Penny Jarrin D, Grant Claire, Salerno Fabio, Brumfield Anne, Mianulli Marcus, Poole Lori, Mcintyre Christopher W
The Lilibeth Caberto Kidney Clinical Research Unit, London, Canada.
Department of Medical Biophysics, Western University, London, Canada.
Hemodial Int. 2018 Jul;22(3):351-358. doi: 10.1111/hdi.12632. Epub 2018 Jan 23.
The safe delivery of hemodialysis (HD) faces dual challenges; the accurate detection of systemic circulatory stress producing cardiovascular (CV) injury, and the ability to enable effective preemptive intervention for such injury. We performed a pilot study to examine the capability of a new noninvasive, real-time monitoring system to detect the deleterious effects of HD on CV stability.
Eight patients were evaluated with echocardiography prior to the initiation of HD and again at peak HD stress. Continuous CV physiologic monitoring was performed throughout using oximeter-based pulse waveform analysis (CVInsight Monitoring System, Intelomed, Inc., Warrendale, PA, USA). Longitudinal strain (LS) values for 12 left ventricular segments were generated using speckle-tracking software (EchoPac, GE), to assess the presence of HD-induced regional wall motion abnormalities (RWMA), indicative of myocardial stunning.
A reduction in pulse strength (PS) of ≥40% detected by CVI was associated with the development of RWMA (P = 0.005). This reduction occurred in 6/8 patients, all of whom exhibited myocardial stunning. Two patients had no significant reduction in PS nor evidence of myocardial stunning. In subjects with cardiac stunning, the decrease in PS was evident early during HD, 11.49 ± 10 minutes into HD treatment, prior to the detection of RWMA, which were assessed at peak HD stress, mean 210 ± 16.43 minutes into HD treatment.
Percutaneous perfusion monitoring, using pulse wave analysis, appears to be useful in identifying circulatory stress during HD and predicting the development of HD-induced myocardial stunning with a lead time long enough to consider timely intervention.
血液透析（HD）的安全实施面临双重挑战；准确检测产生心血管（CV）损伤的全身循环应激，以及对这种损伤进行有效预防性干预的能力。我们进行了一项试点研究，以检验一种新型非侵入性实时监测系统检测HD对CV稳定性有害影响的能力。
8名患者在HD开始前接受超声心动图评估，并在HD应激高峰时再次评估。在整个过程中使用基于血氧计的脉搏波形分析（CVInsight监测系统，美国宾夕法尼亚州沃伦代尔市英特尔医疗公司）进行连续的CV生理监测。使用斑点追踪软件（EchoPac，GE）生成12个左心室节段的纵向应变（LS）值，以评估HD诱导的局部室壁运动异常（RWMA）的存在，这表明心肌顿抑。
CVI检测到脉搏强度（PS）降低≥40%与RWMA的发生相关（P = 0.005）。这种降低发生在6/8的患者中，所有这些患者均表现出心肌顿抑。两名患者的PS没有显著降低，也没有心肌顿抑的证据。在有心脏顿抑的受试者中，PS降低在HD早期很明显，在HD治疗开始后11.49±10分钟，在检测到RWMA之前，RWMA在HD应激高峰时评估，平均在HD治疗开始后210±16.43分钟。
使用脉搏波分析进行经皮灌注监测似乎有助于识别HD期间的循环应激，并预测HD诱导的心肌顿抑的发生，其提前期足够长，可考虑及时干预。
