лѯѭѳќяЦѳЧѿЧќлѭЬгЦѳѻЬѯЬѸѱЧЭѳЦйЬфѳдЦѳЭєѿЧЭѳхд
ѻѯѿЧяЦЬќѳяѳќѳѭЭЬѯїѳяќдѿѳѭЦЬѸѯѻѯъЧхЬѸѳ
Vesna STOJANOV1˨¿»ÎÏÈÅÈƺ©2Í¿ÑһάȽƺ¯º©3½ÑÊÑ¿¨ÒÑÇȣƺ©3
1ÒÀʨʶÊÓѻѿèÎÔÑÀ»¶¸Ñ¿Ò¾Î¸Àʨ½¸¨Ò¨´»¨®ÒÊÑ¿³¿¾¨µÍβ¿ÑÃ
2ÆɼÊѾθҨ®Ñ<ÍÆ¿¸ÑÒè¤=ÍÑ¿3Institut za higijenu i medicinsku ekologiju,
Medicinski fakultet, Univerzitet u Beogradu, Beograd
ƭƳƢƵƢƭƴƢƧƳƩƢNJ
ƵǠǢǑǜǣǟǑǗǝǗǜǤǢǚǩǟǑǒǚǠǚǞǡǗǖǑǟǨǚǹǑǹǗǟǠǓǟǗǚǟǓǑǙǚǓǑǟǞǗǤǠǖǙǑǠǖǢǗdzǚǓǑǻǗǧǗǞǠǖǚǟǑǞǣǜǚǧǡǑǢǑǞǗǤǑǢǑǜǠǖǚǣǡǚ ǤǑǟǚǜǑƵǗǧǟǚǜǑǚǙǓǠdzǗǻǑǡǠǖǢǑǙǥǞǗǓǑǡǢǠǡǥǪǤǑǻǗǟǑǚǙǞǗǟǚǩǟǗǣǤǢǥǹǗǞǑǝǗǑǞǡǝǚǤǥǖǗǚǓǚǣǠǜǗǦǢǗǜǓǗǟǨǚǹǗǜǢǠǙǔǢǥǖ ǟǚǜǠǪǡǥǤǗǞǖǓǑǡǑǢǑǗǝǗǜǤǢǠǖǑƴǤǢǥǹǑǚǟǖǥǜǥǹǗǣǤǓǑǢǑǻǗǠǤǡǠǢǑǥǔǢǥǖǟǠǞǜǠǪǥǜǠǹǚǗǝǗǜǤǢǠǖǗǢǗǔǚǣǤǢǥǹǥƶǜǥǡǟǑǚǞ ǡǗǖǑǟǨǚǹǑǤǠǢǑǜǣǑǹǗǞǗǢǑǗǝǗǜǤǢǚǩǟǠǔǠǤǡǠǢǑǤǠǢǑǜǣǑǠǓǠǹǓǚǣǠǜǠǦǢǗǜǓǗǟǤǟǠǹǣǤǢǥǹǚǞǑǝǗǹǑǩǚǟǗƶǜǝǚǟǚǩǜǠǹǡǢǑǜǣǚǤǠ ǢǑǜǣǟǑǗǝǗǜǤǢǚǩǟǑǒǚǠǚǞǡǗǖǑǟǨǚǹǑǹǗǟǑǪǝǑǡǢǚǞǗǟǥǥǖǚǹǑǔǟǠǣǤǚǩǜǗǤǗǢǑǡǚǹǣǜǗǚǡǢǠǔǟǠǣǤǚǩǜǗǣǓǢǧǗǜǠǖǠǣǠǒǑǣǚǟǣǥ ǦǚǨǚǹǗǟǨǚǹǠǞǢǑǖǑǣǢǨǑǠǖǟǠǣǟǠǧǚǡǗǢǤǗǟǙǚǹǠǞǜǠǖǠǣǠǒǑǣǥǔǢǑdzǗǟǚǞǡǗǹǣǞǗǹǜǗǢǠǞǢǑǖǚǢǑǟǠǔǠǤǜǢǚǓǑǻǑǠǖǒǑǨǚǓǑǻǑ ǚǞǡǝǑǟǤǑǡǠǣǝǗǤǢǑǟǣǡǝǑǟǤǑǨǚǹǗǣǢǨǑǜǑǠǚǜǠǖǒǠǝǗǣǟǚǜǑǣǠǒǠǺǗǻǚǞǑǒǥǒǢǗǔǑǡǢǗǚǡǠǣǝǗǖǚǹǑǝǚǙǗƯǗdzǥǤǚǞǹǗǖǟǑǠǖ ǟǑǹǙǟǑǩǑǹǟǚǹǚǧǥǝǠǔǑǹǗǥǚǙǒǠǢǥǑǟǤǚǧǚǡǗǢǤǗǟǙǚǓǟǗǤǗǢǑǡǚǹǗǒǥǖǥǼǚǖǑǣǗǡǢǚǞǗǟǠǞǠǓǠǔǞǗǤǠǖǑǖǠǒǚǹǑǹǥǡǑǢǑǞǗǤǢǚǜǠǹǚ ǥǩǗǣǤǓǥǹǥǥǟǑǣǤǑǟǜǥǡǠǓǚǪǗǟǠǔǑǢǤǗǢǚǹǣǜǠǔǜǢǓǟǠǔǡǢǚǤǚǣǜǑǑǻǚǧǠǓǚǞǡǠǙǟǑǓǑǻǗǞǞǠǘǗǞǠǠǖǢǗǖǚǤǚǠǡǤǚǞǑǝǟǠǝǗǩǗǻǗ ǡǢǚǝǑǔǠdzǗǟǠǧǗǞǠǖǚǟǑǞǣǜǠǞǣǤǑǤǥǣǥǒǠǝǗǣǟǚǜǑ
