心律失常时有创动脉压力波及脉氧饱和度波曲线下面积的变化

Study on the changes of area under the curve of invasive arterial pressure waveform and pulse oximetry waveform in patients with arrhythmia

目的观察及测量心律失常前、后的有创动脉压力波形(简称压力波)与脉搏血氧饱和度波形(简称脉氧波)曲线下面积的改变,探讨其临床意义。方法收集因治疗需要已行有创动脉压力监测及脉搏血氧饱和度监测的200例患者的压力、脉氧波曲线,分为窦性心律组(简称窦律组)及心律失常组,心律失常组分为房性期前收缩组(简称房早组)、室性期前收缩组(简称室早组)、心房颤动组(简称房颤组)及快速性(室上性/室性)心律失常组(简称快速心律组),分别计算窦性心律时与心律失常时的压力波与脉氧波曲线下面积,及其对应的心电图周期的PR、RR间期,收集患者心脏多普勒超声检测的左室射血分数(LVEF)、左室短轴缩短率(FS)、左室舒张末径(LVED)等参数及临床检验参数。结果窦律时的压力波曲线下面积为:64.75±40.75mm^(2),脉氧波曲线下面积为87.05±37.46mm^(2),男性与女性之间无明显差异性,RR间期与脉氧及压力曲线下面积均呈正相关,相关系数分别为γ=0.378、0.609(p=0.036、p<0.001)。房早、房颤、室早的压力、脉氧波曲线下面积与RR间期均呈正相关,与PR间期无关。房早的压力、脉氧波曲线下面积及两者与RR间期的相关系数分别为γ=0.848、0.675、0.614(p<0.001);房颤时的压力、脉氧波曲线下面积及两者与RR间期的相关系数分别为γ=0.430、0.641、0.392(p<0.001);室早的压力、脉氧波曲线下面积及两者与RR间期的相关系数分别为γ=0.820、0.554、0.714(p<0.001)。室上速及室速的压力波曲线下面积与RR间期呈正相关,相关系数分别为γ=0.847(p<0.05)。室上速及室速发作前、后压力波曲线下面积减少有显著差异(p<0.05)。结论有创动脉压力、脉搏血氧饱和度波形曲线下面积在不同的心律失常有明显差异性;房早、房颤、室早的压力、脉氧波曲线下面积均与RR间期呈正相关,与PR间期无关,其压力与脉氧波曲线下面积呈正相关。室上/室速的压力波曲线下面积与RR间期呈正相关,其发作前、后压力波曲线下面积减少有显著差异。故可通过观察及估算压力、脉氧波曲线下面积的变化,即时评估心律失常时对每搏输出量的影响,结合有创血压可及时了解心律失常对血流动力学的影响,及时调整RR间期可改善每搏输出量及快速性心律失常时的血流动力学,具有较大的临床意义。

Objective To observe and measure the changes of area under the waveform curves of invasive arterial pressure waveform(IABW)and pulse oximetry waveform(POW)before and after arrhythmia,and to explore its clinical significance.Methods The invasive arterial pressure and pulse oximetry waveform curves of 200 patients who underwent invasive arterial pressure monitoring and pulse oximetry monitoring were collected.They were divided into sinus rhythm group and arrhythmia group,and the arrhythmia group was divided into atrial presystolic group(AP),ventricular presystolic group(VP),atrial fibrillation group(AF)and tachyarrhythmia(supraventricular/ventricular)group.The areas under the curve of invasive arterial pressure and pulse oximetry waveform in sinus rhythm and arrhythmia were calculated respectively,and the PR and RR intervals of corresponding electrocardiogram cycles were calculated too.And LVEF,FS,LVED and other parameters of cardiac Doppler and clinical test parameters were collected.Results The area under the IABW curve in the sinus rhythm was 64.75±40.75mm^(2).The area under POW curve was87.05±37.46mm^(2).There was no significant difference between male and female.RR interval was positively correlated with the area under IABW and POW curve,with correlation coefficientsγ=0.609,0.378,p<0.001,p=0.036respectively.The areas under IABW and POW curve of atrial premature,atrial fibrillation and ventricular premature were positively correlated with RR interval,but not with PR interval.The correlation coefficients between the area under the IABW curve and POW curve,and RR interval in AP group wereγ=0.848,0.675,0.614 respectively,p<0.001;and the correlation coefficients during AF group wereγ=0.430,0.641,0.392,p<0.001;andγ=0.820,0.554,0.714 in VP group,p<0.001.The area under the IABW curve of tachyarrhythmia was positively correlated with RR interval,and the correlation coefficient wasγ=0.847,p<0.05.There was significant difference in the decrease of areas under IABW curve in tachyarrhythmia compared with cardioversion,p<0.05.Conclusions The area under the curve of invasive arterial pressure waveform and pulse oximetry waveform is significantly different in different arrhythmias.The areas under IABW and POW curve of atrial premature,atrial fibrillation and ventricular premature were positively correlated with RR interval,but not with PR interval.The areas under IABW curve is positively correlated with the area under the POW curve.And the area under the IABW curve of tachyarrhythmia was positively correlated with RR interval.There was significant difference in the decrease of areas under IABW curve in tachyarrhythmia compared with cardioversion.Therefore,we can immediately evaluate the impact of arrhythmia on stroke output by observing and estimating the changes of area under the curve of IABW and POW.Combined with invasive blood pressure,we can timely understand the impact of arrhythmia on hemodynamics,and timely adjust RR interval can improve stroke output and hemodynamics in tachyarrhythmia,which has great clinical significance.