严重多发伤患者心率变异性分析及其临床意义

Analysis of heart rate variability in patients with multiple traumas

目的探讨严重多发伤患者心率变异性(HRV)测定的意义。方法对46例严重多发伤患者于创伤后1、3、7d监测HRV短程频域分析的变化及测定外周血去甲肾上腺素、皮质醇水平(放免法)。设正常对照组10例。结果以损伤严重度评分(ISS)≤16分为分组界限,伤后24h内,各组低频标化功率(LFnm)、高频标化功率(HFnm)、LF/HF明显升高;随后,各组LFnm、HFnm、LF/HF显著降低并低于正常对照组。ISS>16分组的LFnm、HFnm、LF/HF在各个时相点与ISS≤16组相比存在显著性差异(P<0.01)。结论创伤患者HRV发生了显著变化,反映出自主神经功能受损和失衡,并与创伤应激程度密切相关。

AIM To study the significance of measuring heart rate variability （HRV） in multiple-injury patients. METHODS Changes of HRV in the frequency domain were observed, and norepinephrine （NE） and cortisol（Cor） were measured on the 1st, 3 rd and 7 th day post-trauma in forty-six patients with muhiple-traumas and in control of 10 health subjects. RESULTS The patients were divided into two groups according to ISS ≤ 16 and 〉 16. Within 24 hour after trauma, LFnm, HFnm and LF/HF increased obviously in both groups. Subsequently, LF, HF and LF/HF of the two groups decreased obvi- ously and were lower remarkably than those of the control group. Compared with those in the ISS ≤16 group, LF, HF and LF/HF in the ISS 〉 16 group were remarkably different at every time points after trauma. CONCLUSION Significant changes of HRV occur after trauma, which reflect injuries and imbalance of autonomous nervous function in severe traumatic patients and are closely correlated with the degrees of injury stress.