ƭǺǥǩǟǗǢǗǩǚǤǠǢǑǜǣǟǑǗǝǗǜǤǢǚǩǟǑǒǚǠǚǞǡǗǖǑǟǨǚǹǑǗǝǗǜǤǢǠǦǚǙǚǠǝǠǔǚǹǑǚǟǣǥǦǚǨǚǹǗǟǨǚǹǑǢǑǖǑǣǢǨǑǧǚǡǗǢǤǗǟǙǚǹǑ
UVOD
¦Î¿Ñ»ÀÒѸ»Ê¿¨´ÒѾ¨Î¨§ÉÃÑÒ®¨µÑµÒ¨ÒÔÑ Ó¨ÔÑÒ§ÊÎÃÎÿ±¨ÔÑ Ñª§ÎèÒѧÀ»Î²ÀÊÑʶÀѨÀ ɨÊÑÒ¨»ÑÇ¿ÔÑÉ¿¨§ÒѸ»Ê¿¨®¨ÊÊѶ§Ã¨®¨Ò À»ÀÔ¿ªÉδ¸Ñµ¶Ô»¶»ÀÉ¿¨§Òʨ§Ñ˨ ¸¿ÀÑ Mullers), koji je opisao promene u impedanci
µ¨Ê»¨ÔÑÉ¿¨É¿ÎÊλ¶¸»Ê¿¨´ÒÀÊ¿¶µÇδʻΧ
Ô»ÑÂξ¿À HoebersµÓÑ»¹¶´¨ÎÃÑ»ÎÒö»Ê¨Ô
nost krvi zavisi od frekvencije primewene elek
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¦Î¿Ñ»ÀÒѸ»Ê¿¨´ÒѾ¨Î¨§ÉÃÑÒ®¨µÑ ¦Í¨¸¨
impedantna pletizmografija, prvi put je primewe
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Ô趧ÒÑ»¿Ô¨ ҘV#%¨¾¶¿ Nyboerµ²Î
Ã¨Ò É¿Ô¨ É¿¨§Ò¨Î ¾¨Î¸»Ê¿¨´Ò¶ ¨§ÉÃÑÒ®¨µ¶ ÓÑÎÿ±¨ÔÑ ¶ÃÑ¿ÒβÔ趧ÒѸԻΧοѽ¶
¾¨´» Kubicek¨ÀÑ¿ÑÃÒ¨®¨#%À¶²ÎèҧÎ
è֨»ÎÔѸ¨ ¨¾¶¿ÎÔ¶ µÃÒÑ´¨Ò¶ ¨ ÊѻΠÉÎÀÊѸ¨ ÓÑÀ¸¶ÁÒ¨ ÓÑ ¿ÑÓÔε 免¨ÒÑ¸Ò ÊªÒ¨» ÊοѻÀÒ ¸»Ê¿¨´Ò¾¨Î¨§ÉÃÑÒ®¨µ»Ñ»ÔÑÉÎÀÊ娨ÃÑÒÑÀ
½Ôµ¸ Quail¨ÀÑ¿ÑÃÒ¨®¨#%À¶²ÎèҶԸ¨
ÊÓÔÖÑ»Êο¿Ó¨ÀÊÒÊÒÎÀʨ¶Î¿¨²¨ÒѸҶµÃÒÑ´¨
Ҷѳ¿Ñ§» Sramek¨ÀÑ¿ÑÃÒ¨®¨#%À¶²Îè
Ò§Îè֨»ÎÔѸ¨½¶¾¨´»ÎÔ¶µÃÒÑ´¨Ò¶¶Ôα § É¿®¨ÓÒ¨µÖ臨¸»ÎµÑÎòÎÔÑ¿Ñ»ÎÒÑ´ÒΧξ¸¨ »¶²¿¶ÃÒβ»Î¼ÑÇ¿Ô¨»Î§¿®¨µÑ¸Ò¨¦Í»Ñ¿Ã¨Î ²¿ÑÖɿΨÓÔÃÒµ¿ÑÒ¨ªÀÃѧÃÀʨª²ÎèÒÑ Ô»Ñ Minnesota Impedance Cardiograph¿¶²Ñ²Ò
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Òθ⨵ÑÓÑÃξ¨µÑ ÉѿѧÊѿѶ<¿Ñ¸ÒΧԿ§
