[无创连续血流动力学监测系统在呼吸困难患者鉴别诊断中的价值]
[Value of non-invasive continuous hemodynamic monitoring system in the differential diagnosis of the patients with dyspnea].
作者信息
Gu Zhen-liang, Cheng Cui-e, Wu Gang, Zhang Bo-sheng, Lu Zhu-kang, Xu Li-hua
机构信息
Department of Emergency, the First People's Hospital in Changshu, Changshu 215500, Jiangsu, China.
出版信息
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2004 May;16(5):287-91.
OBJECTIVE
To evaluate non-invasive 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
(1) Clinical 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. (2) Indexes 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) Omega vs. (28.8+/-5.5) Omega, (0.76+/-0.42) Omega/s vs. (1.40+/-0.72) Omega/s, and (7.04+/-4.25) Omega/s2 vs. (13.60+/-6.36) Omega/s2. If Zo value of patients with dyspnea was 22 omicron or less, the sensitivity in diagnosing heart failure was 79 percent, and its specificity was 94 percent. If Zo value was 18.0 omicron or less, the sensitivity in diagnosing heart failure was 47 percent, and its specificity was 100 percent. (3) Comparison 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. (4) Pre-ejection 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.
目的
评估无创连续血流动力学（IQ系统）监测在呼吸困难鉴别诊断中的作用。
方法
根据出院诊断，将48例诊断为肺源性呼吸困难的患者纳入对照组，38例心源性呼吸困难患者纳入心力衰竭组。每位患者入院时及病情恢复后均接受IQ监测。分析入院诊断与出院诊断的差异以及IQ指数的差异。
结果
（1）临床诊断：心力衰竭组7例患者入院时漏诊，其中5例诊断为肺炎，2例诊断为慢性阻塞性肺疾病（COPD）。对照组1例气胸患者误诊为心力衰竭。（2）心功能指标：心力衰竭组的基础阻抗（Zo）、dz/dt最大值（dz/dt max）和希瑟指数（HI）明显低于对照组（均P<0.001）。各自的值分别为（19.0±3.5）Ω对（28.8±5.5）Ω、（0.76±0.42）Ω/s对（1.40±0.72）Ω/s、（7.04±4.25）Ω/s²对（13.60±6.36）Ω/s²。若呼吸困难患者的Zo值小于或等于22Ω，诊断心力衰竭的敏感性为79%，特异性为94%。若Zo值小于或等于18.0Ω，诊断心力衰竭的敏感性为47%，特异性为100%。（3）组内比较：对照组的心功能指标无明显变化，心力衰竭组病情恢复后Zo、dz/dt max、HI、每搏输出量（SV）和加速收缩指数（ACI）值显著升高。（4）两组的射血前期（PEP）和左心室射血时间（VET）差异无统计学意义。
结论
IQ系统在判断呼吸困难是否由心力衰竭引起的鉴别诊断中具有重要价值。Zo、dz/dt max和HI，尤其是Zo，是可靠的。
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