心率变化歧视了儿童心脏骤停后的结果
Duncan B Mackie1, Craig M Smith1,2, L Nelson Sanchez-Pinto1,2
1Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
概括
在儿科心脏骤停后的前12小时内,心率变化 (HRV) 较低,表明死亡风险更高,神经学结果较差. 这一发现表明,HRV可以帮助预测重症儿童的预后.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 心血管生理学心血管生理学
- 神经学 神经学
背景情况:
- 儿童心脏骤停与显著的死亡率和长期的神经系统缺陷有关.
- 准确的预后对于指导治疗决策和儿科重症监护病房 (PICU) 的资源分配至关重要.
- 心率变化 (HRV) 反映了自主神经系统的功能,并显示出在各种严重疾病中作为预后标记物的潜力.
研究的目的:
- 评估心率变化 (HRV) 在预测心脏骤停后儿科患者的死亡率和功能神经学结果方面的有效性.
- 确定PICU入院后最初12小时内HRV测量是否可以区分幸存者和非幸存者,以及良好的和差的神经恢复.
主要方法:
- 在一个拥有46张床位的PICU中,对生理和临床数据进行了回顾性审查.
- 包括七十五名儿童患者 (年龄超过28天,年龄低于18岁),他们在2013年至2019年期间因心脏骤停而入院.
- 中位数整数HRV (mHRVi) 从PICU入院的前12小时计算,并分析其与死亡率和神经学结果的关联 (儿科大脑性能类别得分).
主要成果:
- 一周住院死亡率为23% (17名患者).
- 在前12小时内较低的mHRVi与1周死亡率 (p < 0.01) 和较差的神经结果 (几率比0.26;p = 0.01) 有显著关联.
- 12小时的mHRVi显示了对死亡率的中度歧视 (ROC曲线下的面积:0.74) 并在多变量调整后仍然显著.
结论:
- 儿童心脏骤停后头12小时内mHRVi的降低是1周死亡率和神经系统不良结果的重要预测因素.
- 对于儿科心脏骤停幸存者,mHRVi显示出作为多式预后框架中的辅助工具的潜力.
- 为了确定临床效用,需要在更大,多样化的患者队伍中进一步验证.
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