无创心脏血流动力监测仪在ICU危重病患者中的应用
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摘要
目的评价无创心脏血流动力监测仪对ICU危重病患者心功能测定的有效性。方法选择2016年12月至2017年8月在惠州市第三人民医院急诊重症监护室(EICU)接受治疗并进行无创心脏血流动力监测的40例危重病患者,在行床旁超声心动图检查后立即应用无创心脏血流动力监测仪行心功能测定,监测每搏输出量(SV)、心输出量(CO)和左室射血分数(LVEF)等指标,采用Pearson相关分析评价两种仪器测定结果的相关性。结果无创心脏血流动力监测仪测定的SV、CO及LVEF分别为(51.73±15.49)mL、(4.27±1.34)L/min、(57.05±11.29)%,床旁超声心动图测定的SV、CO及LVEF分别为(44.01±17.05)mL、(3.67±1.46)L/min、(54.88±13.76)%。两种仪器测定的SV、CO及LVEF经Pearson相关分析均呈正相关(r分别为0.725、0.761、0.448,P<0.01),排除心律失常患者后的两种仪器测定的SV、CO及LVEF经Pearson相关分析也呈正相关(r分别为0.875、0.869、0.691,P<0.01)。结论基于生物阻抗法的无创心脏血流动力监测仪可有效地用于ICU危重病患者评价心功能,其监测的SV、CO及LVEF与床旁超声心动图测定的结果具有较好的临床一致性,可反映患者的心功能。
Objective To evaluate the effectiveness of noninvasive cardiac hemodynamic monitor for measuring cardiac function of critically ill patients in ICU. Methods Forty critically ill patients who were treated and underwent noninvasive cardiac hemodynamic monitoring in the Emergency Intensive Care Unit(EICU) of the Third People's Hospital of Huizhou city during December 2016 and August 2017 were selected in this study. Immediately after bedside echocardiography, the noninvasive cardiac hemodynamic monitoring was performed to measure cardiac function, including monitoring stroke volume(SV), cardiac output(CO), and left ventricular ejection fraction(LVEF). Pearson correlation analysis was used to evaluate the correlation between the results of two instruments. Results The SV, CO and LVEF were(51.73±15.49) mL,(4.27±1.34) L/min and(57.05±11.29)%, respectively, measured by the noninvasive cardiac hemodynamic monitor, and(44.01±17.05) mL,(3.67±1.46) L/min,(54.88±13.76)%, respectively, measured by bedside echocardiography. The relevant values(SV, CO and LVEF) measured by two instruments were positively correlated by Pearson correlation(r=0.725, 0.761, 0.448, respectively, P<0.01). After excluding patients with arrhythmia, SV, CO,and LVEF measured by the two instruments were also positively correlated by Pearson correlation analysis(r=0.875,0.869, 0.691, respectively, P<0.01). Conclusion Noninvasive cardiac hemodynamic monitor based on biological impedance method can be effectively used for ICU critically ill patients to evaluate the cardiac function. The monitoring results of SV, CO and LVEF have good clinical consistency with the results of bedside echocardiography and can reflect the cardiac function of patients.
Objective To evaluate the effectiveness of noninvasive cardiac hemodynamic monitor for measuring cardiac function of critically ill patients in ICU. Methods Forty critically ill patients who were treated and underwent noninvasive cardiac hemodynamic monitoring in the Emergency Intensive Care Unit(EICU) of the Third People's Hospital of Huizhou city during December 2016 and August 2017 were selected in this study. Immediately after bedside echocardiography, the noninvasive cardiac hemodynamic monitoring was performed to measure cardiac function, including monitoring stroke volume(SV), cardiac output(CO), and left ventricular ejection fraction(LVEF). Pearson correlation analysis was used to evaluate the correlation between the results of two instruments. Results The SV, CO and LVEF were(51.73±15.49) mL,(4.27±1.34) L/min and(57.05±11.29)%, respectively, measured by the noninvasive cardiac hemodynamic monitor, and(44.01±17.05) mL,(3.67±1.46) L/min,(54.88±13.76)%, respectively, measured by bedside echocardiography. The relevant values(SV, CO and LVEF) measured by two instruments were positively correlated by Pearson correlation(r=0.725, 0.761, 0.448, respectively, P<0.01). After excluding patients with arrhythmia, SV, CO,and LVEF measured by the two instruments were also positively correlated by Pearson correlation analysis(r=0.875,0.869, 0.691, respectively, P<0.01). Conclusion Noninvasive cardiac hemodynamic monitor based on biological impedance method can be effectively used for ICU critically ill patients to evaluate the cardiac function. The monitoring results of SV, CO and LVEF have good clinical consistency with the results of bedside echocardiography and can reflect the cardiac function of patients.
引文
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[2]Cecconi M,De Backer D,Antonelli M,et al.Consensus on circulatory shock and hemodynamic monitoring.Task force of the European Society of Intensive Care Medicine[J].Intensive Care Med,2014,40(12):1795-1815.
[3]中国医师协会急诊医师分会.急性循环衰竭中国急诊临床实践专家共识[S].中华急诊医学杂志,2016,25(2):146-152.
[4]Vincent JL,De Backer D.Circulatory shock[J].N Engl J Med,2013,369(18):1726-1734.
[5]Bernstein DP,Lemmens HJ.Stroke volume equation for impedance cardiography[J].Med Biol Eng Comput,2005,43(4):443-450.
[6]洪虹,金雪娟,潘翠珍.无创心脏血流动力学监测仪与超声心动图检测心功能指标的相关性分析[J].中国医疗器械杂志,2009.33(5):328-331.
[7]Melamed R,Sprenkle MD,Ulstad VK,et al.Assessment of left ventricular function by intensivists using hand-held echocardiography[J].Chest,2009,135(6):1416-1420.
[8]Moore CL,Rose GA,Tayal VS,et al.Determination of left ventricular function by emergency physician echocardiography of hypotensive patients[J].Acad Emerg Med,2002,9(3):186-193.
[9]Kimura BJ,Amundson SA,Willis CL,et al.Usefulness of a hand-held ultrasound device for bedside examination of left ventricular function[J].Am J Cardiol,2002,90(9):1038-1039.
[10]Hundley WG,Bluemke DA,Finn JP,et al.ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance:a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents[J].Circulation,2010,121(22):2462-2508.