椎管内无创血流动力学监测：心脏前负荷值对预测血流动力学不稳定的作用

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia Pub Date : 2024-11-01 DOI:10.1016/j.nefro.2024.05.009

María Ángeles Fernández Rojo , Rafael Díaz-Tejeiro Izquierdo , Mario Vaquero Alonso , Dabaiba Regidor Rodríguez , Laura Cueto Bravo , Iván Carmena Rodríguez , David Carro Herrero , Carlos Jesús Cabezas Reina , Francisco Javier Ahijado Hormigos

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引用次数: 0

摘要

导言：血液透析（HD）过程中对患者血容量的适当控制是至关重要的，因为它是导致发病率和死亡率的一个可改变的风险因素。在这项研究中，我们建议使用生物反应（Starling™ SV. Baxter）进行连续无创血流动力学监测，并对心脏前负荷数据进行实时分析，以帮助准确评估血容量状态并改善血液透析患者的耐受性。方法：对心脏前负荷数据与透析内血流动力学不稳定性之间的关系进行观察性和前瞻性研究。招募了 46 名病情稳定的 HD 患者。收集了所有参与者的临床、分析和透析数据。方案包括生物阻抗（BIVA）、透析前后超声心动图和组织多普勒以及透析过程中的血流动力学参数监测。结果根据Fall20的定义，24名患者（51.19%）出现了渠内低血压（IDH）。我们发现 IDH 与分析、超声心动图、BIVA 参数或相对血容量测量 (BVM) 值之间没有关系。在血液动力学监测方面，IDH 患者的指数收缩容积（ISV）较低（38.2 ± 0.9 vs. 39.2 ± 1.9; P<.001）。IDH组的指数收缩容积变化（ISVV）和心率（HR）分别较高（14.1 ± 0.7 vs. 13.5 ± 0.7; P<.0001）和（70.01 ± 2.1 vs. 68.97 ± 1.1; P<.0001）。IDH组的指数心输出量（ICO）和指数外周阻力（IPR）也分别较低（2.62 ± 0.09 vs. 2.65 ± 0.13; P<.05）和（3201 ± 325 vs. 3432 ± 231; P<.05）。结论无创血液动力学监测和前负荷数据可能是管理 HD 患者容量状态和预防 IDH 的有效工具。

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Monitorización hemodinámica no invasiva intradiálisis: utilidad de los valores de precarga cardiaca en la predicción de la inestabilidad hemodinámica

Introduction

Adequate control of patient blood volume in hemodialysis (HD) is essential as a modifiable risk factor for morbidity and mortality. In this study, we propose continuous non-invasive hemodynamic monitoring using bioreactance (Starling™ SV. Baxter) and real-time characterization of cardiac preload data to aid in the accurate assessment of volume status and improvement of tolerance in HD.

Methodology

Observational and prospective study on the relationship between cardiac preload data and intradialytic hemodynamic instability. Forty-six stable HD patients were recruited. Clinical, analytical, and dialysis data were collected from all participants. The protocol included bioimpedance (BIVA), pre- and post-dialysis echocardiography and tissue Doppler, and monitoring of hemodynamic parameters during the session.

Results

According to the Fall20 definition, 24 patients (51.19%) experienced intradialytic hypotension (IDH). We found no relationship between IDH and analytical, echocardiographic, BIVA parameters, or relative blood volume measurement (BVM) values. Regarding hemodynamic monitoring, indexed systolic volume (ISV) was lower in patients with IDH (38.2 ± 0.9 vs. 39.2 ± 1.9; P<.001). Indexed systolic volume variation (ISVV) and heart rate (HR) were higher in the IDH group (14.1 ± 0.7 vs. 13.5 ± 0.7; P<.0001), (70.01 ± 2.1 vs. 68.97 ± 1.1; P<.0001), respectively. Indexed cardiac output (ICO) and indexed peripheral resistances (IPR) were also lower in the IDH group (2.62 ± 0.09 vs. 2.65 ± 0.13; P<.05) and (3201 ± 325 vs. 3432 ± 231; P<.05), respectively. Patients who started the session with lower preload (ΔSV after infusion of 250 cc ≥ 10%) more frequently developed IDH (P<.001).

Conclusions

Non-invasive hemodynamic monitoring and preload data may constitute a valid tool in managing the volume status of HD patients and preventing IDH.

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来源期刊

Nefrologia 医学-泌尿学与肾脏学

CiteScore

3.40

自引率

7.70%

发文量

148

审稿时长

47 days

期刊介绍： Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.