血压状态对危重症患者脉搏率变异性和心率变异性的不同影响。

Differential effects of the blood pressure state on pulse rate variability and heart rate variability in critically ill patients.

作者信息

Mejía-Mejía Elisa, May James M, Elgendi Mohamed, Kyriacou Panayiotis A

机构信息

Research Centre for Biomedical Engineering, City, University of London, London, United Kingdom.

Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

出版信息

NPJ Digit Med. 2021 May 14;4(1):82. doi: 10.1038/s41746-021-00447-y.

Abstract

Heart rate variability (HRV) utilizes the electrocardiogram (ECG) and has been widely studied as a non-invasive indicator of cardiac autonomic activity. Pulse rate variability (PRV) utilizes photoplethysmography (PPG) and recently has been used as a surrogate for HRV. Several studies have found that PRV is not entirely valid as an estimation of HRV and that several physiological factors, including the pulse transit time (PTT) and blood pressure (BP) changes, may affect PRV differently than HRV. This study aimed to assess the relationship between PRV and HRV under different BP states: hypotension, normotension, and hypertension. Using the MIMIC III database, 5 min segments of PPG and ECG signals were used to extract PRV and HRV, respectively. Several time-domain, frequency-domain, and nonlinear indices were obtained from these signals. Bland-Altman analysis, correlation analysis, and Friedman rank sum tests were used to compare HRV and PRV in each state, and PRV and HRV indices were compared among BP states using Kruskal-Wallis tests. The findings indicated that there were differences between PRV and HRV, especially in short-term and nonlinear indices, and although PRV and HRV were altered in a similar manner when there was a change in BP, PRV seemed to be more sensitive to these changes.

摘要

心率变异性(HRV)利用心电图(ECG),并已作为心脏自主神经活动的非侵入性指标得到广泛研究。脉搏率变异性(PRV)利用光电容积脉搏波描记法(PPG),最近已被用作HRV的替代指标。多项研究发现,PRV作为HRV的估计并不完全有效,包括脉搏传输时间(PTT)和血压(BP)变化在内的几个生理因素对PRV的影响可能与对HRV的影响不同。本研究旨在评估不同血压状态(低血压、正常血压和高血压)下PRV与HRV之间的关系。利用MIMIC III数据库,分别使用5分钟的PPG和ECG信号片段来提取PRV和HRV。从这些信号中获得了几个时域、频域和非线性指标。采用Bland-Altman分析、相关性分析和Friedman秩和检验来比较每种状态下的HRV和PRV,并使用Kruskal-Wallis检验比较不同血压状态下的PRV和HRV指标。研究结果表明,PRV和HRV之间存在差异,尤其是在短期和非线性指标方面,尽管当血压发生变化时PRV和HRV的变化方式相似,但PRV似乎对这些变化更敏感。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/26a7/8121822/83f4424e8141/41746_2021_447_Fig1_HTML.jpg

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