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

doi:10.3969/j.issn.1000-8535.2019.01.002

广州医药 ›› 2019, Vol. 50 ›› Issue (1): 7-11.DOI: 10.3969/j.issn.1000-8535.2019.01.002

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

潘建光¹, 李红艳¹, 王新航¹, 张宏英¹, 黄进宝¹, 吕骁¹, 马晨晖², 翁恒¹, 李天林^1,3

1 福建医科大学教学医院福州肺科医院呼吸内科、RICU （福州 350008）;
2 福建医科大学教学医院福州肺科医院影像科（福州 350008）;
3 厦门长庚医院呼吸内科（厦门 361026)

收稿日期:2018-08-08 出版日期:2019-01-20 发布日期:2021-12-21
通讯作者: 潘建光,E-mail：iampanjianguang@sina.com
基金资助:
福州市科技计划项目（2013-S-124-10）：福建省级临床重点专科建设项目[闽卫医致函（2018）145号]

The clinical research of etiological diagnosis by using bioreactance noninvasive cardiac output monitoring in patients with dyspnea

PAN Jianguang¹, LI Hongyan¹, WANG Xinhang¹, ZHANG Hongying¹, HUANG Jinbao¹, LV Xiao¹, MA Chenhui², WENG Heng¹, LI Tianlin^1,3

1 Department of Respiratory Medicine and Respiratory Intensive Care Unit,Fuzhou Pulmonary Hospital of Fujian,Clinical Teaching Hospital of Fujian Medical University,Fuzhou 350008,China;
2 Department of Radiology,Fuzhou Pulmonary Hospital of Fujian ,Clinical Teaching Hospital of Fujian Medical University,Fuzhou 350008,China;
3 Department of Respiratory Medicine,Xiamen Chang Gung Hospital,Xiamen 361026,China

Received:2018-08-08 Online:2019-01-20 Published:2021-12-21

摘要/Abstract

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 operating 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。

关键词: 呼吸困难, 心力衰竭, 心排血量, 血流动力学

Abstract: 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. Methods Prospective,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. Results Compared 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 2.65L/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 353dynes.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%. Conclusion NICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.

Key words: Dyspnea, Heart Failure, Cardiac Output, Hemodynamics

潘建光, 李红艳, 王新航, 张宏英, 黄进宝, 吕骁, 马晨晖, 翁恒, 李天林. 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[J]. 广州医药, 2019, 50(1): 7-11.

PAN Jianguang, LI Hongyan, WANG Xinhang, ZHANG Hongying, HUANG Jinbao, LV Xiao, MA Chenhui, WENG Heng, LI Tianlin. The clinical research of etiological diagnosis by using bioreactance noninvasive cardiac output monitoring in patients with dyspnea[J]. Guangzhou Medical Journal, 2019, 50(1): 7-11.

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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

The clinical research of etiological diagnosis by using bioreactance noninvasive cardiac output monitoring in patients with dyspnea

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