心率变异性评价新生儿高胆红素血症对自主神经功能的影响

Use of Heart Rate Variability in Evaluating Influence of Newborn Hyperbilirubinemia on Autonomic Nerve Function

目的:观察高胆红素血症对新生儿的心率变异性(HRV)的影响。方法:回顾性选择我科治疗的高胆红素血症新生儿162例,根据是否达到换血治疗指征及是否接受换血治疗分为A组(未达到换血指征,未进行换血治疗)89例,B组(达到换血指征,未进行换血治疗)34例和C组(达到换血指征,进行换血治疗)39例,另选取健康新生儿50例作为对照组,分析比较治疗前后HRV各指标的差异。结果:治疗前,A组各HRV指标与对照组差异无统计学意义(均P>0.05);治疗前,B组和C组正常窦性R-R间期的标准差(SDNN),总功率(TP)和高频功率(HF)较对照组显著下降(均P<0.05)。治疗后,A组各HRV指标与治疗前差异无统计学意义(均P>0.05);B组SDNN和HF较治疗前明显升高(均P<0.05),C组SDNN、TP和HF较治疗前明显升高(均P<0.05),且C组SDNN升高较B组更为显著(P<0.05)。Spearman直线相关分析显示,血清总胆红素水平与SDNN、HF呈负相关(r=-0.217,-0.266;P=0.000)。结论:新生儿HRV可作为评价高胆红素血症严重程度的指标,换血治疗对改善重度高胆红素血症新生儿自主神经功能可能有一定积极意义。

Objective: To observe the change of heart rate variability (HRV) in newborns with hyperbilirubinemia, and to discuss the influence of hyperbilirubinemia on autonomic nerve function in newborns. Methods: We selected for this study 162 newborn infants treated in our hospital for hyperbilirubinemia. According to whether indexes of exchange transfusion was achieved and whether exchange transfusion therapy was received, patients were divided into Group A (neither achieved indexes of nor received transfusion, n=89), Group B (achieved indexes of but did not receive transfusion, n=34), and Group C (achieved indexes of and received transfusion, n=39). An additional 50 healthy newborns were selected as the control group. Indexes of HRV of the three patient groups before and after treatment were analytically compared with that of the control group. Results: Before treatment, there was no significant difference between Group A and the control group in all indexes of HRV (all P>0.05). Compared with the control group, standard deviation of R-R intervals (SDNN), total power (TP), and high frequency (HF) of Groups B and C before treatment were decreased (all P<0.05). After treatment, there was no significant difference between Group A and the control group in all indexes of HRV (all P>0.05). SDNN and HF of Group B and SDNN, TP, and HF of Group C were increased after treatment (all P<0.05), and SDNN of Group C was higher than that of Group B (P<0.05). Spearman linear correlation analysis showed that SDNN and HF were negatively correlated with level of total serum bilirubin (r=-0.217,-0.266;P= 0.000). Conclusion: HRV is a reliable indicator of the severity of neonatal hyperbilirubinemia. For newborns with severe hyperbilirubinemia, exchange transfusion was effective in improving autonomic nerve function.