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ЧѿЧќлѭѯѬЬьЬѯѿѯѽќЬ ѱѭЬЦйЬѱЬлѯѭѳќяЦЧЧѿЧќлѭЬгЦЧ
ѻЬѯЬѸѱЧЭѳЦйЬфЧ
¦ªÒ¨»Ñ ¨ÓÔα Ñ ÊοѻÀÒ ¸»Ê¿¨´Ò ¾¨Î¨§ ÉÃÑÒ®¨µ ÉÎÿÑÓ¶§ÔÑ É¿Îɶ¼ÊÑ ÒѨӧҨ´Ò ÀÊ¿¶µ§Ñ¸Ñ§É¸¨Ê¶Ã ImA) i visoke frekven
®¨µ fHz) kroz grudni koš ispitanika pu
ʧÃÔÑÉѿѸ»Ê¿ÎÃѸ»Ê¿ÎÃÀÉÎÀÊÑԹѵ¶¶ É¿ÃλοÒÑÔ¿ÑÊÑ5ÉÎÃÔÀξÀÊ¿ÑÒÔ¿ÑÊÑÑ
po dve na sredwoj aksilarnoj liniji u visini ksi
ÖΨÃÒβÒÑÀÊÑÔ»ÑÒÑξÀÊ¿ÑÒÊοѻÀÑ»ÑμÊε É¿¨»ÑÓÑÒÎÒÑÀ¸¨®¨³ÉιѼ ¨ÉÑ¿ÎÔ¨¸»Ê¿ÎÃÑ ÒÑÔ¿ª¶¨ÒÑÃҶɿÃÀÊÑԹѵ¶¨ÓÔ喝¼¤¸» Ê¿¨´ÒÀÊ¿¶µÑ¶Ò¶Ê¿Ñ¼ ¨ÉÑ¿ÎÔ¨¸»Ê¿ÎÃÑ ÒÑ
korenu vrata i u visiniprocessus xiphoideus) kori
ÀÊÀÓÑÎÿ±¨ÔÑ À¨²ÒѸѨ§ÉÃÑÒ®¨µ¨Ô»ÊÎ¿Ñ ¸»Ê¿Î»Ñ¿Ã¨Î²¿Ñ§Ñ#%¸»Ê¿¨´ÒÑÀÊ¿¶µÑÉ¿Î¸Ñ Ó¨»¿ÎÓÊ»¨ÔѨʴÒÎÀʨ²¿¶ÃÒβ»Î¼ÑÒѵ»¿Ñ¤¨§¨ Òѵ»ÎÒö»Ê¨ÔÒ¨µ¨§É¶Ê§»Îµ¨É¿ÃÀÊÑԹѻ¿Ô¶Ô ¸¨»¨§»¿ÔÒ¨§À¶ÃÎÔ¨§ÑÉѿѸ¸Ò¨§ÀÑ»¨´§Ò¨§ Àʶ¾Î§5¶ÊοѻÀÒεÑοʨ¨ÔÒ¨»ÑÔ¨À¶É¿¨Î¿¨ ¨ÒÖ¿¨Î¿³Ê¿¶µÑ¨Òö»¶µÀÊÔÑ¿Ñ ÒÑÉÎÒѨÎÊ
pora u grudnom košu, koji registruju drugi parovi
¸»Ê¿ÎÃѸή¨¿ÑÒ¨ª¶Ò¶ÊÑ¿ÀÊ¿¶µÒβÊλѽο» ÊÒÎÉÎÀÊÑÔ¹Ñ ¸»Ê¿ÎÃѵԿ¸ÎÔÑÁÒÎÓÑÊÑ´ÒÎÀÊ §¿ Ñ#%
Ç¿§ÑƧÎÔΧÓÑ»ÎÒ¶»ÑÃÑÀ»ÎÒÀÊÑÒÊÒÑÀÊ¿¶
ja primeni na toraks, promene wenog napona su di
rektno proporcionalne promenama otpora ili im
ÉÃÑÒ®¨µ#%£À»¸ÑöÀÎÔ¨§ÓÑ»ÎÒΧ¶»¶ÉÒѨ§É
dancija toraksa, osnovna impedancija ili toraksna
¸»Ê¿¨´ÒѨ§ÉÃÑÒ®¨µÑ Z0µ§¿Ñ¸»Ê¿¨´ÒβÎÊ pora toraksa ovoj visokofrekventnoj struji male ja
