生物电抗无创心排监测对呼吸困难患者病因诊断的临床研究
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摘要
目的探讨生物电抗无创心排监测(bioreactance noninvasive cardiac output monitoring,NICOM)心指数(cardiac index,CI)和总外周阻力指数(total peripheral resistance index TPRI)对呼吸困难病因诊断的临床价值。方法采用前瞻性观察性研究的方法 ,纳入急性呼吸困难或慢性呼吸困难急性加重的患者共113例,临床医师根据2010年中华医学会心血管病学分会编委会组织编写的《急性心力衰竭诊断和治疗指南》为金标准分为心力衰竭组(n=55)和非心力衰竭组(n=58),通过NICOM监测CI、TPRI,构建受试者工作特征曲线(receiver op-erating characteristic curve,ROC曲线),分析CI和TPRI对心力衰竭的诊断价值。结果心力衰竭组患者的CI低于非心力衰竭组(P<0.001);心力衰竭组患者TPRI高于非心力衰竭组(P<0.001);利用ROC曲线进行分析,CI曲线下面积(area under the curve,AUC)为0.792 (95%CI:0.708～0.875,P=0.000),当CI截断值取2.65L/(min·m2)时,诊断心力衰竭的敏感度为63.6%,特异度为87.9%;TPRI的AUC为0.733 (95%CI:0.641～0.825,P=0.000),当TPRI截断值取2 353dynes.sec/(cm5·m2)时,诊断心力衰竭的敏感度为72.7%,特异度为67.2%;CI联合TPRI诊断心力衰竭的敏感度为80%,特异度为65.5%。结论 NICOM监测CI对心力衰竭所致的呼吸困难特异度高,联合TPRI监测可提高敏感度。
Objective To investigate the clinical values of etiological diagnosis by testing cardiac index CI and total peripheral resistance index TPRI using bioreactance noninvasive cardiac output monitoring NICOM in patients with dyspnea.MethodsProspective,observational study was taken in 113 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease.The patients were divided into two groups namely heart failure group(n=55) and non-heart failure group(n=58) according to the guidelines on the diagnosis and treatment of acute heart failure(2010) as the standard criterion.All patients underwent CI and TPRI test by using NICOM.Receiver operating characteristic curve(ROC curve)was plotted to evaluate the diagnostic value of CI and TPRI.ResultsCompared with non-heart failure group,the CI was worse(P<0.001),and the TPRI was elevated(P<0.001).ROC curve showed that the area under the curve(AUC) of CI was 0.792(95%CI:0.708～0.875,P=0.000).The cut-off of CI was 2.65 L/min/m2,the sensitivity was 63.6%,and specificity was 87.9%.The AUC of TPRI was 0.733(95%CI:0.641～0.825,P=0.000).The cut-off of CI was 2 353 dynes.sec/cm5/m2,the sensitivity was 72.7%,and specificity was 67.2%.The sensitivity of CI combined TPRI was 80%,and specificity was 65.5%.ConclusionNICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.
Objective To investigate the clinical values of etiological diagnosis by testing cardiac index CI and total peripheral resistance index TPRI using bioreactance noninvasive cardiac output monitoring NICOM in patients with dyspnea.MethodsProspective,observational study was taken in 113 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease.The patients were divided into two groups namely heart failure group(n=55) and non-heart failure group(n=58) according to the guidelines on the diagnosis and treatment of acute heart failure(2010) as the standard criterion.All patients underwent CI and TPRI test by using NICOM.Receiver operating characteristic curve(ROC curve)was plotted to evaluate the diagnostic value of CI and TPRI.ResultsCompared with non-heart failure group,the CI was worse(P<0.001),and the TPRI was elevated(P<0.001).ROC curve showed that the area under the curve(AUC) of CI was 0.792(95%CI:0.708～0.875,P=0.000).The cut-off of CI was 2.65 L/min/m2,the sensitivity was 63.6%,and specificity was 87.9%.The AUC of TPRI was 0.733(95%CI:0.641～0.825,P=0.000).The cut-off of CI was 2 353 dynes.sec/cm5/m2,the sensitivity was 72.7%,and specificity was 67.2%.The sensitivity of CI combined TPRI was 80%,and specificity was 65.5%.ConclusionNICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.
引文
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[7]吴文,聂昆,孟军,等.肺部超声联合N-末端B型钠尿肽前体诊断急性呼吸呼吸困难的临床价值[J].中国急救医学,2016,36(6):507-512.
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[9]陈炜,赵磊,李丽娟,等.血管外肺水指数与心指数对心源性休克患者预后的预测价值[J].中国循环杂志,2014,29(11):895-898.
[10]KEREN H,BURKHOFF D,SQUARA P.Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance[J].Am J Physiol Heart Circ Physiol,2007,293(293):H583-589.
[11]COTTER G,KALUSKI E,MILO O,et al.The role of cardiac power and systemic vascular resistance in the pathophysiology and diagnosis of patients with acute congestive heart failure[J].J Am Coll Cardiol,2003,2(S1):443-451.
[12]叶宁,骆雪萍,钟荣,等.严重脓毒症患者循环功能指标与血管外肺水指数的相关性探讨[J].山东医药,2013,53(4):51-53.
[2]CHEUNG H,QUAN D,RONG D,et al.Correlation of cardiac output measured by non-invasive continuous cardiac output monitoring(NICOM)and thermodilution in patients undergoing off-pump coronary artery bypass surgery[J].J Anesth,2015,29(3):416-420.
[3]中华医学会心血管病学分会.急性心力衰竭诊断和治疗指南[J].中华心血管病杂志,2010,38(3):195-208
[4]MEMBERS W C,HUNT S A,ABRAHAM W T,et al.ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult[J].JAm Coll Cardiol,2005,46(6):1116-1143.
[5]SINGER A J,EMERMAN C,CHAR D M,et al.Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease.[J].Ann Emerg Med,2008,51(1):25-34.
[6]POLITIS J,LE B,SMALLWOOD N.Respiratory depression secondary to morphine use in a patient with COPD and refractory breathlessness[J].Eur Respir,2017,49(5):1601858.
[7]吴文,聂昆,孟军,等.肺部超声联合N-末端B型钠尿肽前体诊断急性呼吸呼吸困难的临床价值[J].中国急救医学,2016,36(6):507-512.
[8]RICH J D,ARCHER S L,RICH S.Evaluation of noninvasively measured cardiac output in patients with pulmonary hypertension[C].Am Thorac Soci 2011 Int Conf,2011:A6440-A6440.
[9]陈炜,赵磊,李丽娟,等.血管外肺水指数与心指数对心源性休克患者预后的预测价值[J].中国循环杂志,2014,29(11):895-898.
[10]KEREN H,BURKHOFF D,SQUARA P.Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance[J].Am J Physiol Heart Circ Physiol,2007,293(293):H583-589.
[11]COTTER G,KALUSKI E,MILO O,et al.The role of cardiac power and systemic vascular resistance in the pathophysiology and diagnosis of patients with acute congestive heart failure[J].J Am Coll Cardiol,2003,2(S1):443-451.
[12]叶宁,骆雪萍,钟荣,等.严重脓毒症患者循环功能指标与血管外肺水指数的相关性探讨[J].山东医药,2013,53(4):51-53.