Shalev A Y, Sahar T, Freedman S, Peri T, Glick N, Brandes D, Orr S P, Pitman R K
The Center for Traumatic Stress, Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel.
Arch Gen Psychiatry. 1998 Jun;55(6):553-9. doi: 10.1001/archpsyc.55.6.553.
Physiological arousal during traumatic events may trigger the neurobiological processes that lead to posttraumatic stress disorder (PTSD). This study prospectively examined the relationship between heart rate and blood pressure recorded immediately following a traumatic event and the subsequent development of PTSD.
Eighty-six trauma survivors who presented at the emergency department of a general hospital were followed up for 4 months. Heart rate and blood pressure were recorded on arrival at the emergency department. Heart rate, anxiety, depression, and PTSD symptoms were assessed 1 week, 1 month, and 4 months later. The clinician-administered PTSD scale defined PTSD status at 4 months.
twenty subjects (23%) met PTSD diagnostic criteria at the 4-month assessment (PTSD group), and 66 (77%) did not (non-PTSD group). Subjects who developed PTSD had higher heart rates at the emergency department (95.5+/-13.9 vs 83.3+/-10.9 beats per minute, t=4.4, P<.001) and 1 week later (77.8+/-11.9 vs 72.0+/-9.5 beats per minute, t=2.25, P<.03), but not after 1 and 4 months. The groups did not differ in initial blood pressure measurement. Repeated-measures analysis of variance (ANOVA) for heart rate showed a significant group effect (P<.02), time effect (P<.001), and group x time interaction (P<.001). The time effect and group x time interaction remained significant when adjusted for sex, age, trauma severity, immediate response, and dissociation during the traumatic event.
Elevated heart rate shortly after trauma is associated with the later development of PTSD.
创伤事件期间的生理唤醒可能会触发导致创伤后应激障碍（PTSD）的神经生物学过程。本研究前瞻性地考察了创伤事件后立即记录的心率和血压与PTSD后续发生之间的关系。
对86名在综合医院急诊科就诊的创伤幸存者进行了4个月的随访。在到达急诊科时记录心率和血压。在1周、1个月和4个月后评估心率、焦虑、抑郁和PTSD症状。由临床医生实施的PTSD量表确定4个月时的PTSD状态。
在4个月评估时，20名受试者（23%）符合PTSD诊断标准（PTSD组），66名（77%）不符合（非PTSD组）。发生PTSD的受试者在急诊科时心率较高（95.5±13.9次/分钟对83.3±10.9次/分钟，t = 4.4，P <.001），1周后也较高（77.8±11.9次/分钟对72.0±9.5次/分钟，t = 2.25，P <.03），但在1个月和4个月后无差异。两组在初始血压测量上无差异。心率的重复测量方差分析（ANOVA）显示出显著的组效应（P <.02）、时间效应（P <.001）和组×时间交互作用（P <.001）。在对性别、年龄、创伤严重程度、即时反应和创伤事件期间的分离进行校正后，时间效应和组×时间交互作用仍然显著。
创伤后不久心率升高与PTSD的后期发生有关。