´¨ÒÆÒѵµÃÒÑ»ÑÀ¶§¨¨§ÉÃÑÒ®¨µÑÉεèÒÑ´Ò¨ª »Î§ÉÎÒÒʨ²¿¶ÃÒβ»Î¼Ñ§¨¼¨¤ÑÀ¿®Ñ¨À»¸ÊÒ¨ª §¨¼¨¤Ñɸ¶¤ÑÔÑÀ»¶¸Ñ¿Òβʻ¨ÔѧÑÀÒβʻ¨ÔÑ»Î
Àʨ¨ÎÃÒÎÀÑÔÑÓöªÑ¨Ê´ÒÎÀʨ¶ÊοѻÀ¶£ÃÎÉε èÒÑ´Ò¨ª¸§ÒÑÊѻε¨ÃÎÉ¿¨ÒÎÀɿΧҨ¨§É
ÃÑÒ®¨µ ҘZ¶À¨ÀÊθ¨É¿¨»ÑÓÑÒµÒÑÀª§¨
£»¶ÉÒÑ ¨§ÉÃÑÒ®¨µÑ ÊοѻÀÑ µ ¿ÑÓ¸¨´¨ÊÑ »ÎÃ
svakog ispitanika, a procewen normalan raspon za
ÎÿÑÀ¸¶ÎÀҚ#%ǿΧҨ§ÉÃÑÒ®¨ µ ҘZ) u fiziološkim uslovima nastaju usled res piracije i pulzatornog protoka krvi u toku ciklu
ÀÑ¿ÑÃÑÀ¿®ÑÇμÊεÔÑÓöª¸Î¼É¿ÎÔÎÃÒ¨»¨§ ÉÃÑÒ®¨µÑÀÊλΧ¨ÒÀɨ¿¨µ¶§ÑÉÎÔ¤ÑÔÑÑÊλΧ
ekspirijuma smawuje; suprotno tome, tokom sisto
¸¨§ÉÃÑÒ®¨µÑÀÀ§Ñ ¶µµ¿ÀÉÎÔ¤ÑÔѻθ¨´¨ÒÑ »¿Ô¨¶²¿¶ÃÒΧ»Î¼¶ÑÊλΧèµÑÀÊθÀÉÎÔ¤Ñ Ôѳª§Ñ¨¸¶ÀÊ¿¶µÔ¿§ÒÀ»¨ÎÃÒÎÀÀ¨²ÒѸѸ» ʿλѿèβ¿Ñ§ÑÀ¨²ÒѸѾ¨Î¨§ÉÃÑÒ®¨µҘZi pr vog diferencijala signala impedancijedZ/dt
Æÿ±¨ÔÑ QzupcaQRS»Î§É¸»ÀÑÒѽ·¨ÒÑ
dZ/dtÀ¨²ÒѸ¶Î§Î²¶¤ÑÔѧ¿ À¨ÀÊθÒβԿ§Ò
À»Î²¿ÑȄ systolic time intervals), odnosno ventri
»¶¸Òβµ»®¨ÎÒβԿ§ÒÑ ventricular ejection time
5VET¨É¿µ»®¨ÎÒβɿ¨ÎÃÑ pre-ejection period
5PEPÆÔ¨¨Ó§¿Ò¨Éѿѧʿ¨ÓѵÃÒÎÀÑÔθ¶
§ÒΧ ¸»Ê¿¨´ÒÎ É¿ÎÔÎù¨Ô¨ª Ê»¨ÔÑ volume of electrically participating tissues5VEPT), koji zavisi od pola, telesne visine i mase ispitanika, koriste
ÀÓÑÃξ¨µÑ ¶ÃÑ¿ÒβÔ趧ÒÑÀ¿®Ñ stroke volume
5SVÉ¿§Ñ³¿Ñ§»ÎÔεµÃÒÑ´¨Ò¨
SV=VEPT×VET×EPCI
SHEMA 1.ƫǙǓǠǢǚǡǢǠǞǗǟǗǗǝǗǜǤǢǚǩǟǗǚǞǡǗǖǑǟǨǚǹǗŞZǥǣǚǣǤǠǝǚ SCHEME 1. Sources of the cardiac-induced impedance change during systole.
