连续无创血流动力学监护在呼吸困难鉴别诊断中的作用

Value of non-invasive continuous hemodynamic monitoring system in the differential diagnosis of the patients with dyspnea

目的 探讨连续无创血流动力学 (IQ )监护在呼吸困难病因鉴别诊断中的作用。方法 根据患者出院诊断分为肺源性呼吸困难组 (对照组 ,4 8例 )和心源性呼吸困难组 (心力衰竭组 ,38例 )。在患者入院时及病愈后分别进行 IQ监护 ,比较出院与入院诊断的符合情况及两次 IQ指标的变化。结果 1临床诊断 :在入院时 ,心力衰竭组有 7例被漏诊 ,诊断为肺炎 (5例 )和慢性阻塞性肺疾病 (COPD,2例 ) ;对照组中有 1例(气胸 )误诊为心力衰竭。 2心功能指标 :心力衰竭组基础阻抗 (Zo)、阻抗变化最大速率 (dz/ dt m ax)、Heather指数 (HI)显著低于对照组 (P均 <0 .0 0 1) ,其值分别为 (19.0± 3.5 ) Ω比 (2 8.8± 5 .5 ) Ω,(0 .76± 0 .4 2 ) Ω/ s比(1.4 0± 0 .72 )Ω / s和 (7.0 4± 4 .2 5 )Ω / s2 比 (13.6 0± 6 .36 )Ω / s2 。在呼吸困难的患者中 ,若 Zo值≤ 2 2Ω ,诊断心力衰竭的敏感度为 79% ,特异度为 94 % ;若 Zo值≤ 18Ω ,则诊断心力衰竭的敏感度为 4 7% ,特异度为 10 0 %。3组内比较 :对照组治疗前后心功能指标没有明显变化 ,心力衰竭组中 Zo、dz/ dt m ax、HI、每搏出量 (SV )、加速收缩指数 (ACI)在病愈后有上升恢复趋势 ,皆具统计学意义。 4左室射血前期 (PEP)、左室射血时间 (VET)

Objective To evaluate noninvasive continuous hemodynamic (IQ System) monitoring in the differential diagnosis of dyspnea. Methods According to the diagnosis on discharge,48 patients diagnosed as pulmonary dyspnea were enrolled in control group and 38 patients with cardiac dyspnea were in heart failure group. Each patient underwent IQ monitoring on admission and after recovery. The difference in the diagnosis on admission and on discharge,and the difference in IQ index were analyzed. Results ①Clinical diagnosis: 7 patients in heart failure group were missed on admission as 5 were diagnosed as pneumonia and 2 were diagnosed as chronic obstructive pulmonary disease(COPD). One patient with pneumothorax in control group was misdiagnosed as heart failure. ②Indexes of cardiac function: base impedance(Zo), maximum value of dz/dt(dz/dt max) and Heather index(HI) of heart failure group were markedly lower than those of control group (all P <0.001). The respective values were (19.0±3.5)Ω vs. (28.8±5.5)Ω,(0.76±0.42)Ω/s vs. (1.40±0.72)Ω/s,and (7.04±4.25)Ω/s 2 vs. (13.60±6.36)Ω/s 2. If Zo value of patients with dyspnea was 22 Ω or less,the sensitivity in diagnosing heart failure was 79%,and its specificity was 94%. If Zo value was 18.0 Ω or less,the sensitivity in diagnosing heart failure was 47%,and its specificity was 100%. ③Comparison within groups: indexes of cardiac function of control group did not change obviously and Zo,dz/dt max,HI,stroke volume(SV) and acceleration contraction index(ACI) values of heart failure group rose significantly after recovery. ④Preejection period(PEP) and left ventricular ejection time(VET) in both groups had no statistical significance in differences. Conclusion IQ System was valuable in differential diagnosis to judge if dyspnea is caused by heart failure. Zo,dz/dt max and HI,especially Zo,are reliable.