单位：某三级儿童医院儿科重症监护室。50例患者（中位年龄8个月，范围2天至16岁）共进行了104次测量，并根据同时器官衰竭的数量分为三组：0-1个OF，2个OF和≥3个OF。干预当患者血流动力学稳定时，在5分钟内记录心率。幂律模型表示将频率分布与效应幅度（在这种情况下，与平均心率的平方偏差）相关联的幂函数。在双对数标度上绘制数据，为每个测量值生成回归线，以r2、斜率和x截距描述。与其他HRV测量方法的比较包括两种时域测量方法（正常R-R间期的标准差和连续正常R-R间期均方差的平方根），一种频域方法（功率谱分析）和一种非线性方法（去趋势波动分析）。测量和结果对于幂律模型，患者表现出相似的r2为0.87（0.09）（平均值[sd]）和斜率为-1.80（0.29），无论OF的程度如何。因此，HRV可以纯粹用x截距来描述，这表明随着OF的增加而左移（p < .001）。这与年龄和心率无关。所有方法都证明了随着OF增加HRV的损失;然而，只有幂律模型能够区分每个OF组。使用该模型，个别患者连续几天的HRV变化往往与OF状态的变化定性一致。结论幂律模型对儿童心率变异性无年龄和心率敏感性，是一种较为合适的测量方法。HRV的损失随着OF的增加而发生;与HRV的其他测量相比，该模型更好地证明了这种效果。
ObjectiveTo develop a power-law model for measurement of heart rate variability (HRV) and to compare this model with established methods for measuring HRV in a group of children with organ failure (OF). DesignProspective, observational study. SettingPediatric intensive care unit of a tertiary children’s hospital. PatientsA total of 104 measurements were made on 50 patients (median age, 8 months; range, 2 days to 16 yrs) and categorized into three groups according to the number of simultaneous organs failing: 0–1 OF, 2 OF, and ≥3 OF. InterventionsHeart rate was recorded over a 5-min period when patients were hemodynamically stable. The power-law model represents a power function relating frequency distribution to magnitude of effect (in this case, squared deviation from the mean heart rate). Plotting the data on a bi-logarithmic scale produces a regression line for each measurement, described in terms of r2, slope, and x-intercept. Comparison with other HRV measures included two time-domain measures (sd of the normal R-R intervals and the square root of the mean squared differences of successive normal R-R intervals), one frequency-domain method (power spectral analysis), and one nonlinear method (detrended fluctuation analysis). Measurements and ResultsFor the power-law model, patients exhibited a similar r2 of .87 (.09) (mean [sd]) and slope of −1.80 (0.29), regardless of the degree of OF. HRV could thus be described purely in terms of x-intercept, which demonstrated a left shift with increasing OF (p < .001). This was independent of age and heart rate. Loss of HRV with increasing OF was demonstrated by all methods; however, only the power-law model was able to discriminate between each OF group. Using the model, change in HRV in individual patients over successive days often concurred qualitatively with the change in OF status. ConclusionThe power-law model is an appropriate measure of HRV in pediatric patients, being neither age nor heart rate sensitive. Loss of HRV occurs with increasing OF; this effect was better demonstrated by the model compared with other measures of HRV.
影响因子：
37.8
作者：
K. C. Ho;G. Moody;Chung-Kang Peng;J. Mietus;M. Larson;D. Levy;A. Goldberger
通讯作者：
K. C. Ho;G. Moody;Chung-Kang Peng;J. Mietus;M. Larson;D. Levy;A. Goldberger