Bioz.com数字化监测系统在血液净化中心的应用价值

摘要

Objective Hemodynamic and volume load states are important issues in patients on blood purification. In this study we monitored the hemodynamic status in 235 patients by using the Bioz.com digital noninvasive hemodynamic monitoring system to explore clinical value of this instrument in purification centers. Method A total of 235 hemodialysis patients (65 ± 13 years old) were divided into 3 types: new administers, clinically stable patients and critically ill patients. Hemodynamic variables such as cardiac output (CO), acceleration cardiac index (ACI), thoracic fluid level (TFC) and systemic vascular resistance (SVR) measured by the Bioz. com system were compared with the results from echocardiography and chest X-ray examinations as the golden standards for the same patients and for parallel controls. Results Values of CO and ACI from Bioz.com system were consistent with those from echocardiography. TFC from Bio.com system was positively correlated to the cardio-thoracic ratio from X-ray films and mean arterial pressure (MAP), and SVR was positively correlated to MAP. By using the values from the bio.com system as the therapeutic guidance, maintenance hemodialysis patients showed the decreases of dehydration amount and heart failure frequency, and critically ill patients treated with continuous blood purification displayed lower APACHE II score and higher percentage of stable blood pressure period. Conclusion Bioz.com digital noninvasive hemodynamic monitoring system provides multiple, reliable and clinically significant data for determining cardiac function status, volume load capacity, dry body weight and dehydration amount. It is a useful monitoring instrument in the field of blood purification.%目的血液净化治疗患者的血流动力学状况和容量负荷状态是倍受关注的问题,本研究探讨Bioz.com数字化无创血流动力学监测系统在血液净化中心应用的临床价值.方法选取济南车区总医院血液净化中心的235例患者,平均年龄(65±13)岁,分为新入院患者、病情平稳患者和病情危重患者3组,以心脏彩超、胸片报告为金标准,同期行血流动力学检查,选取心排血量(cardiac output,CO)、心肌加速度指数(acceleration cardiac index,ACI)、胸腔体液水平(thoracic fluid level,TFC)、外周血管阻力(systemic vascular resistance,SVR)等指标,进行自身对照或平行对照观察.结果 Bioz.com系统监测的CO和ACI结果与彩超对应的指标具有一致性,TFC与胸片所示心胸比值及平均动脉压(meanarterial pressure,MAP)正相关,SVR与MAP正相关,应用该系统指导临床6个月后维持性透析患者脱水量和心力衰竭发作频率下降.危重患者应用本系统指导临床后连续性血液净化(Contianous blood purification,CBP)治疗中血压平稳时间百分比增加,APACHE Ⅱ评分降低.结论 Bioz.com数字化无创血流动力学监测系统在判断血液净化中心患者心功能状态、容量负荷状态、指导评估干体质量、制定脱水量、指导危重症抢救等方面均具有指导意义.