可穿戴监护在术后早期下床活动风险监测中的应用研究

Risk monitoring using wearable patient monitor during early mobilization after surgery

目的加速康复外科(ERAS)提倡术后早期下床活动。在亚重症科室,常规术后监护时长一般不超过24 h,而患者解除常规监护后下床活动是否存在风险尚无定论。通过统计患者术后长时间生命体征异常报警的分布情况,研究使用可穿戴监护延长监护时间对术后早期下床活动风险监测的临床价值。方法采集使用可穿戴监护的62例消化外科术后患者自术后到出院真实的3327次生理异常报警,对报警的种类、时间分布和患者分布进行分析统计。结果人均每小时生理报警在0~24 h和24~48 h内分别为0.91次和1.22次,时间分布差异无统计学意义(P>0.05);在48~72 h内为0.36次,与前两者时间分布差异有统计学意义(P<0.01)。24~48 h内的血氧、心率、血压、恶性心律失常人均报警数量分别占72 h内人均报警总数的45.12%,70.34%,39.25%,37.62%。结论早期下床活动的患者在24~48 h内仍存在与常规监护24 h内相似的临床风险。可穿戴监护可在患者下床活动的过程中,持续地对48 h内或更长时间范围不良事件发生的风险进行全面有效监测。

【Objective】Early mobilization was recommended by early recovery after surgery(ERAS).The routine monitoring time after surgery was no more than 24 hours except intensive care unit.There was no agreement whether existed risks during the early mobilization after routine monitoring time.To discover the clinical value of the wearable patient monitor in extending the routine monitoring time,the distribution of vital alarms after surgery was analyzed comprehensively.【Methods】A total of 3327 valid alarms were collected from the 62 patients after gastrointestinal surgery during hospitalization by the wearable patient monitor and analyzed from the distribution of the alarm type,collected time and patients.【Results】There were no significant differences in the average valid alarm number of patients per hour between 0-24 hours and 24-48 hours(P>0.05),with 0.91 in 0-24 hours and 1.22 in 24-48 hours.However,there were significant differences between 48-72 hours and either of mentioned above(P<0.01),with 0.36 in 48-72 hours.The number of alarms per capita of SpO2,heart rate,NIBP and malignant arrhythmia within 24-48 hours respectively accounted for 45.12%,70.34%,39.25%and 37.62%of the total number of alarms per capita within 72 hours.【Conclusion】There are similar clinical risks in 0-24 hours and 24-48 hours,which reveals that the clinical risks within 48 hours or longer could be monitored continuously and comprehensively by the wearable patient monitor.