非侵入性连续监测与间歇性示波测量在消化内镜检查中检测低血压的比较。

Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy.

机构信息

Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.

Université Paris-Descartes, Sorbonne Paris Cité, Paris, France.

出版信息

PLoS One. 2020 Oct 2;15(10):e0240241. doi: 10.1371/journal.pone.0240241. eCollection 2020.

DOI:10.1371/journal.pone.0240241

PMID:33007051

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7531858/

Abstract

BACKGROUND

Hemodynamic monitoring during digestive endoscopy is usually minimal and involves intermittent brachial pressure measurements. New continuous noninvasive devices to acquire instantaneous arterial blood pressure may be more sensitive to detect procedural hypotension.

PURPOSE

To compare the ability of noninvasive continuous monitoring with that of intermittent oscillometric measurements to detect hypotension during digestive endoscopy.

METHODS

In this observational prospective study, patients scheduled for gastrointestinal endoscopy and colonoscopy under sedation were monitored using intermittent pressure measurements and a noninvasive continuous technique (ClearSight™, Edwards). Stroke volume was estimated from the arterial pressure waveform. Mean arterial pressure and stroke volume values were recorded at T1 (prior to anesthetic induction), T2 (after anesthetic induction), T3 (gastric insufflation), T4 (end of gastroscopy), T5 (colonic insufflation). Hypotension was defined as mean arterial pressure < 65 mmHg.

RESULTS

Twenty patients (53±17 years) were included. Six patients (30%) had a hypotension detected using intermittent pressure measurements versus twelve patients (60%) using noninvasive continuous monitoring (p = 0.06). Mean arterial pressure decreased during the procedure with respect to T1 (p < 0.05), but the continuous method provided an earlier warning than the intermittent method (T3 vs T4). Nine patients (45%) had at least a 25% reduction in stroke volume, with respect to baseline.

CONCLUSION

Noninvasive continuous monitoring was more sensitive than intermittent measurements to detect hypotension. Estimation of stroke volume revealed profound reductions in systemic flow. Noninvasive continuous monitoring in high-risk patients undergoing digestive endoscopy under sedation could help in detecting hypoperfusion earlier than the usual intermittent blood pressure measurements.

摘要

背景

消化内镜检查期间的血流动力学监测通常很少，涉及间歇性肱动脉血压测量。新的连续无创设备可获取即时动脉血压，可能更敏感地检测到程序低血压。

目的

比较连续无创监测与间歇性示波测量在消化内镜检查期间检测低血压的能力。

方法

在这项观察性前瞻性研究中，接受镇静下胃肠内镜和结肠镜检查的患者使用间歇性压力测量和无创连续技术（Edwards 的 ClearSight™）进行监测。从动脉压力波形估计每搏量。在 T1（麻醉诱导前）、T2（麻醉诱导后）、T3（胃充气）、T4（胃镜检查结束）、T5（结肠充气）记录平均动脉压和每搏量值。低血压定义为平均动脉压<65mmHg。

结果

共纳入 20 例患者（53±17 岁）。6 例（30%）患者使用间歇性压力测量检测到低血压，12 例（60%）患者使用无创连续监测检测到低血压（p=0.06）。与 T1 相比，术中平均动脉压降低（p<0.05），但连续方法比间歇方法更早发出警告（T3 与 T4）。9 例（45%）患者的每搏量与基线相比至少减少了 25%。