可穿戴远程监测设备在心血管疾病的研究进展

心血管疾病仍是中国人群死亡的首要因素,心血管疾病的预防、诊断、治疗和管理将是不得不面对的一项挑战。随着科学技术的不断发展,可穿戴远程监测设备在医疗领域的探索取得重大突破。现着重介绍目前可穿戴远程监测设备在几种常见心血管疾病中的最新研究进展,提出不足之处,对可穿戴远程监测设备的未来进行展望。     

可穿戴式血压监测设备的研究和应用进展

在卫生保健领域,便携式或电子化的可穿戴的医疗设备可直接穿戴在人体,并可以用来感知、记录、分析、管理和干预以保持健康,甚至可以用于治疗疾病和各种技术的支持识别、传感、连接、云服务和存储^[1]。高血压是常见慢性病之一,我国现患高血压人数有2.45亿,35～44 岁人群高血压患病率已达到15.0%,但对高血压的知晓率、治疗率和控制率分别仅为31.7%、24.5%和9.9%^[2]。同时高血压是导致我国居民心血管病发病和死亡增加的首要且可改变的危险因素,约 50%的心血管病发病和 20%的心血管病死亡归因于高血压^[3]。     

可穿戴设备在心肌梗死患者随访管理中的应用

主动健康要求个体主动获得持续的健康能力,要求慢性病患者自发和积极地关注自身健康,参与到疾病的管理中来.然而,常规随访手段不能满足心肌梗死患者的长期管理要求,患者对自己生命体征的把握,以及心血管健康状况、药物优化治疗方案和康复锻炼效果缺乏足够的了解手段.具有多种传感器的可穿戴设备为心肌梗死患者危险因素的管理、病情的监测和...     

单导联可穿戴远程心电监测设备在有症状心律失常患者中的应用模式探讨

目的 探讨单导联可穿戴远程心电监测设备不同监测模式在有症状心律失常患者中的应用效果.方法 选取银川市基层医疗机构纳入的确诊为心律失常的40例患者为研究对象,均在两周内出现头晕、胸闷、心悸、气短等症状时采用自行佩戴单导联可穿戴心电监测设备采集1次24 h心电图作为对照组、5次1 h心电图作为观察组.数据均实时上传至云端,...     

12导联实时可穿戴心电设备在家庭和基层医院患者远程早期事件监测中的应用

目的 分析12导联实时可穿戴心电设备监测家庭和基层医院患者远程早期事件的价值.方法 在家庭和基层医院使用12导联实时可穿戴心电设备采集20271例受检者的心电图并传输至我院基层诊断会诊中心.按照危急、急和普通的等级对全部心电图数据进行分类,并及时告知患者及其家属或基层医院.对危急心电图病例在1～12 d内完成随访.结果 共纳入21253份心电图进行分析.其中,男性12007份(56.50％),比例略高于女性;有11695份(55.03％)来源于基层医院,比例略高于来源于家庭的心电图.有40.55％(8619份)的心电图来自有不适症状的受检者,以胸闷胸痛和心慌心悸为主;66.63％的心电图(14160份)出现异常,其中心肌缺血心电图占39.45％(8385份),心律失常心电图占24.64％(5237份).心律失常中室性早搏最多(5.52％).危急心电图报告占0.61％(130份),来自94例受检者,其中20.21％(19/94)发生严重的临床事件.结论 12导联实时可穿戴心电设备可以对家庭和基层医院患者的远程早期心律失常和心肌缺血进行监测,对远程心电进一步就诊进行危急、急和普通分类,可改善患者预后,最终惠及患者和基层医疗机构.     

可穿戴设备在慢性心力衰竭患者管理中的应用进展

医院外随访是慢性心力衰竭诊治体系中必不可少的部分，是减少不良心血管事件的关键。目前多采用专科门诊、社区医院或电话随访等方式，定期进行病情监测和药物治疗优化。但这些随访方式间隔数周到数月，且受患者依从性影响，不能及时发现心力衰竭恶化先兆并干预。新兴的可穿戴设备是一种由患者日常佩戴的外部应用设备，可连续性获得患者居家状态下的多种生理参数，用于综合判断患者病情并预设报警，提供给心力衰竭管理专业团队进行干预，以弥补传统随访方式的不足。目前研发的可穿戴设备种类较多，在使用方法、参数采集、应用场景和解释方式上存在较大差异。现综述常用可穿戴设备在慢性心力衰竭患者管理中的应用，并讨论其在未来的应用前景。     

