英國1109位4-16歲兒童統計之心跳HR及呼吸速率研究,發現平均心跳從4歲時的每分鐘103次逐漸降至16歲時的每分鐘71次(已與成人相同),而兒童的平均呼吸速率從4歲時的每分鐘22次逐漸降至16歲時的每分鐘14次(已與成人相同)
Age related reference ranges for respiration
rate
and heart rate from 4 to 16 years
L A Wallis, M Healy, M B
Undy, I Maconochie
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Correspondence to:
Dr L A Wallis, PO Box
901, Wellington, 7654,
South Africa; leewallis@
bvr.co.za
Accepted 30 June 2005
Published Online First
27 July 2005
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Arch Dis Child 2005;90:1117–1121. doi: 10.1136/adc.2004.068718
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720181/
Background: Clinical vital signs in
children (temperature, heart rate, respiration rate, and blood pressure) are
an integral part of
clinical assessment of degree of illness or normality. Despite this, only blood
pressure and
temperature have a reliable
evidence base. The accepted ranges of heart and respiration rate vary widely.
Methods: This study examined 1109
children aged 4–16 years in their own schools. Age, sex, height,
weight, and resting
respiration rate and heart rate were recorded. The data were used to produce
age
related reference ranges for
everyday clinical use.
Results: Reference intervals are
presented for the range of heart rate and respiration rate of healthy resting
children aged 4–16 years. The
recorded values are at variance with standard quoted ranges in currently
available texts.
Clinical decision
making relies on the history, examination,
and results of selected
investigations. As part of
the general clinical
examination, four vital signs are
routinely recorded: heart rate,
respiration rate, blood pressure,
and temperature.
In order to derive
clinically meaningful information for the
paediatric patient, we must compare the vital signs
recorded
against a normal or reference
range. Normal values for
temperature are well established1
and there is good evidence
for normal values of
blood pressure at various ages.2–4 With
regard to respiration rate
(RR) and heart rate (HR), however,
there is little evidence on
which to base our ‘‘normal’’ values.
Despite this,
textbooks produce tables of reference values for
various age groups, based on
small numbers of patients.
Bates’ guide to
physical examination and history taking5 states that
the normal values for RR
in a newborn ‘‘should be 30–60,
reducing to 20–40 in early
childhood and 15–25 in older
children’’. The same book
states that the normal HR for a
newborn should be 140, reducing
to 115 between 6 months
and 1 year, 110 between 1
and 2 years, 103 between 2 and 6,
95 aged 6 to 10, and
85 between 10 and 14 years. Both the
Forfar and Arneill6 and Nelson7 textbooks also quote
ranges of
values.
These values produce
widely differing ranges of what may
be termed normal for
healthy children. In a 1 year old, for
instance, the range of RR
values is from 25 to 60: a rate of 30
would be considered normal
in some of these texts, while
others consider this bradypnoea and recommend intervention.
In view of the lack of
evidence behind the values that are
commonly quoted, we undertook
a study in Plymouth, UK, to
investigate the reference ranges
of heart rate and respiration
rate in healthy, resting
schoolchildren.
The aim of this study
was to produce up to date reference
ranges of heart rate and
respiration rate for healthy resting
children aged 4–16 years.
METHODS
Plymouth was chosen as
the site of the study as it is a fairly
typical medium sized town,
situated at sea level in the
southwest of the UK. It has a
population of 240 000 and a
fairly typical socioeconomic
mix.8
Ethical approval was
obtained through the South Devon
Local Regional Ethics
Committee. Following sample size
calculations and estimates of
likely consent rates, eight
schools in Plymouth, Devon
were approached; six agreed to
take part in the study.
The schools were chosen at random
from lists of primary and
secondary schools supplied by the
local education board: four
primary and four secondary
schools were selected. Random
number generation of
subjects was undertaken by
computer.
All children aged 4–16
years were asked to participate.
After explanation to
the children and their parents (in the
form of a letter, and a
presentation at the schools’
assemblies), parental consent
was sought for each child; in
addition, children over 12
were asked to give their own
consent. Children were
excluded from the study if consent
was refused or the form
was not returned.
All children were seen
in their school by a single
investigator (LAW), in the
presence of a female nurse
chaperone. Children were
brought out of their classrooms
and left to sit quietly
in a warm waiting area for 10 minutes.
The children then sat
quietly in a warm, well lit classroom
while their RR was measured
by 60 seconds of direct
observation of the clothed chest
wall (by LAW). A partially
completed breath in the 60
second time period was counted
as a whole breath.
Each child then had
their HR measured for 60 seconds
using a Datex
S5 Lite monitor. A finger probe was used in all
cases. Recording did not
commence until a suitable trace with
a regular, pulsatile
waveform was achieved continuously for
20 seconds. Data were
transferred real time to a computer,
using Datex
software: recordings were made at 5 second
intervals for 60 seconds. The
mean of these recordings was
registered as the child’s HR.
Height and weight were
recorded. Height was measured
barefoot using a Leicester
height measure: weight was also
taken barefoot, with scales
calibrated by the Department of
Medical Physics at Derriford Hospital, Plymouth.
Children who were
unwell on the day of the study (but
were well enough to attend
school) were still included in the
sample, as were children
with diagnosed or undiagnosed
medical conditions. No
attempt was made to identify these
children in the database.
Abbreviations: HR, heart rate; RR,
respiration