宋天娇;王小亭;晁彦公;
SONG Tianjiao;WANG Xiaoting;CHAO Yangong;ICU of the First Affiliated Hospital of Tsinghua University;Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:清华大学第一附属医院ICU
• 2:中国医学科学院北京协和医院重症医学科

摘要(Abstract)：

血流动力学优化是重症医学危重患者复苏的关键，处理延迟或不当将不可避免地造成机体灌注不足、组织缺氧和多器官功能障碍，从而影响患者结局。血流动力学管理的关键原则是根据当前组织代谢情况优化血流及氧流。要实现这一目标需要获取并监测血压、心输出量、器官特异性自动调节和组织微循环等参数。鉴于指标的多样性和连续性，通过临床监测提供的数据十分庞大，同一时段可有近百项数据客观呈现患者的病理生理状态，而不同时段的数据变化可为患者的病情进展描述提供理论支撑。因此，基于毫秒级高分辨率数据的时域/频域整合分析，即颗粒化多模态监测，将促进血流动力学认知与实践迈入微观化，有助于更清晰地判断患者病情并进行更精准的治疗。
Hemodynamic optimization is key to resuscitation of critically ill patients in intensive medicine. Delayed or improper treatment will inevitably lead to hypoperfusion, tissue hypoxia and multiple organ failure, which affects the patients' outcome. Therefore, early identification of patients at risk and implementation of adequate monitoring and guidance intervention have a profound impact on the results. The key principle of hemodynamic management is to optimize blood flow and oxygen flow according to current tissue metabolism. To achieve this goal, we need to monitor and get blood pressure, cardiac output, organ-specific automatic regulation and tissue microcirculation. However, the clinical monitoring data is huge. At the same time nearly one hundred pieces of data objectively present the pathophysiological state of the patient, and the changes of data at different time periods can describe the progress of the patients' condition. Therefore, the integrated analysis of time/frequency domain based on millisecond-level high-resolution data will promote theunderstanding and practice of hemodynamics at microcosmic level, and help to facilitate clearer judgment and more precise treatment of patients' condition.

关键词(KeyWords)： 多模态监测;血流动力学;脓毒症;重症
multimodal monitoring;hemodynamic;sepsis;critically ill

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81771938)~~

作者(Authors): 宋天娇;王小亭;晁彦公;
SONG Tianjiao;WANG Xiaoting;CHAO Yangong;ICU of the First Affiliated Hospital of Tsinghua University;Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College;

参考文献(References)：

• [1]Khanna AK,Karamchandani K.Macrocirculation and Microcirculation:The“Batman and Superman”Story of Critical Care Resuscitation[J].Anesth Analg,2021,132:280-283．
• [2]Saugel B,Michard F,Thomas WL.ScheerenGoal-directed therapy:hit early and personalize[J].J Clin Monit Comput,2018,32:375-377．
• [3]Goldstein B,McNames J,McDonald BA,et al.Physiologic data acquisition system and database for the study of disease dynamics in the intensive care unit[J].Crit Care Med,2003,31:433-441．
• [4]Lee HC,Jung CW.Vital recorder-a free research tool for automatic recording of high-resolution time-synchronised physiological data from multiple anaesthesia Devices[J].Sci Rep,2018,8:1527．
• [5]Sun YC,Guo F,Kaffashi F,et al.INSMA:An integrated system for multimodal data acquisition and analysis in the intensive care unit[J].J Biomed Inform,2020,106:103434．
• [6]Calfee CS,Delucchi K,Parsons PE,et al.Subphenotypes in acute respiratory distress syndrome:Latent class analysis of data from two randomised controlled trials[J].Lancet Respir Med,2014,2:611-620．
• [7]王剑，张政波，王卫东，等．基于重症监护数据库MIMIC-Ⅱ的临床数据挖掘研究[J]．中国医疗器械杂志，2014,38:402-406．
• [8]Halford GS,Baker R,McCredden JE,et al.How many variables can humans process?[J].Psychol Sci,2005,16:70-76．
• [9]Jozwiak M,Monnet X,Teboul JL.Pressure Waveform Analysis[J].Anesth Analg,2018,126:1930-1933．
• [10]Tusman G,Acosta CM,Pulletz S,et al.Photoplethysmographic characterization of vascular tone mediated changes in arterial pressure:an observational study[J].J Clin Monit Comput,2019,33:815-824．
• [11]Chen L,Dubrawski A,Wang D,et al.Using supervised machine learning to classify real alerts and artifact in online multisignal vital sign monitoring data[J].Crit Care Med,2016,44:e456-463．
• [12]Guillame-Bert M,Dubrawski A,Wang D,et al.Learning temporal rules to forecast instability in continuously monitored patients[J].J Am Med Inform Assoc,2017,24:47-53．
• [13]Hatib F,Jian Z,Buddi S,et al.Machine-learning Algorithm to Predict Hypotension Based on High-fidelity Arterial Pressure Waveform Analysis[J].Anesthesiology,2018,129:663-674．
• [14]Davidson S,Pretty C,Balmer J,et al.Blood pressure waveform contour analysis for assessing peripheral resistance changes in sepsis[J].Biomed Eng Online,2018,17:171．
• [15]Le Roux P,Menon DK,Citerio G,et al.Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care:a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive[J].Neurocrit Care,2014,21:S1-S26．
• [16]Vespa PM,McArthur DL,Xu Y,et al.Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy[J].Neurology,2010,31:792-798．
• [17]Claassen J,Mayer SA,Kowalski RG,et al.Detection of electrographic seizures with continuous EEG monitoring in critically ill patients[J].Neurology,2004,25:1743-1748．
• [18]Claassen J,Taccone FS,Horn P,et al.Recommendations on the use of EEG monitoring in critically ill patients:consensus statement from the neurointensive care section of the ESICM[J].Intensive Care Med,2013,39:1337-1351．
• [19]Steiner LA,Czosnyka M,Piechnik SK,et al.Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury[J].Crit Care Med,2002,30:733-738．
• [20]Aries MJ,Czosnyka M,Budohoski KP,et al.Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury[J].Crit Care Med,2012,40:2456-2463．
• [21]Jacobi J.The pathophysiology of sepsis--2021 update:Part2,organ dysfunction and assessment[J].Am J Health Syst Pharm,2022,79:424-436．
• [22]Boucsein W.Electrodermal Activity(2nd ed)[M].Germany:Springer Verlag,2012:153-154．
• [23]Carrara M,Ferrario M,Bollen Pinto B,et al.The autonomic nervous system in septic shock and its role as a future therapeutic target:a narrative review[J].Ann Intensive Care,2021,11:80.