Korean Journal of Family Medicine (가정의학회지)

The Korean Academy of Family Medicine (대한가정의학회)
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The Relationship between Heart Rate Variability and Illness Severity

심박동수 변이와 질병의 중증도와의 관계

Kim, Sang-Hwan;Hwang, Hee-Jin;Kim, Jae-Won;Sim, Jae-Yong;Lee, Hye-Ree
김상환;황희진;김재원;심재용;이혜리

  • Published : 20050300
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Abstract

Background: In severity of illness index, there is an acute physiologic and chronic health evaluation (APACHE) scoring system which was modified to APACHE III in 1990. Heart rate variability (HRV) studies for the intensive care unit (ICU) patients provides an indirect but noninvasive probe of autonomic cardiovascular control. Therefore, we intended to find out the relationship between the APACHE III score and the HRV variables in ICU patients. Methods: We examined 22 patients in medical ICU of one college hospital from April to May of 2003, excluding patients with cardiac disorders, neurologic disorders or surgical diseases. We also examined 22 patients in general wards of family medicine. We checked the APACHE III during the 24 hours of admission, and examined the HRV on the second day of admission and then the total power (TP), normalized low frequency (LFnorm), low frequency/high frequency ratio (LF/HF ratio) and approximate entropy (ApEn). Results: The average of TP (msec$^{2}$) were 538.9$\pm$896.7 in ICU patients and 1605.3$\pm$3091.8 in patients of general ward. The average APACHE III score was 35.9$\pm$18.5 and by Pearson correlation analysis, the correlation coefficient between the APACHE III score and the log (TP) was-0.58 (P=0.005). Conclusion: We found that the medical ICU patients had more decreased autonomic function than the patients of general ward, and there was a negative correlation with the APACHE III score and the disease severity.

연구배경: 질병의 중증도를 평가하는 방법에는, acute physiologic and chronic health evaluation (APACHE) 점수 체계가 있으며 90년대 들어 APACHE III로 수정되었다. 심박동수 변이는 자율신경계의 심혈관 조절에 대한 정보를 간접적이지만 비침습적으로 제공하고 있다. 이에 중환자에 있어 APACHE III 점수와 심박동수 변이 변수들의 관계에 대해 알아보았다. 방법: 2003년 4월과 5월 사이 일개 대학병원 중환자실에 입원한 환자 중 심장질환, 뇌질환, 외과계 환자를 제외한 22명을 대상으로 하였다. 대조군은 대학병원 가정의학과에 입원한 환자 중에서 나이, 성별로 짝짓기를 하여 22명을 선정하였다. 입원 2일째, 입원 후 24시간 동안의 환자상태로 APACHE III 점수를 부여하고, 심박동수 변이를 시행하여 total power (TP), normalized low frequency (LFnorm), low frequency/high frequency ratio (LF/HF ratio)와 approximate entropy (ApEn)를 구하였다. 결과: 심박동수 변이에서 TP (msec$^{2}$)는 중환자실에 입원한 환자에서 538.9$\pm$896.7이고, 일반병실에 입원한 환자는 1605.3$\pm$3091.8였다. Log (TP)는 중환자실에 입원한 환자가 일반병실에 입원한 환자보다 작았으며, 이는 통계적으로 유의하였다(P=0.003). 중환자에 있어 APACHE III의 평균 점수는 35.0$\pm$18.2였으며, APACHE III 점수와 log (TP)의 피어슨 상관분석 결과 상관계수 -0.582으로 유의하였다(P=0.005). 결론: 중환자실에 입원한 환자의 경우 일반 병실환자보다 전반적인 자율신경계 기능이 감소되어 있으며, 심박동수 변이가 작을수록 질병의 중증도는 커짐을 알 수 있었다.

