基于可穿戴技术的临床监护新模式探索研究

Investigation on new paradigm of clinical physiological monitoring by using wearable devices

可穿戴作为一种低负荷生理监测技术,可为慢病的监测、评估和管理提供新的技术手段,是未来监护技术的一个发展方向,但作为一种新型监护技术,其临床应用模式和价值尚需深入探索。本研究在解放军总医院普通病房(非重症监护病房)搭建了基于可穿戴设备的病区中央监护系统,分析了穿戴式生理监护技术临床应用价值点,将其与诊疗流程相结合并应用于临床监护。系统能够有效采集心电、呼吸、血氧、脉搏、体位/体动等数据,实现实时监护、预测预警和病情评估等功能。自2018年3月—2020年1月共进行了1268人次(657例患者)的连续穿戴式生理监护,通过信号质量算法和人工判读对信号进行筛查,1198人次(632例)数据可用于分析,占总数的94.48%(96.19%)。通过连续生理数据分析和人工校正,632例患者中检测出睡眠呼吸事件、夜间低血氧症、心动过速、室性早搏等各类患者232(36.65%)、58(9.16%)、30(4.74%)、42(6.64%)例,而在病案中,这些异常事件记录的人数分别为4(0.63%)、0(0.00%)、24(3.80%)、15(2.37%)例,从睡眠呼吸事件结果统计分析中发现,与健康人群相比,慢病患者更容易发生睡眠呼吸事件,且男性发生率(62.93%)高于女性(37.07%)。研究表明,穿戴式生理监测技术能够为住院患者提供一种新型监护模式,通过可穿戴设备的连续生理监测与分析能够捕捉到更多异常事件,为临床诊疗提供更加丰富的决策支持信息,并且这种新型监护模式能够有效融入现有医疗流程。后续可进一步探索新型监护模式在不同临床应用场景中的适用性,丰富可穿戴技术临床应用价值点,为慢病的监测、评估和管理提供更加丰富的工具和手段。

As a low-load physiological monitoring technology,wearable devices can provide new methods for monitoring,evaluating and managing chronic diseases,which is a direction for the future development of monitoring technology.However,as a new type of monitoring technology,its clinical application mode and value are still unclear and need to be further explored.In this study,a central monitoring system based on wearable devices was built in the general ward(non-ICU ward)of PLA General Hospital,the value points of clinical application of wearable physiological monitoring technology were analyzed,and the system was combined with the treatment process and applied to clinical monitoring.The system is able to effectively collect data such as electrocardiogram,respiration,blood oxygen,pulse rate,and body position/movement to achieve real-time monitoring,prediction and early warning,and condition assessment.And since its operation from March 2018,1268 people(657 patients)have undergone wearable continuous physiological monitoring until January 2020,with data from a total of 1198 people(632 cases)screened for signals through signal quality algorithms and manual interpretation were available for analysis,accounting for 94.48%(96.19%)of the total.Through continuous physiological data analysis and manual correction,sleep apnea event,nocturnal hypoxemia,tachycardia,and ventricular premature beats were detected in 232(36.65%),58(9.16%),30(4.74%),and 42(6.64%)of the total patients,while the number of these abnormal events recorded in the archives was 4(0.63%),0(0.00%),24(3.80%),and 15(2.37%)cases.The statistical analysis of sleep apnea event outcomes revealed that patients with chronic diseases were more likely to have sleep apnea events than healthy individuals,and the incidence was higher in men(62.93%)than in women(37.07%).The results indicate that wearable physiological monitoring technology can provide a new monitoring mode for inpatients,capturing more abnormal events and provide richer information for clinical diagnosis and treatment through continuous physiological parameter analysis,and can be effectively integrated into existing medical processes.We will continue to explore the applicability of this new monitoring mode in different clinical scenarios to further enrich the clinical application of wearable technology and provide richer tools and methods for the monitoring,evaluation and management of chronic diseases.