颅脑损伤患者镇静后颅内压变化与心率变异性的相关性研究

Research on the correlation between changes of intracranial pressure after sedation and heart rate variability in patients with craniocerebral injury

目的观察颅脑损伤患者镇静后颅内压变化情况及心率变异性特点,分析颅脑损伤患者镇静后颅内压变化与心率变异性的关系。方法回顾性分析濮阳市人民医院2017-07—2019-07符合条件并接受镇静治疗的36例颅脑损伤患者为研究对象,分别于镇静治疗开始前、镇静治疗后1 d、镇静治疗后3 d对比颅内压变化情况及心率变异性变化情况,分析患者颅内压变化与心率变异性主要指标之间的相关性。结果镇静前、镇静后1 d、镇静后3 d颅脑损伤患者的颅内压监测结果分别为(20.01±3.21)mmHg、(17.14±2.31)mmHg、(13.17±2.02)mmHg,各时点间两两比较差异有统计学意义(F=64.608,P<0.001);镇静后1 d、镇静后3 d患者的SDNN、SDANN、RMSDD、PNN50%水平分别为[(90.22±9.51)ms、(87.75±8.02)ms、(36.12±5.34)ms、(5.11±0.96)%]、[(104.55±10.17)ms、(101.47±7.51)ms、(41.17±5.51)ms、(6.17±1.03)%],均较镇静前升高,差异有统计学意义(F=61.269、64.41、24.568、41.569,P<0.05);镇静后1 d、镇静后3 d患者的LF、HF、TP、LF/HF水平分别为[(617.45±21.47)msec^(2)、(469.02±24.11)msec^(2)、(2464.25±14.12)msec^(2)、(1.41±0.39)%]、[(686.65±23.22)msec^(2)、(502.47±32.31)msec^(2)、(2874.69±120.24)msec^(2)、(1.52±0.31)%],均较镇静前升高,差异有统计学意义(F=307.692、61.206、31.455、4.073,P<0.05);经双变量Pearson直线相关分析显示,颅脑损伤患者镇静后颅内压水平与各心率变异性主要指标水平均呈负相关(r<0,P<0.05),各心率变异性指标间均两两间呈正相关(r>0,P<0.05)。结论颅脑损伤患者常规治疗期间给予镇静治疗更利于降颅内压,且患者心率变异性明显改善,这种颅内压与心率变异性的变化之间可能相互影响、相互作用参与患者病情的进展,故对于颅内损伤患者的镇静治疗,临床应重视监测颅内压与心率变异性,以指导镇静有效性与安全性的评价。

Objective To observe the changes of intracranial pressure after sedation and characteristics of heart rate variability in patients with craniocerebral injury,and to analyze the correlation between changes of intracranial pressure after sedation and heart rate variability in patients with craniocerebral injury.Methods Totally 36 patients with craniocerebral injury who were eligible and received sedation therapy in Puyang People’s Hospital from July 2017 to July 2019 were selected as the research subjects.The changes of intracranial pressure and heart rate variability of patients before the start of sedation,after 1d of sedation and after 3d of sedation were detected and compared.The correlation between changes of intracranial pressure and main indexes of heart rate variability was analyzed.Results Before sedation,after 1d of sedation and after 3d of sedation,the monitoring results of intracranial pressure in patients with craniocerebral injury were(20.01±3.21)mmHg,(17.14±2.31)mmHg and(13.17±2.02)mmHg respectively,compared them with pairs at each time point,the difference was statistically significant(F=64.608,P<0.001);after 1d of sedation and after 3d of sedation,the levels of SDNN,SDANN,RMSD and PNN50%were((90.22±9.51)ms,(87.75±8.02)ms,(36.12±5.34)ms,(5.11±0.96)%),((104.55±10.17)ms,(101.47±7.51)ms,(41.17±5.51)ms,(6.17±1.03)%),respectively,all were increased than before sedation,the difference was statistically significant(F=61.269,64.41,24.568,41.569,P<0.05);after 1d of sedation and after 3 d of sedation,the levels of LF,HF,TP and LF/HF of patients were((617.45±21.47)msec^(2),(469.02±24.11)msec^(2),(2464.25±14.12)msec^(2),(1.41±0.39)%),((686.65±23.22)msec^(2),(502.47±32.31)msec^(2),(2874.69±120.24)msec^(2) and(1.52±0.31)%),respectively,all were increased than before sedation,the difference was statistically significant(F=307.692,61.206,31.455,4.073,P<0.05);the results of bivariate Pearson linear correlation showed that intracranial pressure was negatively correlated with the main indexes of heart rate vari ability after sedation(r<0,P<0.05),each index of heart rate variability was positively correlated with each other in pairs(r>0,P<0.05).Conclusion The sedation therapy during routine treatment of patients with craniocerebral injury is more conducive to lowering intracranial pressure,and the heart rate variability of patients is significantly improved.Such changes in intracranial pressure and heart rate variability may interact with each other and participate in the progress of the patient’s condition.Therefore,for the sedation treatment of patients with intracranial injury,it is necessary to pay attention to clinical monitoring of intracranial pressure and heart rate variability,so as to guide the evaluation of the effectiveness and safety of sedation.