期刊
JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY
卷 13, 期 3, 页码 260-268出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/00008506-200107000-00016
关键词
severe head injury; heart rate variability; autonomic nervous system; brain death; prognosis
Despite major improvements in the resuscitation of patients with head injury, the outcome of patients with head trauma often remains poor and difficult to establish. Heart rate variability (HRV) analysis is a noninvasive tool used to measure autonomic nervous system (ANS) activity. The aim of this prospective study was to investigate whether HRV analysis might be a useful adjunct for predicting outcome in patients with severe head injury. Twenty patients with severe head trauma (Glasgow Coma Scale [GCS] less than or equal to 8) underwent 24-hour electrocardiogram recording 1 day after trauma and again 48 hours after withdrawal of sedative drugs. Heart rate variability was assessed, in both time domain and spectral domain. The authors initially compared ton Day 1) HRV in patients who processed to brain death to HRV in survivors; then during the awakening period compared HRV in surviving patients with good recovery (GCS greater than or equal to 10) to HRV in patients characterized by a worsened neurologic state (GCS < 10). Statistical analysis used the Kruskal-Wallis test, P < .05. To assess whether HRV could predict evolution to brain death, receiver operating characteristic (ROC) curves were generated the day after trauma for Total Power, natural logarithm of high-frequency component of spectral analysis (LnHF), natural logarithm of low-frequency component of spectral analysis (LnLF), and root mean square for successive interval differences (rMSSD). Seven patients died between Day 1 and Day 5 after trauma, Six of those had progressed to brain death. In these six patients, at Day 1, Global HRV and parasympathetic tone were significantly higher. Referring to the area under the rMSSD ROC curve, HRV might provide useful information in predicting early evolution of patients with severe head trauma. During the awakening period, global HRV and the parasympathetic tone were significantly lower in the worsened neurologic state group. In conclusion, HRV could be helpful as a predictor of imminent brain death and a useful adjunct for predicting the outcome of patients with severe head injury.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据