Batchinsky Andriy I, Skinner James E, Necsoiu Corina, Jordan Bryan S, Weiss Daniel, Cancio Leopoldo C
US Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA.
J Trauma. 2010 May;68(5):1178-85. doi: 10.1097/TA.0b013e3181bb98a6.
Traditional vital signs such as heart rate, blood pressure, and oxygen saturation are not ideal for timely and accurate assessment of physiologic status after trauma (TR) and hemorrhagic shock (HS). Analysis of the complex beat-to-beat variability present in the heart-rate time series has been proposed as a "new vital sign" in this setting. We determined the effect of chest TR and HS on heart-rate complexity (HRC) in a porcine model.
Anesthetized swine in group II (n = 20) underwent blunt right chest TR with a modified captive-bolt stunner; then, 10 minutes later, hemorrhage of 12 mL/kg over 10 minutes, followed by resuscitation with lactated Ringer's solution, and reinfusion of blood. Group I (n = 15) served as time controls. Two hundred beat sections of EKG waveforms were analyzed at 7 time points: at baseline, after TR, immediately after hemorrhage (HS), and 1 hour, 2 hours, 4 hours, and 5 hours after HS. Several computationally different measures of HRC were calculated, including sample entropy, similarity of distribution, and point correlation dimension.
HRC was decreased after TR, HS, and at 1 hour, manifested by decreased sample entropy and point correlation dimension and increased similarity of distribution. These HRC measures were all restored by resuscitation.
Several independent measures demonstrated decreased HRC after combined TR/HS and restored HRC with resuscitation. Complexity analysis may be useful for diagnosis of TR/HS and for monitoring resuscitation.
传统生命体征，如心率、血压和血氧饱和度，对于创伤（TR）和失血性休克（HS）后生理状态的及时准确评估并不理想。心率时间序列中存在的复杂逐搏变异性分析已被提议作为这种情况下的“新生命体征”。我们在猪模型中确定了胸部TR和HS对心率复杂性（HRC）的影响。
第二组（n = 20）的麻醉猪用改良的速眠新II型致昏器进行右胸钝性TR；然后，10分钟后，在10分钟内失血12 mL/kg，接着用乳酸林格氏液复苏，并回输血液。第一组（n = 15）作为时间对照组。在7个时间点分析200个心动周期的心电图波形：基线时、TR后、失血（HS）后即刻、HS后1小时、2小时、4小时和5小时。计算了几种计算方式不同的HRC指标，包括样本熵、分布相似性和点关联维数。
TR、HS后及1小时时HRC降低，表现为样本熵和点关联维数降低以及分布相似性增加。这些HRC指标在复苏后均恢复。
几种独立指标显示，TR/HS联合后HRC降低，复苏后HRC恢复。复杂性分析可能有助于TR/HS的诊断及复苏监测。
