Journal of cardiothoracic surgery · 2026
Predictive value of intraoperative hemodynamics and heart rate variability for postoperative emergence quality in children undergoing transcatheter VSD closure.
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Xie Yingxiang
Аннотация
BACKGROUND: To study the predictive values of intraoperative hemodynamics and heart rate (HR) variability for the postoperative emergence quality of children undergoing transcatheter closure of ventricular septal defects.
METHODS: A total of 110 pediatric patients treated from January 2023 to January 2024 were divided into good and poor emergence groups according to the presence of emergence delirium and/or agitation. Hemodynamic and HR variability parameters were recorded at four time points (T0: start of surgery; T1: 30 min; T2: 60 min; T3: 30 min before end).
RESULTS: The good emergence group showed significantly lower HR from T0 to T3 and higher systolic and diastolic blood pressure from T1 to T3 and T2 to T3 compared with the poor emergence group (P < 0.05). Across T0-T3, total power (TP), high-frequency (HF), and low-frequency (LF) components were significantly higher, whereas the LF/HF ratio was significantly lower in the good emergence group (P < 0.05). At T2, TP was 586.20 ± 130.07 ms² versus 422.16 ± 86.85 ms², HF was 152.36 ± 26.02 ms² versus 93.57 ± 20.49 ms², and the LF/HF ratio was 1.07 ± 0.16 versus 1.35 ± 0.29 in the good and poor groups, respectively. The combined predictive value of intraoperative hemodynamics and HR variability showed an AUC of 0.892 (95% CI: 0.825-0.959), with 93.55% sensitivity and 79.75% specificity.
CONCLUSIONS: More stable intraoperative hemodynamics and higher HR variability were associated with better postoperative emergence quality. The combined assessment demonstrated high predictive accuracy, suggesting potential clinical utility.
METHODS: A total of 110 pediatric patients treated from January 2023 to January 2024 were divided into good and poor emergence groups according to the presence of emergence delirium and/or agitation. Hemodynamic and HR variability parameters were recorded at four time points (T0: start of surgery; T1: 30 min; T2: 60 min; T3: 30 min before end).
RESULTS: The good emergence group showed significantly lower HR from T0 to T3 and higher systolic and diastolic blood pressure from T1 to T3 and T2 to T3 compared with the poor emergence group (P < 0.05). Across T0-T3, total power (TP), high-frequency (HF), and low-frequency (LF) components were significantly higher, whereas the LF/HF ratio was significantly lower in the good emergence group (P < 0.05). At T2, TP was 586.20 ± 130.07 ms² versus 422.16 ± 86.85 ms², HF was 152.36 ± 26.02 ms² versus 93.57 ± 20.49 ms², and the LF/HF ratio was 1.07 ± 0.16 versus 1.35 ± 0.29 in the good and poor groups, respectively. The combined predictive value of intraoperative hemodynamics and HR variability showed an AUC of 0.892 (95% CI: 0.825-0.959), with 93.55% sensitivity and 79.75% specificity.
CONCLUSIONS: More stable intraoperative hemodynamics and higher HR variability were associated with better postoperative emergence quality. The combined assessment demonstrated high predictive accuracy, suggesting potential clinical utility.