Kwon Hye-Mee, Kim Sung-Hoon, Park Hee-Sun, Park Yong-Seok, Moon Young-Jin, Kim Jae-Man, Thiele Robert
Biosignal Analysis and Perioperative Outcome Research Laboratory, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.dd
Health Innovation Bigdata Center, Asan Institute for Lifesciences, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
J Clin Med. 2019 Apr 12;8(4):505. doi: 10.3390/jcm8040505.
Although intravenous administration of contrast media may trigger a variety of adverse reactions, sedated patients undergoing computed tomography (CT) scanning usually are not able to report their symptoms, which may delay detection of adverse reactions. Furthermore, changes in vital signs cannot be typically measured during mobile CT scanning, which worsens the situation. We aimed to characterize contrast-related hemodynamic changes that occur during mobile CT scanning and predict sudden hypotension based on subtle but robust changes in the electrocardiogram (ECG). We analyzed the digitized hemodynamic data of 20 consecutive patients who underwent clipping of a cerebral artery aneurysm and contrast-enhanced CT scanning following the surgical procedure. Hemodynamic variables, including ECG findings, invasive blood pressure (BP), pulse oximetry results, capnography findings, cardiac output, and systemic vascular resistance, were monitored simultaneously. We measured morphological changes in ECG-derived parameters, including the R-R interval, ST height, and QRS R-amplitude, on a beat-to-beat basis, and evaluated the correlation between those parameters and hemodynamic changes. After the radiocontrast injection, systolic BP decreased by a median 53 mmHg from baseline and spontaneously recovered after 63 ± 19 s. An increase in QRS R-amplitude (median 0.43 mV) occurred 25 ± 10 s before hypotension developed. The receiver operating characteristic curve showed that a 16% increase in QRS R-amplitude can predict a decrease in systolic BP of >25% (area under the curve 0.852). Increased cardiac output (median delta 2.7 L/min from baseline) and decreased systemic vascular resistance (median delta 857 dyn·s/cm from baseline) were also observed during hypotension. During mobile CT scanning, profound but transient hypotension can be observed, associated with decreased vascular resistance. Augmentation of QRS R-amplitude from an ECG represents a sensitive surrogate for onset of a hypotensive episode after contrast injection, thereby serving as a simple and continuous noninvasive hemodynamic monitoring tool.
尽管静脉注射造影剂可能引发多种不良反应，但接受计算机断层扫描（CT）的镇静患者通常无法报告其症状，这可能会延迟不良反应的发现。此外，在移动CT扫描过程中通常无法测量生命体征的变化，这使情况更加恶化。我们旨在描述移动CT扫描期间发生的与造影剂相关的血流动力学变化，并根据心电图（ECG）中细微但明显的变化预测突然低血压。我们分析了20例连续接受脑动脉瘤夹闭手术及术后造影增强CT扫描患者的数字化血流动力学数据。同时监测血流动力学变量，包括心电图表现、有创血压（BP）、脉搏血氧饱和度结果、二氧化碳描记法表现、心输出量和全身血管阻力。我们逐搏测量心电图衍生参数的形态变化，包括R-R间期、ST段高度和QRS波R波振幅，并评估这些参数与血流动力学变化之间的相关性。注射放射性造影剂后，收缩压较基线下降了中位数53 mmHg，并在63±19秒后自发恢复。在低血压发生前25±10秒，QRS波R波振幅增加（中位数0.43 mV）。受试者工作特征曲线显示，QRS波R波振幅增加16%可预测收缩压下降>25%（曲线下面积0.852）。在低血压期间还观察到心输出量增加（较基线中位数增加2.7 L/min）和全身血管阻力降低（较基线中位数降低857 dyn·s/cm）。在移动CT扫描期间，可观察到严重但短暂的低血压，伴有血管阻力降低。心电图上QRS波R波振幅的增加代表造影剂注射后低血压发作的敏感替代指标，从而可作为一种简单且连续的无创血流动力学监测工具。
