心率变异性在高血压脑出血患者气管切开后并发肺部感染中的作用

摘要/Abstract

摘要：

目的：探讨心率变异性（heart rate variability, HRV）与高血压脑出血（hypertensive cerebral hemorrhage,HICH）患者气管切开后并发肺部感染的关系，为临床诊疗提供参考。方法：回顾性分析2018年2月至2022年12月医院收治的101例行气管切开术的HICH患者临床资料。根据并发肺部感染情况分为感染组和非感染组。比较2组一般资料、炎症标志物与HRV指标情况。采用Pearson相关性分析HRV与HICH患者气管切开后并发肺部感染的关系。结果：101例HICH患者气管切开后7 d内并发肺部感染54例，占53.5%。2组术前格拉斯哥昏迷评分（Glasgow coma score, GCS）比较，差异有统计学意义（P<0.05）。感染组白介素-6（interleukin 6, IL-6）、C反应蛋白（C-reactive protein, CRP）、肿瘤坏死因子-α（tumor necrosis factor-α, TNF-α）、降钙素原（procalcitonin, PCT）均高于未感染组，24 h全部窦性心搏RR间期标准差（standard deviation of normal to normal interval,SDNN）、24 h平均SDNN（standard deviation of average normal to normal interval, SDANN）、24 h相邻RR间期差值均方根(root mean square of successive differences in adjacent RR interval, RMSSD）、相邻RR间期差值>50 ms的心搏数占总RR间期个数百分比（percentage of adjacent normal to normal intervals differing by more than 50 ms, PNN50）、高频功率（high frequency power, HF）、低频功率（low frequency power, LF）均低于未感染组（P<0.05）；Pearson相关性检验示，HRV各指标与IL-6、CRP、TNF-α、PCT均呈负相关（均P<0.05）。结论：HICH患者HRV与气管切开后并发肺部感染有关，SDNN、SDANN、RMSSD、PNN50、HF、LF降低提示肺部感染风险增加。

关键词:高血压脑出血,气管切开术,肺部感染,心率变异性

Abstract:

ObjectiveTo investigate the relationship between heart rate variability (HRV) and pulmonary infection after tracheotomy in patients with hypertensive cerebral hemorrhage (HICH), to provide reference for clinical diagnosis and treatment.MethodsThe clinical data of 101 HICH patients who underwent tracheotomy from February 2018 to December 2022 were analyzed retrospectively. The patients were divided into infection group and non-infection group according to the complicated pulmonary infection. The general data, inflammatory markers and HRV indexes of the two groups were compared. Pearson correlation was used to analyze the relationship between HRV and pulmonary infection after tracheotomy in HICH patients.ResultsIn 101 patients with HICH, there were 54 cases (53.5%) developed pulmonary infection within 7 d after tracheotomy. There was a statistically significant difference in preoperative Glasgow coma scale (GCS) between the two groups (P<0.05). The cytokines such as interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and procalcitonin (PCT) in the infected group were higher than those in the non-infection group. The HRV indexes including the standard deviation of RR interval for all sinus beats within 24 h standard deviation of normal to normal interval (SDNN), 24 h average SDNN (SDANN), the root mean square of successive differences in adjacent RR interval(RMSSD), the percentage of beats with percentage of adjacent normal to normal intervals differing by more than 50 ms(PNN50), high frequency power (HF) low frequency power (LF) were all lower than those of non-infection group (P<0.05). The Pearson correlation test showed that HRV was negatively correlated with IL-6, CRP, TNF-α and PCT (P<0.05).ConclusionsHRV in patients with HICH is associated with pulmonary infection after tracheotomy. The lower values of SDNN, SDANN, RMSSD, PNN50, HF, LF suggest an increased risk of pulmonary infection.

Key words:Hypertensive cerebral hemorrhage,Tracheotomy,Pulmonary infection,Heart rate variability

中图分类号:

R563.1
R743

陈李, 汪少卫, 汪云旗. 心率变异性在高血压脑出血患者气管切开后并发肺部感染中的作用[J]. 内科理论与实践, 2024, 19(04): 249-253.

CHEN Li, WANG Shaowei, WANG Yunqi. Role of heart rate variability in patients with hypertensive cerebral hemorrhage complicated by pulmonary infection after tracheotomy[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(04): 249-253.

图/表3

项目	未感染组（n=47）	感染组（n=54）	χ²/t/Z	P
性别[n(%)]			0.004	0.951
男	29（51.7）	33（61.1）
女	18（38.3）	21（38.9）
年龄（岁）	61.00±10.04	61.57±11.25	0.269	0.789
合并糖尿病史	8（17.0）	12（22.2）	0.428	0.513
收缩压（mmHg）	169.40±11.11	168.63±12.30	0.330	0.742
舒张压（mmHg）	101.62±8.33	100.24±8.14	0.838	0.404
术前GCS（分）	10.00（10.00，11.00）	8.00（7.75，9.00）	7.307	<0.001
术前血肿量（mL）	46.81±4.25	46.87±4.36	0.072	0.943

表1

表2

患者炎症标志物与HRV指标情况（$\bar{x}±s$）

项目	未感染组（n=47）	感染组（n=54）	t	P
IL-6（ng/L）	67.04±8.24	81.64±8.97	8.477	<0.001
CRP（mg/L）	60.83±7.42	71.85±8.23	7.025	<0.001
TNF-α（ng/L）	38.69±5.32	47.43±5.64	7.974	<0.001
PCT（ng/mL）	0.64±0.13	0.97±0.18	10.933	<0.001
SDNN（ms）	90.32±10.46	61.24±8.71	15.052	<0.001
SDANN（ms）	132.00±16.52	109.17±18.14	6.575	<0.001
RMSSD（ms）	26.02±6.23	18.26±4.13	7.262	<0.001
PNN50（%）	4.11±0.36	3.44±0.29	10.227	<0.001
HF（ms²）	342.89±12.25	286.70±11.42	23.847	<0.001
LF（ms²）	923.64±24.05	714.69±16.47	50.190	<0.001

表2

表3

HRV指标与患者炎症标志物的关系

项目	IL-6		CRP		TNF-α		PCT
项目	r	P	r	P	r	P	r	P
SDNN	-0.513	<0.001	-0.568	<0.001	-0.474	<0.001	-0.576	<0.001
SDANN	-0.348	<0.001	-0.364	<0.001	-0.242	0.015	-0.352	<0.001
RMSSD	-0.340	0.001	-0.391	<0.001	-0.314	0.001	-0.476	<0.001
PNN50	-0.442	<0.001	-0.387	<0.001	-0.496	<0.001	-0.533	<0.001
HF	-0.564	<0.001	-0.513	<0.001	-0.574	<0.001	-0.714	<0.001
LF	-0.632	<0.001	-0.551	<0.001	-0.595	<0.001	-0.721	<0.001

表3

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