ƲǢǚǝǑǔǠdzǗǟǠǡǢǗǞǑModified to: Osypka MJ, Bernstein DP. Electrophysiologic principles and theory of stroke volume determination by thoracic electrical bioimpedance. AACN Clin Issues 1999; 10(3):385-99
SLIKA 1.ƮǠǜǑǨǚǹǑǠǣǑǞǠǣǟǠǓǟǚǧǗǝǗǜǤǢǠǖǑǚǖǓǗǡǠǞǠǼǟǗǗǝǗǜ ǤǢǠǖǗǟǑǔǢǥǖǟǠǞǜǠǪǥǒǠǝǗǣǟǚǜǑǙǑǡǢǚǞǗǟǥǤǠǢǑǜǣǟǗǗǝǗǜǤǢǚǩ ǟǗǒǚǠǚǞǡǗǖǑǟǨǚǹǗ
ÆÔÑ µÃÒÑ´¨ÒÑ ÎÃÀ¸¨»ÑÔÑ Ö¨Ó¨Î¸Î¼»¶ ÎÀÒÎÔ¶
Îÿ±¨ÔÑ Ñ¶ÃÑ¿ÒβÔ趧ÒÑÇ¿ÔÎÎҵè¿»ÊÒÎ É¿ÎÉﮨÎÒѸÑÒÖ¨Ó¨´»¨§Ã¨§ÒÓ¨µÑ§Ñ¨ÀɨÊÑÒ¨ »Ñ ÃÖ¨Ò¨ÀÑÒ¨§ÉΧΤ¶VEPT); drugo, direktno je
É¿ÎÉﮨÎÒѸÑÒÊ¿ÑµÑ ¶¶¸ÑÀ»Ñ»¿Ô¨¶Ñοʶ VET);
¨Ê¿¤Ã¨¿»ÊÒεɿÎÉﮨÎÒѸÑҧѻÀ¨§Ñ¸ÒΧ
É¿ÎÊ붻¿Ô¨¶Ñοʨ EPCI½ÑÃÑÀ¶ÃÑ¿Ò¨Ôθ¶
§ÒÒο§Ñ¸¨Ó¶µÉ¿§ÑÉÎÔ¿¼¨Ò¨Ê¸Ñ body surface area5BSA§ÎÁÀ¨Ó¿Ñ´¶ÒÑʨ¨ÒûÀ¶ÃÑ¿Ñ stroke index5SI»Îµ¨µª§ÎèÒѧÀ»¨ÔΧÑÓÒѴѵÑÒÉÑ rametar protoka krvi:
SI=SV÷BSA
BSA m2µÀ¸ÎÁÒÑÖ¶Ò»®¨µÑʸÀÒÔ¨À¨Ò¨
§ÑÀ ¨ÀɨÊÑÒ¨»Ñ ¨ ¨Ó¿Ñ´¶ÒÑÔÑ À É¿§Ñ Ö臨¸¨ »Îµ¶À¶¨ÓÔ¸¨¨¾ÎÑ DuBois¨¨¾ÎÑ DuBois), gde jeWʸÀÒѧÑÀÑ kg), aHʸÀÒÑÔ¨À¨ÒÑ cm):
BSA=W0,425×H0,725×0,007184
ÒûÀ¿ÑÃÑÀ¿®Ñ cardiac index – CI) se onda izra
´¶ÒÑÔÑ»ÑÎ
CI=SI×HR
VETiPEPÀ»Î¿¨ÀÊÓѨӿѴ¶ÒÑÔÑ µ»®¨Î
ÒÖ¿Ñ»®¨µÀ¿®Ñ ejection fraction – EF#%É¿§ÑµÃ
ÒÑ´¨Ò¨
EF=0,84-0,64×(PEP÷VET)
ѨЧѸѯЭЬЦѳѸяќЬѱѳѭѳѸЧлѭЬќѯфЬ яЧѯЭѭЧѹдфдлѯѭѳќяЦѯѸЧѿЧќлѭЬгЦѯѸ
ѻЬѯЬѸѱЧЭѳЦйЬфѯѸ
¦Î¿Ñ»ÀÒΧ¸»Ê¿¨´ÒΧ¾¨Î¨§ÉÃÑÒ®¨µÎ§Ãξ¨ µÑÀÔ¸¨»¨¾¿Îµª§ÎèÒѧÀ»¨ªÉѿѧÊѿѦÎÀ¶ Éѿѧʿ¨É¿ÎÊλѻ¿Ô¨ §¨Ò¶ÊÒ¨Ô趧ҨÒûÀ
