Batchinsky Andriy I, Cancio Leopoldo C, Salinas Jose, Kuusela Tom, Cooke William H, Wang Jing Jing, Boehme Marla, Convertino Victor A, Holcomb John B
US Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA.
J Trauma. 2007 Sep;63(3):512-8. doi: 10.1097/TA.0b013e318142d2f0.
To improve our ability to identify physiologic deterioration caused by critical injury, we applied nonlinear analysis to the R-to-R interval (RRI) of the electrocardiogram of prehospital trauma patients.
Ectopy-free, 800-beat sections of electrocardiogram from 31 patients were identified. Twenty patients survived (S) and 11 died (NonS) after hospital admission. Demographic data, heart rate, blood pressure, field Glasgow Coma Scale (GCS) score, and survival times were recorded. RRI complexity was assessed via nonlinear statistics, which quantify entropy or fractal properties.
Age and field heart rate and blood pressure were not different between groups. Mean survival time (NonS) was 129 hours +/- 62 hours. NonS had a lower GCS score (8.6 +/- 1.7 vs. 13.2 +/- 0.8, p < 0.05). RRI approximate entropy (ApEn; 0.87 +/- 0.06 vs. 1.09 +/- 0.07, p < 0.01), sample entropy (SampEn; 0.80 +/- 0.08 vs. 1.10 +/- 0.05, p < 0.01) and fractal dimension by dispersion analysis (1.08 +/- 0.02 vs. 1.13 +/- 0.01, p < 0.05) were lower in NonS. Distribution of symbol 2 (Dis_2), a symbol-dynamics measure of RRI distribution, was higher in NonS (292.6 +/- 34.4 vs. 222 +/- 21.3, p < 0.10). For RRI data, logistic regression analysis revealed ApEn and Dis_2 as independent predictors of mortality (area under the receiver-operating characteristic curve = 0.96). When GCSMOTOR was considered, it replaced Dis_2 whereas ApEn was retained (area under curve = 0.92). When Injury Severity Score was considered, it replaced GCSMOTOR; ApEn was retained.
Prehospital loss of RRI complexity, as evidenced by decreased entropy, was associated with mortality in trauma patients independent of GCS score or Injury Severity Score.
为提高我们识别由严重创伤导致的生理功能恶化的能力，我们将非线性分析应用于院前创伤患者心电图的R - R间期（RRI）。
从31例患者的心电图中识别出无异位搏动、800次心跳的片段。20例患者入院后存活（S组），11例死亡（非S组）。记录人口统计学数据、心率、血压、现场格拉斯哥昏迷量表（GCS）评分和生存时间。通过非线性统计评估RRI复杂性，非线性统计可量化熵或分形特性。
两组间年龄、现场心率和血压无差异。非S组的平均生存时间为129小时±62小时。非S组的GCS评分较低（8.6±1.7对13.2±0.8，p<0.05）。非S组的RRI近似熵（ApEn；0.87±0.06对1.09±0.07，p<0.01）、样本熵（SampEn；0.80±0.08对1.10±0.05，p<0.01）以及通过离散分析得到的分形维数（1.08±0.02对1.13±0.01，p<0.05）均较低。符号动力学测量RRI分布的符号2分布（Dis_2）在非S组中较高（292.6±34.4对222±21.3，p<0.10）。对于RRI数据，逻辑回归分析显示ApEn和Dis_2是死亡率的独立预测因子（受试者工作特征曲线下面积=0.96）。当考虑GCS运动评分时，它取代了Dis_2，而ApEn得以保留（曲线下面积=0.92）。当考虑损伤严重度评分时，它取代了GCS运动评分；ApEn得以保留。
院前RRI复杂性降低，如熵减少所示，与创伤患者的死亡率相关，且独立于GCS评分或损伤严重度评分。