Keywords

References

  1. 정영균, 이헌근, 최 윤. 마취 회복 시 R-R간격의 변화의 Power Spectrum의 변화에 관한 연구. 대한마취과학회지 1992;25:928-34
  2. Task force of the european society of cardiology and the north american society of pacing and electrophysiology. Heart rate variability-standard of measurement, physiological interpretation and clinical use. Eur Heart J 1996;17:354-81 https://doi.org/10.1093/oxfordjournals.eurheartj.a014868
  3. Malik M, Camm AJ. Heart rate variability and clinical cardiology. Br Heart J 1994;71:3-6 https://doi.org/10.1136/hrt.71.1.3
  4. Barnaby D, Ferric K, Kaplan DT, Shah S, Bijur P, Gallagher EJ. Heart rate variability in emergency department patients with sepsis. Acad Emerg Med 2002;9:661-70 https://doi.org/10.1111/j.1553-2712.2002.tb02143.x
  5. Pincus SM, Goldberger AL. Physiologic time-series analysis: what does regularity quantify? Am J Physiol 1994;226: H1643-56
  6. Vikman S, Makikallio TH, Yli-Mayry S, Pikkujamsa S, Koivisto AM, Reinikainen P, et al. Altered complexity and correlation properties of R-R interval dynamics before the spontaneous onset of paroxysmal atrial fibrillation. Circulation 1999; 100:2079-84 https://doi.org/10.1161/01.CIR.100.20.2079
  7. Godin PJ, Fleisher LA, Eidsath A, Vandivier RW, Preas HL, Banks SM, et al. Experimental human endotoxemia increases cardiac regularity: Results from a prospective, randomized, crossover trial. Crit Care Med 1996;24:1117-24 https://doi.org/10.1097/00003246-199607000-00009
  8. Makikallio TH, Ristimae T, Airaksinen KE, Peng CK, Goldberger AL, Huikuri HV. Heart rate dynamics in patients with stable angina pectoris and utility of fractal and complexity measures. Am J Cardiol 1998;81:27-31 https://doi.org/10.1016/S0002-9149(97)00799-6
  9. Lanza GA, Guido V, Galeazzi MM, Mustilli M, Natali R, Ierardi C, et al. Prognostic role of heart rate variability in patients with a recent acute myocardial infarction. Am J Cardiol 1998;82:1323-8 https://doi.org/10.1016/S0002-9149(98)00635-3
  10. Doulalas AD, Flather MD, Pipilis A, Campbell S, Studart F, Rizos IK, et al. Evolutionary pattern and prognostic importance of heart rate variability during the early phase of acute myocardial infarction. Int J Cardiol 2001;77:169-79 https://doi.org/10.1016/S0167-5273(00)00420-4
  11. Kanaya N, Hirata N, Kurosawa S, Nakayama M, Namiki A. Differential effects of propofol and sevoflurane on heart rate variability. Anesthesiology 2003;98(1):34-40 https://doi.org/10.1097/00000542-200301000-00009
  12. 안유헌, 함준수, 임헌길, 이정균, 김목현, 강성수 등. 당뇨병 환자에서의 심전도 분석기를 이용한 자율 신경장애의 빠 른 선별 검사. 당뇨병 1994;18:46-55
  13. Baillard C, Vivien B, Mansier P, Mangin L, Jasson S, Riou B, et al. Brain death assessment using instant spectral analysis of heart rate variability. Crit Care Med 2002; 30(2):306-10 https://doi.org/10.1097/00003246-200202000-00007
  14. 이용제, 김문성, 김범택, 곽태환, 심재용, 이혜리. 대사증후 군과 심박동수 변이와의 관계. 가정의학회지 2002;23(12): 1432-9
  15. Buchman TG, Stein PK, Goldstein B. Heart rate variability in critical illness and critical care. Curr Opin Crit Care 2002; 8:311-5 https://doi.org/10.1097/00075198-200208000-00007
  16. Yien HW, Hseu SS, Lee LC, Kuo TB, LEE TY, Chan SH. Spectral analysis of systemic arterial pressure and heart rate signals as a prognostic tool for the prediction of patient outcome in the intensive care unit. Crit Care Med 1997;25:258-66 https://doi.org/10.1097/00003246-199702000-00011
  17. Winchell RJ, Hoyt DB. Spectral analysis of heart rate variability in the ICU: A measure of autonomic function. J Surg Res 1996;63:11-6 https://doi.org/10.1006/jsre.1996.0214
  18. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE　III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619-36 https://doi.org/10.1378/chest.100.6.1619
  19. 김준식, 이영주, 조준필. 중환자에서 APACHE III score와 사 망률과의 관계. 대한응급의학회지 1995;6(1):58-65
  20. 유진홍, 김연근, 신완식, 강문원. APACHE III를 이용한 내 과 중환자실 환자의 질병 중증도 평가. 대한내과학회지 1996;50(3):392-8
  21. 정상원, 윤유상, 김승호, 이한식, 김유선, 지훈상. 출혈성 숔 환자에서 Power Spectral Analysis를 이용한 심박수 변이도 분석의 의의. 대한응급의학회지 2000;11:44-53
  22. Korach M, Sharshar T, Jarrin I, Fouillot JP, Raphael JC, Gajdos P, et al. Cardiac variability in critically ill adults: influence of sepsis. Crit Care Med 2001;29:1380-5 https://doi.org/10.1097/00003246-200107000-00013
  23. 민성원. 술 후 심근허혈시 심박수 변이도의 선형 및 비선형 분석: 시간변역 분석 및 Approximate entropy. 대한마취과학 회지 2001;41:140-7
  24. Ryan SM, Goldberger AL, Pincus SM, Mietus J, Lipsitz LA. Gender and age related differences in heart rate dynamics: Are women more complex than men? J Am Coll Cardiol 1994; 24:1700-7 https://doi.org/10.1016/0735-1097(94)90177-5
  25. Goldberger AL, Mietus JE, Rigney DR, Wood ML, Fortney SM. Effects of head-down bed rest on complex heart rate variability: response to LBNP testing. J Appl Physiol 1994; 77:2863-9 https://doi.org/10.1152/jappl.1994.77.6.2863