心率变异性在手术后不良心脏事件危险分层中的作用

越来越多的证据表明自主神经系统的功能紊乱与心源性猝死关系密切。心率变异性（HRV）测定已广泛用于自主神经系统功能变化的检测。数项关于心脏患者的研究显示，HRV减小及压力感受器功能障碍与现有的左室射血分数等临床预测因子相比，是更强的心源性猝死的预测因子。所有手术后并发症中的1／3和超过半数的死亡可归因于心脏并发症。几个风险指数仅在单个患者围手术期近期危险分层中有效，而在远期预后的危险分层中无效。目前临床上尚缺乏用于评估手术后远期危险性的类似方法。最近有少数研究显示手术前HRV减小可作为手术后远期病死率的独立预测因子，但还需要进行更多的关于手术患者的研究，以确立手术前压力感受器功能障碍（单独存在或与HRV合并存在）对手术后近期及远期预后的可能预测价值。

There is growing evidence of a strong association between the compromised autonomic nervous system and sudden cardiac death. Heart rate variability （HRV） measures are widely used to measure alterations in the autonomic nervous system. Several studies with cardiac patients show that decreased HRV as well as baroreceptor dysfunction are more powerful predictors for sudden cardiac death than established clinical predictors such as left ventricular ejection fraction. One-third of all postoperative complications and more than haft of the deaths are due to cardiac complications. Several risk indices are use- ful for immediate perioperative short-term, but not for long-term outcome risk stratification of an individual patient. Current- by, there are no clinically assimilated methods for long-term postoperative risk assessment. Recently, few studies have shown that preoperatively decreased HRV can independently predict postoperative long-term mortality. Further studies with surgical patients are needed to establish a possible predictive value of preoperative baroreceptor dysfunction, alone and combined with HRV, for short-and long-term postoperative outcome.