Department of Anesthesiology, Oulu University Hospital, PO Box 21, FIN-90029 OUH, Oulu, Finland.
Anesth Analg. 2013 Jan;116(1):190-7. doi: 10.1213/ANE.0b013e318270034a. Epub 2012 Oct 31.
Electrocardiographic (ECG) abnormalities are frequent in patients with intracranial insult. In this study, we evaluated the factors predisposing to the repolarization abnormalities, i.e., prolonged corrected QT (QTc) interval, ischemic-like ECG changes and morphologic end-repolarization abnormalities, and examined the prognostic value of these abnormalities in patients with subarachnoid and intracerebral hemorrhages requiring intensive care.
This was a prospective, observational clinical study in a university-level intensive care unit. Clinical characteristics, the level of consciousness, and findings in primary head computed tomography were recorded on admission. The study period was divided into three 2-day sections. In each section, a 12-lead ECG, transthoracic echocardiography, the results of standard blood electrolytes and cardiac troponin I, as well as the rate of vasoactive and sedative drug infusions were recorded. Repolarization abnormalities such as prolongation of the QTc interval (millisecond), ischemic-like ECG changes, and morphologic end-repolarization abnormalities (present/absent) were evaluated and analyzed. The 1-year functional outcome was determined using the Glasgow Outcome Score.
During the 2-year study period, 108 patients were included in the study. Different repolarization abnormalities were frequent in both types of hemorrhage. Prolongation of the QTc interval was predisposed by female gender (β, 24.5; P = 0.010) and the use of propofol (β, 30.5; P = 0.001). The predisposing factor for ischemic-like ECG changes were male gender (odds ratio [OR], 5.9; P = 0.003) and for morphological end-repolarization abnormalities aneurysmatic bleeding (OR, 13.0; P = 0.002). Ischemic-like ECG changes were common, in 87/108 patients during the study period, and were associated with a poorer 1-year functional outcome (OR, 4.7; lower 95% confidence interval, 1.5; P = 0.010).
Each repolarization abnormality has characteristic predisposing factors. Ischemic-like ECG changes are common and are associated with a poorer 1-year functional outcome.
心电图（ECG）异常在颅内损伤患者中很常见。在这项研究中，我们评估了导致复极异常的因素，即校正 QT（QTc）间期延长、类似缺血性心电图改变和形态终末复极异常，并检查了这些异常在需要重症监护的蛛网膜下腔和脑出血患者中的预后价值。
这是一项在大学水平的重症监护病房进行的前瞻性观察性临床研究。入院时记录临床特征、意识水平和原发性头部计算机断层扫描结果。研究期间分为三个为期两天的部分。在每个部分中，记录 12 导联心电图、经胸超声心动图、标准电解质和肌钙蛋白 I 的结果，以及血管活性和镇静药物输注的速度。评估和分析复极异常，如 QTc 间期延长（毫秒）、类似缺血性心电图改变和形态终末复极异常（存在/不存在）。使用格拉斯哥结局量表确定 1 年的功能结局。
在 2 年的研究期间，共有 108 例患者入组。两种类型的出血均常出现不同的复极异常。女性（β，24.5；P = 0.010）和使用异丙酚（β，30.5；P = 0.001）易导致 QTc 间期延长。缺血性心电图改变的易患因素是男性（比值比[OR]，5.9；P = 0.003）和形态学终末复极异常的动脉瘤性出血（OR，13.0；P = 0.002）。在研究期间，缺血性心电图改变很常见，在 108 例患者中有 87 例出现，与 1 年的功能结局较差相关（OR，4.7；较低的 95%置信区间，1.5；P = 0.010）。
每种复极异常都有其特征性的易患因素。类似缺血性心电图改变很常见，与 1 年的功能结局较差相关。
