Department of Internal Medicine "C", Tel Aviv Sourasky Medical Center, 6 Weizman Street Tel Aviv 64239, Israel.
J Geriatr Cardiol. 2012 Dec;9(4):321-7. doi: 10.3724/SP.J.1263.2012.07231.
To evaluate the efficacy of preventive treatment (PT) on alveolar pulmonary edema (APE) of cardiogenic origin using a monitor based on principles of internal thoracic impedance (ITI) measurements.
We conducted blinded clinical trials on patients with ST-elevation myocardial infarction (STEMI) and monitored whether the condition would progress to APE. ITI was measured non-invasively by the Edema Guard Monitor (EGM, model RS-207) every 30 min. The measurement threshold for the diagnosis of APE was fixed at > 12% decrease in ITI from baseline as described in our methodology. The patients were divided into one group that received standard treatment after the appearance of clinical signs of APE without considering the prediction of APE by EGM devise (Group 1), and another group of asymptomatic patients in whom development of APE was predicted by using only EGM measurements (Group 2). The latter participants' PT consisted of furosemide, intravenous nitroglycerine and supplemental oxygen.
One-hundred and fifty patients with acute STEMI were enrolled into this study. Group 1 included 100 patients (53% males, age 64.1 ± 12.6 years). Treatment was started after the clinical appearance of overt signs of APE. Group 2 included 50 patients (54% males, age 65.2 ± 11.9 years) who received PT based on EGM measurements. Group 2 had significantly fewer cases of APE (n = 4, 8%) than Group 1 (n = 100, 100%) (P > 0.001). While APE was lethal in six (6%) Group 1 patients, PT resulted in prompt resolution of APE in all four (8%) Group 2 patients.
ITI is a useful modality for early diagnosis and PT of pulmonary edema of cardiogenic origin.
评估基于内部胸阻抗（ITI）测量原理的监护仪对心源性肺泡性肺水肿（APE）的预防治疗（PT）效果。
我们对 ST 段抬高型心肌梗死（STEMI）患者进行了盲法临床试验，并监测其是否会发展为 APE。通过 Edema Guard Monitor（EGM，型号 RS-207）每隔 30 分钟进行非侵入性 ITI 测量。根据我们的方法学，APE 的诊断测量阈值固定为 ITI 较基线下降> 12%。将患者分为两组：一组在出现 APE 临床症状后接受标准治疗，而不考虑 EGM 设备对 APE 的预测（第 1 组）；另一组为无症状患者，仅使用 EGM 测量来预测 APE 的发生（第 2 组）。后一组患者的 PT 包括呋塞米、静脉硝酸甘油和补充氧气。
本研究共纳入 150 例急性 STEMI 患者。第 1 组包括 100 例患者（53%为男性，年龄 64.1±12.6 岁）。在出现明显 APE 临床症状后开始治疗。第 2 组包括 50 例患者（54%为男性，年龄 65.2±11.9 岁），他们根据 EGM 测量结果接受 PT。第 2 组发生 APE 的病例明显少于第 1 组（n=100，100%）（n=4，8%）（P>0.001）。第 1 组中有 6 例（6%）APE 患者死亡，而第 2 组所有 4 例（8%）患者接受 PT 后 APE 迅速缓解。
ITI 是诊断和治疗心源性肺水肿的有用方法。
