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目的评价全身炎症反应综合征(SIRS)患者的自主神经活动,了解心率变异(HRV)与SIRS患者病情严重程度、脏器受损程度以及预后的关系。方法用24h动态心电图监测分析100例SIRS组患者和30例非SIRS组患者及30例正常对照组患者的HRV时域指标及频域指标。结果①SIRS组与非SIRS组相比,APACHEⅡ评分、MODS评分明显升高(P＜0．01),HRV下降(P＜0．05)。②SIRS亚组中生存组与死亡组相比,后者APACHEⅡ评分、MODS评分明显升高(P＜0．01),HRV下降(P＜0．01)。③患者预后与SDNN呈负相关,相关系数r=-4．68,P＜0．01；SDNN＜55ms预测SIRS患者的敏感性、特异性、阳性预测值和阴性预测值最高(分别为76．2%、76．7%、90．4%、52．6%)。结论①SIRS患者HRV明显降低,且与疾病严重程度,及脏器功能受损程度呈负相关,与预后呈负相关。②HRV可以作为评价SIRS患者预后的有用指标。
Objective To evaluate the autonomic nervous system activity in patients with systemic inflammatory response syndrome (SIRS) and to understand the relationship between heart rate variability (HRV) and the severity of SIRS, organ damage and prognosis. Methods The HRV time domain and frequency domain indices of 100 patients with SIRS and 30 patients with non-SIRS and 30 normal controls were monitored with 24-hour Holter monitoring. Results ① Compared with non-SIRS group, APACHEⅡ score and MODS score increased significantly (P <0.01) and HRV decreased (P <0.05). (2) Compared with the death group, the APACHEⅡscores and the MODS scores of the survivors in the SIRS subgroup were significantly increased (P <0.01) and HRV decreased (P <0.01). The prognosis of patients with SIRS was negatively correlated with SDNN, the correlation coefficient r = -4.68, P <0.01; SDNN <55ms predicted the sensitivity, specificity, positive predictive value and negative predictive value of SIRS patients (76%, respectively). 2%, 76.7%, 90.4%, 52.6%). Conclusion ① The HRV in patients with SIRS is significantly lower than that in patients with SIRS, and is negatively correlated with the severity of the disease and the degree of organ dysfunction. The HRV is negatively correlated with the prognosis. ② HRV can be used as a useful indicator to evaluate the prognosis of patients with SIRS.