诊断辅助技术在低血压的评估:一个潜在的试点项目
Prerna Ladha1, Evelyn I Truong2, Peter Kanuika2
1Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio.
The Journal of surgical research
|September 10, 2023
概括
在重症监护室评估流体状况仍然很困难. 这项研究发现,非侵入性心脏输出监测和超声波测量与临床低血压不相关,这表明需要改进诊断工具.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 确定适合低血压复苏的终点是重症监护机构面临的重大挑战.
- 评估流体状况的现有方法,包括临床低血压 (CH),往往缺乏精度.
- 非侵入性心脏输出监测 (NICOM) 和超声波 (US) 技术越来越多地使用,但它们与CH的相关性需要进一步调查.
研究的目的:
- 为了比较非侵入性心脏输出监测 (NICOM) 和两种基于超声波的方法 (静态的IVC折叠性和动态的动脉动脉上升速度) 在评估临床低血压 (CH) 中的准确性.
- 为了确定美国的措施是否与CH比NICOM更密切地相关.
- 评估这些附加剂在指导重症患者的液体复苏中的实用性.
主要方法:
- 一项涉及成人创伤/手术ICU患者的前性研究,怀疑在复苏后患有低血压症.
- 测量包括NICOM,超声波评估的IVC折叠性 (US-IVC) 和超声波评估的动脉上升速度 (US-C).
- 用科恩的卡帕 (κ) 分析数据,以评估附加剂和临床低血压之间的一致性.
主要成果:
- 没有一个辅助测量 (NICOM,US-IVC,US-C) 显示出与临床低血压 (CH) 有意义的相关性 (κ值在-0.045到0.029之间).
- 即使在调整之前未知的心脏功能障碍后,相关性仍然不显著 (k值在-0.036到0.031之间).
- 不同的诊断技术本身之间没有发现显著的相关性 (k值在-0.118到0.083之间).
结论:
- 目前的非侵入性监测技术,包括NICOM和基于超声波的评估,与重症患者的临床低血压没有可靠的相关性.
- 在重症监护中评估流体状况仍然是一个复杂的挑战,需要开发更准确的诊断工具.
- 在开始液体复苏之前,超声检查应优先评估右心室功能障碍.
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