Papaioannou Vasilios E, Maglaveras Nikos, Houvarda Ioanna, Antoniadou Ellen, Vretzakis George
Intensive Care Unit of AHEPA University Hospital of Thessaloniki, 54006 Thessaloniki, Greece.
J Crit Care. 2006 Mar;21(1):95-103; discussion 103-4. doi: 10.1016/j.jcrc.2005.12.007.
To investigate longitudinally over time heart rate dynamics and relation with mortality and organ dysfunction alterations in patients admitted to a multidisciplinary intensive care unit.
Data from 53 patients were used, with heart rate recorded from monitors and analyzed on a daily basis (every morning) for 600 seconds and sampling rate at 250 Hz, from admission to the intensive care unit until final discharge from the unit. Variance, which is a measure of heart rate variability; exponent alpha2; and approximate entropy (ApEn), which assess long-range correlations and periodicity within a signal, respectively; were measured and compared with every day Sequential Organ Failure Assessment Score (SOFA) and mortality.
Nonsurvivors had lower ApEn mean (greater periodicity in their signals) and minimum values compared to survivors (0.53 +/- 0.25 vs 0.62 +/- 0.23, P = .04; 0.24 +/- 0.23 vs 0.48 +/- 0.23, P = .01, respectively). Patients in better conditions with SOFA of less than 7 (mean value) had higher variance and ApEn (more variable, less periodic signals) than those with SOFA of 7 or higher (0.47 +/- 0.51 vs 0.10 +/- 0.65, P < .001; 0.67 +/- 0.28 vs 0.49 +/- 0.24, P < .001, respectively). The alpha2 exponent and variance were correlated with length of stay (r = 0.55, P = .02, and r = 0.53, P = .02, respectively) and minimum ApEn with mortality (r = 0.41, P = .01).
Loss of variability and increase in periodicity in heart rate of critically ill patients are linked with parallel deterioration of organ dysfunction and high mortality.
对多学科重症监护病房收治的患者进行长期随访，以研究心率动态变化及其与死亡率和器官功能障碍改变之间的关系。
使用了53例患者的数据，从入住重症监护病房直至最终出院，通过监测仪记录心率，并每天（每天早晨）进行600秒的分析，采样率为250Hz。测量了方差（心率变异性的一种度量）、α2指数和近似熵（ApEn），后者分别评估信号内的长期相关性和周期性，并将其与每日序贯器官衰竭评估评分（SOFA）和死亡率进行比较。
与幸存者相比，非幸存者的ApEn平均值较低（信号的周期性更强）且最小值更低（分别为0.53±0.25对0.62±0.23，P = 0.04；0.24±0.23对0.48±0.23，P = 0.01）。SOFA小于7（平均值）的病情较好的患者比SOFA为7或更高的患者具有更高的方差和ApEn（信号更具变异性、周期性更弱）（分别为0.47±0.51对0.10±0.65，P <0.001；0.67±0.28对0.49±0.24，P <0.001）。α2指数和方差与住院时间相关（分别为r = 0.55，P = 0.02和r = 0.53，P = 0.02），最小ApEn与死亡率相关（r = 0.41，P = 0.01）。
重症患者心率变异性丧失和周期性增加与器官功能障碍的平行恶化和高死亡率相关。
