Salahuddin Nawal, Shafquat Azam, Marashly Qussay, Zaza Khaled Juan, Sharshir Moh'd, Khurshid Moazzum, Ali Zeeshan, Malgapo Melissa, Jamil Mouhamad Ghyath, Shoukri Mohamed, Hijazi Mohammed, Al-Ghamdi Bandar
Department of Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia.
Section of Electrophysiology, Heart Center, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia.
Cardiol Res Pract. 2018 Mar 1;2018:1590217. doi: 10.1155/2018/1590217. eCollection 2018.
Reduced heart rate variability (HRV) indicates dominance of the sympathetic system and a state of "physiologic stress." We postulated that, in patients with critical illness, increases in HRV might signal successful resuscitation and improved prognosis.
We carried out a prospective observational study of HRV on all patients referred to the rapid response team (RRT) and correlated with serial vital signs, lactate clearance, ICU admission, and mortality.
Ninety-one patients were studied. Significantly higher HRV was observed in patients who achieved physiological stability and did not need ICU admission: ASDNN 19 versus 34.5, =0.032; rMSSD 13.5 versus 25, =0.046; mean VLF 9.4 versus 17, =0.021; mean LF 5.8 versus 12.4, =0.018; and mean HF 4.7 versus 10.5, =0.017. ROC curves confirmed the change in very low frequencies at 2 hours as a strong predictor for ICU admission with an AUC of 0.772 (95% CI 0.633, 0.911, =0.001) and a cutoff value of -0.65 associated with a sensitivity of 78.6% and a specificity of 61%.
Reduced HRV, specifically VLF, appears closely related to greater severity of critical illness, identifies unsuccessful resuscitation, and can be used to identify consultations that need early ICU admission.
心率变异性（HRV）降低表明交感神经系统占主导地位以及处于“生理应激”状态。我们推测，在危重病患者中，HRV增加可能预示着复苏成功和预后改善。
我们对所有被转诊至快速反应团队（RRT）的患者进行了HRV的前瞻性观察研究，并将其与系列生命体征、乳酸清除率、入住重症监护病房（ICU）情况及死亡率相关联。
共研究了91例患者。在实现生理稳定且无需入住ICU的患者中观察到显著更高的HRV：平均窦性NN间期标准差（ASDNN）为19对比34.5，P = 0.032；相邻正常RR间期差值的均方根（rMSSD）为13.5对比25，P = 0.046；平均极低频（VLF）为9.4对比17，P = 0.021；平均低频（LF）为5.8对比12.4，P = 0.018；平均高频（HF）为4.7对比10.5，P = 0.017。受试者工作特征（ROC）曲线证实，2小时时极低频的变化是入住ICU的有力预测指标，曲线下面积（AUC）为0.772（95%置信区间0.633, 0.911，P = 0.001），截断值为 -0.65，敏感性为78.6%，特异性为61%。
HRV降低，尤其是VLF降低，似乎与危重病的严重程度密切相关；可识别复苏未成功的情况，并可用于确定需要早期入住ICU的会诊病例。