可穿戴心率变异性设备应用的研究进展

心率变异性（HRV）可用来评估病情严重程度及预后情况。常规测量HRV的设备存在佩戴贴片多、电极片易脱落、舒适度不高等问题。智能贴片、基于光学体积描记术（PPG）和纺织品的可穿戴设备凭借穿戴简单、舒适度高和报告自动化等优点,广泛应用于HRV测量中。可穿戴HRV设备有望成为临床健康监测的新策略。本文对可穿戴HRV设备的类型、应用场景、存在的问题及未来展望进行综述。     

远程可穿戴心电设备的应用进展

心电图实时记录心脏的电活动,为检测各种心血管疾病提供了重要的机会。目前,12导联心电图作为标准心电图采集技术用于诊断心律失常以外的许多心脏疾病。然而,12导联心电图的使用仅限于训练有素的医务人员,限制了其使用范围。远程可穿戴心电设备已经试图弥补这一缺陷,让患者能够使用简化的方法,即减少导联的数量（通常是单导联）来获取自身的心电图。其与实时通知技术相结合,可用于心律失常的检测,有充分的证据表明,在诊断特殊心律失常时（如心房颤动）,远程心电设备比传统12导联心电图更可靠,在长程监测方面具有巨大潜力。本文对远程心电设备及其在心律失常诊断中的临床应用、面临的重要挑战和局限性进行综述。     

药物不良事件监测系统在老年人群中的应用

2000年起,全球步人老龄化社会,伴随而来的是老年人群的高发病率和老年人群中药物不良事件高发生率,对家庭、社会和医疗单位都造成了巨大的负担。本文通过对近5年来的相关文献研究,探讨了老年人药物不良事件的特点,综合介绍了药物不良事件监测中的各种方式、方法,以及目前所采用的最有效、最推广的处方自动监测系统。同时对综合性医院使用的数据统计以及处方自动监测系统使用中的弊端进行了分析,并讨论需改良的方法。     

Interventional catheterization performed in the early postoperative period after congenital heart surgery in children

OBJECTIVES: The purpose of this study was to examine the safety and efficacy of interventional catheterization performed early after congenital heart surgery. BACKGROUND: Transcatheter interventions performed in the early postoperative period are viewed as high risk. To date, there have been limited published data regarding these procedures. METHODS: All catheterizations performed within six weeks after congenital heart surgery between August 1995 and January 2001 were retrospectively reviewed. A cardiac anesthesiologist, cardiac intensivist, cardiac surgeon, and operating room team were available for all cases. Interventional procedures were performed based on clinical indications, regardless of the time elapsed from surgery. RESULTS: Sixty-two patients, median age four months (2 days to 11 years), weight 4.7 kg (2.3 to 45 kg), underwent 66 catheterizations on median postoperative day 9 (0 to 42 days). Thirty-five cases involved 50 interventional procedures. Nine patients required extracorporeal cardiopulmonary support. Success rates by procedure were: angioplasty, 100%; stent implantation, 87%; vascular/septal occlusion, 100%; and palliative pulmonary valvotomy, 75%. Complications included stent migration (one patient), cerebral vascular injury (one patient), and left pulmonary artery stenosis (one patient). Thirty procedures involved angioplasty or stent implantation, including 26 involving a recently created suture line. Suture disruption or trans-mural vascular tears were not observed. There was no procedural mortality. Thirty-day survival for patients undergoing intervention was 83%. CONCLUSIONS: Transcatheter interventions can be successfully performed in the early postoperative period. These procedures can have a positive impact on patient outcome; however, they should be performed only by a pediatric interventional cardiologist supported by a multi-disciplinary team.     

Predictors of permanent pacemaker implantation during the early postoperative period after valve surgery

The ability to preoperatively identify patients who may require permanent pacemaker implantation is rather poorly understood. The aim of this study is to determine the current incidence of permanent pacing after valve surgery and to determine which factors place the heart valve patient at risk of requiring permanent pacemaker implantation. We audited the records of 2,392 consecutive adult patients who underwent cardiac valve surgical procedures by the same surgical team from 25 April 1998 through 31 March 2003. Of these, 118 patients (group A) required the postoperative implantation of permanent pacemakers during the same hospitalization; they were compared with 1,959 heart valve patients (group B) who did not require pacemaker placement. Multivariate logistic regression analysis showed that reoperations (odds ratio [OR], 8.23; P <0.001), longer cumulative cross-clamp times (OR, 5.9; P <0.001), multiple-valve surgical procedures (OR, 3.46; P <0.05), and absence of preoperative sinus rhythm (OR 2.52; P <0.001) were independent predictors of the need for permanent pacemaker implantation after valve surgery. These results suggest that patients who display these risk factors for arrhythmias that require permanent pacemaker implantation receive closer observation and advance counseling about the likelihood of such implantation.