持续监测生命体征检测高危患者的心肌损伤

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持续监测生命体征检测高危患者的心肌损伤

贵州医科大学 麻醉与心脏电生理课题组

翻译：马艳燕 编辑：潘志军 审校：曹莹

背景

重大非心脏手术后和急性疾病期间，患者有心肌损伤的风险。心肌损伤与死亡率相关，但通常无症状，目前通过间歇性心脏生物标志物筛查发现。这使得心肌损伤诊断延迟，其中生命体征异常可能作为心肌损伤早期征兆的代表。本研究旨在评估持续监测的生命体征异常与重大腹部癌手术后或慢性阻塞性肺疾病急性加重期后的心肌损伤之间的关系。

方法

接受腹部癌症大手术或因慢性阻塞性肺疾病急性加重而入院的患者每天进行肌钙蛋白监测。在入院或手术后对几种生命体征进行长达96小时的连续无线监测。主要结局指标是在心肌损伤出现前24小时内外周血氧饱和度(SpO2)低于85%的累积持续时间，定义为每日评估的新发缺血性肌钙蛋白升高。如果未发生心肌损伤，则主要结局指标基于测量的前24小时。

结果

共有662名患者接受持续监测，113名（17%）患者有心肌损伤。SpO2<85%的累积持续时间与心肌损伤显着相关（平均差异14.2分钟（95%置信区间-4.7至33.1分钟）；p=0.005）。低氧血症的持续时间（SpO2<88% 和 SpO2<80%）、心动过速（心率>110 次/分和心率>130 次/分）和呼吸急促 （RR>24 次/分钟和 RR>30 次/分钟）也与心肌损伤显著相关（所有p<0.04）。

结论

在入住医院病房的高危患者，持续无线监测检测到的严重低SpO2持续时间与心肌损伤显著相关。接下来应评估早期发现和干预的效果。

原始文献来源 ????

Loft FC, Rasmussen SM, Elvekjaer M, et al; WARD-Project Group. Continuously monitored vital signs for detection of myocardial injury in high-risk patients - an observational study. Acta Anaesthesiol Scand. 2022 Mar 5.

英文原文

Continuously monitored vital signs for detection of myocardial injury in high-risk patients - an observational study

Abstract

Background:Patients are at risk of myocardial injury after major noncardiac surgery and during acute illness. Myocardial injury is associated with mortality, but often asymptomatic and currently detected through intermittent cardiac biomarker screening. This delays diagnosis, where vital signs deviations may serve as a proxy for early signs of myocardial injury. This study aimed to assess the association between continuous monitored vital sign deviations and subsequent myocardial injury following major abdominal cancer surgery and during acute exacerbation of chronic obstructive pulmonary disease.

Methods: Patients undergoing major abdominal cancer surgery or admitted with acute exacerbation of chronic obstructive pulmonary disease had daily troponin measurements. Continuous wireless monitoring of several vital signs was performed for up to 96 hours after admission or surgery. The primary exposure was cumulative duration of peripheral oxygen saturation (SpO2 ) below 85% in the 24 hours before the primary outcome of myocardial injury, defined as a new onset ischaemic troponin elevation assessed daily. If no myocardial injury occurred, the primary exposure was based on the first 24 hours of measurement.

Results: A total of 662 patients were continuously monitored and 113 (17%) had a myocardial injury. Cumulative duration of SpO2 <85% was significantly associated with myocardial injury (mean difference 14.2 min (95% confidence interval -4.7 to 33.1 min); p = 0.005). Durations of hypoxaemia (SpO2 <88% and SpO2 <80%), tachycardia (HR>110 bpm and HR>130 bpm), and tachypnoea (RR>24 min-1 and RR>30 min-1 ) were also significantly associated with myocardial injury (p<0.04, for all).

Conclusion: Duration of severely low SpO2 detected by continuous wireless monitoring is significantly associated with myocardial injury in high-risk patients admitted to hospital wards. The effect of early detection and interventions should be assessed next.