Hanss R, Renner J, Ilies C, Moikow L, Buell O, Steinfath M, Scholz J, Bein B
Department of Anaesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105 Kiel, Germany.
Anaesthesia. 2008 Feb;63(2):129-35. doi: 10.1111/j.1365-2044.2007.05321.x.
This study investigated whether heart rate variability predicts haemodynamic events in high risk patients, defined as Revised Cardiac Risk Index score = 3, scheduled for general anaesthesia. Fifty patients underwent baseline measurement of heart rate variability and were then assigned according to haemodynamic events (hypotension or bradycardia) after standardised induction of anaesthesia into 'stable' (n = 39) and 'unstable' patients (n = 11). Unstable patients had significantly lower baseline total power. Total power < 500 ms2 x Hz(-1) was associated with high sensitivity and specificity for the prediction of hypotension or bradycardia. Prospectively, 29 patients with total power < 500 ms2 x Hz(-1) were compared with 21 patients with total power > 500 ms2 x Hz(-1). Differences were found in the lowest mean arterial pressure and heart rate after induction of anaesthesia. We conclude that the pre-operative total power of heart rate variability in high risk patients may indicate the occurrence of haemodynamic events with high sensitivity and specificity. Heart rate variability may be a suitable tool to identify patients at high risk of a haemodynamic event and may be used to indicate need for intensive monitoring and, perhaps, prophylactic treatment.
本研究调查了心率变异性是否能预测高危患者（定义为修订心脏风险指数评分=3）在全身麻醉时的血流动力学事件。50例患者接受了心率变异性的基线测量，然后根据标准化麻醉诱导后的血流动力学事件（低血压或心动过缓）分为“稳定”组（n = 39）和“不稳定”组（n = 11）。不稳定组患者的基线总功率显著较低。总功率<500 ms2×Hz-1对低血压或心动过缓的预测具有较高的敏感性和特异性。前瞻性地，将29例总功率<500 ms2×Hz-1的患者与21例总功率>500 ms2×Hz-1的患者进行比较。在麻醉诱导后的最低平均动脉压和心率方面发现了差异。我们得出结论，高危患者术前心率变异性的总功率可能以高敏感性和特异性指示血流动力学事件的发生。心率变异性可能是识别血流动力学事件高危患者的合适工具，可用于指示强化监测的必要性，或许还可用于预防性治疗。
