Goldstein B, Fiser D H, Kelly M M, Mickelsen D, Ruttimann U, Pollack M M
Department of Pediatrics, University of Rochester School of Medicine, NY, USA.
Crit Care Med. 1998 Feb;26(2):352-7. doi: 10.1097/00003246-199802000-00040.
To determine if decomplexification of heart rate dynamics occurs in critically ill and injured pediatric patients. We hypothesized that heart rate power spectra, a measure of heart rate dynamics, would inversely correlate with measures of severity of illness and outcome.
A prospective clinical study.
A 12-bed pediatric intensive care unit (ICU) in a tertiary care children's hospital.
One hundred thirty-five consecutive pediatric ICU admissions.
None.
We compared heart rate power spectra with the Pediatric Risk of Mortality (PRISM) score, the Pediatric Cerebral Performance Category (PCPC), and the Pediatric Overall Performance Category (POPC). We found significant negative correlations between minimum low-frequency and high-frequency heart rate power spectral values recorded during ICU stay and the maximum PRISM score (log low-frequency heart rate power vs. PRISM, r2 = .293, p < .001; and log high-frequency heart rate power vs. PRISM, r2 = .243, p < .001) and outcome at ICU discharge (log low-frequency heart rate power vs. POPC or PCPC, r2 = .429, p < .001; and log high-frequency heart rate power vs. POPC or PCPC, r2 = .271, p < .001).
Our data support the hypothesis that measures of heart rate power spectra are inversely related and negatively correlated to severity of illness and outcome in critically ill and injured children. The phenomenon of decomplexification of physiologic dynamics may have important clinical implications in critical illness and injury.
确定危重症和受伤的儿科患者是否会出现心率动力学解耦联现象。我们假设心率功率谱（一种心率动力学指标）与疾病严重程度及预后指标呈负相关。
一项前瞻性临床研究。
一家三级儿童专科医院的拥有12张床位的儿科重症监护病房（ICU）。
135例连续入住儿科ICU的患者。
无。
我们将心率功率谱与儿科死亡风险（PRISM）评分、儿科脑功能表现类别（PCPC）和儿科总体表现类别（POPC）进行了比较。我们发现，在ICU住院期间记录的最低低频和高频心率功率谱值与最高PRISM评分（低频心率功率对数与PRISM评分，r2 = 0.293，p < 0.001；高频心率功率对数与PRISM评分，r2 = 0.243，p < 0.001）以及ICU出院时的预后（低频心率功率对数与POPC或PCPC，r2 = 0.429，p < 0.001；高频心率功率对数与POPC或PCPC，r2 = 0.271，p < 0.001）之间存在显著负相关。
我们的数据支持以下假设，即心率功率谱指标与危重症和受伤儿童的疾病严重程度及预后呈负相关且为反向关系。生理动力学解耦联现象可能在危重症和损伤中具有重要的临床意义。