rada srca, udarni volumen, indeks udarnog volume
ÒÑÉѿѧʿ¨ÎÊÉÎ¿Ñ À¨ÀʧÀ»¨ÔÑÀ»¶¸Ñ¿Ò¨ÎÊÉο
indeks sistemske vaskularne rezistencije), parame
Ê¿¨ÀÑÿÁѵÑÊ´ÒÎÀʨ ÀÊÑ Ê´ÒÎÀʨ¶ÊοѻÀ¶ÀÑ Ã¿ÁѵʴÒÎÀʨ¶ÊοѻÀ¶¨Éѿѧʿ¨»ÎÒʿѻʨ¸ ÒÎÀʨ ɿΧÒѨ§ÉÃÑÒ®¨µ¶Ô¿§Ò¶É¿µ»®¨Î
ni period, ventrikulno ejekciono vreme, sistolni vremenski razmak, indeks akceleracije, indeks kon
ʿѻʨ¸ÒÎÀʨ¨ÒûÀ¿ÑÃѸԻΧοÆÀÊѸ¨ÉÑ
rametri su frekvencija rada srca i sredwi arterij
À»¨É¿¨Ê¨ÀÑ»#%
SHEMA 2.ƤǢǗǞǗǟǣǜǚǠǖǟǠǣǚǙǞǗdzǥǗǝǗǜǤǢǠǜǑǢǖǚǠǔǢǑǞǑ ǟǑǓǢǧǥǣǚǔǟǑǝǑǒǚǠǚǞǡǗǖǑǟǨǚǹǗŞZ ǥǣǢǗǖǚǟǚǚǡǢǓǠǔǖǚǦǗǢǗǟǨǚǹǑǝǑǣǚǔǟǑ ǝǑǚǞǡǗǖǑǟǨǚǹǗdZ/dt ǟǑǖǟǥ
SCHEME 2. Time relations from the ECG (top), bioimpedance signal ΔZ (middle) and its time derivative dZ/dt (bottom).
PEP=ǡǢǗǗǹǗǜǨǚǠǟǚǡǗǢǚǠǖLVET=ǓǗǟǤǢǚǜǥǝǟǠǗǹǗǜǨǚǠǟǠǓǢǗǞǗQ=ǡǠǩǗǤǑǜǖǗǡǠǝǑǢǚǙǑǨǚǹǗǜǠǞǠǢǑB=ǠǤǓǑǢǑǻǗǡǥǝǞǠǟǑǝǟǗǚǑǠǢǤǟǗ ǓǑǝǓǥǝǗC=ǞǑǜǣǚǞǑǝǟǚǠǤǜǝǠǟȆZȆtǤǑǝǑǣǑX=ǙǑǤǓǑǢǑǻǗǑǠǢǤǟǗǓǑǝǓǥǝǗY=ǙǑǤǓǑǢǑǻǗǡǥǝǞǠǟǑǝǟǗǑǠǢǤǗO=ǠǤǓǑǢǑǻǗǞǚǤǢǑǝǟǗǓǑǝ ǓǥǝǗ ǦǑǙǑǒǢǙǠǔǡǥǻǗǻǑǜǠǞǠǢǑ
PEP – preejection period; LVET – left ventricular ejection time; Q – start of ventricular depolarization; B – opening of pulmonic and aortic valves; C – maximal deflection of the ∆Z/∆t; X – closure of aortic valve; Y – closure of pulmonic valve; O – mitral opening (rapid ventricular filling)
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LITERATURA
1. Tsadok S. The historical evolution of bioimpedance. AACN Clin Issues 1999; 10(3):371-84.
2. Nyboer J. Electrical impedance plethysmography: A physical and physiologic approach to peripheral vascular study. Circulation 1950; 2:811-21.
3. Kubicek WG, Karnegis JN, Patterson RP, Witsoe DA, Mattson RH. Development and evaluation of an impedance cardiac output sys-tem. Aerospace Med 1966; 37:1208-12.
4. Quail AW, Traugott FM, Porges WL, White SW. Thoracic resistivi-ty for stroke volume calculation in impedance cardiography. J Appl Physiol 1981; 50:191-5.
5. Sramek BB. Thoracic electrical bioimpedance: Basic principles and physiologic relationship. Noninvas Cardiol 1994; 3(2):83-8. 6. Critchley LAH. Impedance cardiography. The impact of new
tech-nology. Anaesthesia 1998; 53:677-84.
7. Chouhan L. Electrical bioimpedance: a new noninvasive hemody-namic monitoring technique for clinical use. Heart Views 2000; 1(8):317-9.
8. Jewkes C, Sear JW, Verhoeff F, Sanders DJ, Foex P. Non-invasive measurement of cardiac output by thoracic electrical bioimped-ance: a study of reproducibility and comparison with termodilu-tion. Br J Anaesth 1991; 67(6):788-94.
9. Osypka MJ, Bernstein DP. Electrophysiologic principles and theo-ry of stroke volume determination by thoracic electrical bioimped-ance. AACN Clin Issues 1999; 10(3):385-99.
10. Buell JC. A practical, cost-effective, noninvasive system for cardi-ac output and hemodynamic analysis. Am Heart J 1988; 116(2):657-64.
11. Lasater M, Van Rueden KT. Outpatient cardiovascular manage-ment utilizing impedance cardiography. AACN Clin Issues 2003; 14(2):240-50.
12. Strobeck JE, Silve MA. Emerging role of impedance cardiography ICG in heart failure. Congest Heart Fail 2004; 10(Suppl 2):3-6.
13. Sageman WS, Riffenburgh RH, Spiess BD. Equivalence of bio-impedance and thermodilution in measuring cardiac index after cardiac surgery. J Cardiothorac Vasc Anesth 2002; 16(1):8-14. 14. Belardinelli R, Ciampani N, Costantini C. Comparison of
imped-ance cardiography with thermodilution and direct Fick methods of noninvasive measurement of stroke volume and cardiac output during incremental exercise in patients with ischemic cardiomy-opathy. Am J Cardiol 1996; 77:1293-301.
15. Yung GL, Fedullo PF, Kinninger K, Johnson W, Channick RN. Comparison of impedance cardiography to direct Fick and ther-modilution cardiac output determination in pulmonary arterial hypertension. Congest Heart Fail 2004; 10(Suppl 2):7-10. 16. Hendrickson K. Cost-effectiveness of noninvasive hemodynamic
monitoring. AACN Clin Issues 1999; 10(3):419-24.
17. Christensen TB, Jensen BV, Hjerpe J, Kanstrup I-L. Cardiac output measured by electric bioimpedance compared with the CO2 rebreathing technique at different exercise levels. Clin Physiol 2000; 20(2):101-5.
18. Chaney JC, Derdak S. Minimally invasive hemodynamic monitor-ing for the intensivist: current and emergmonitor-ing technology. Crit Care Med 2002; 30:2338-45.
19. Campos PC, D’Cruz I. Functional mitral regurgitation in decom-pensated heart failure: combined bio-impedance and 2D echocar-diography follow-up monitoring. Echocarechocar-diography 2004; 21(4):337-9.
20. Yancy C, Abraham W. Noninvasive hemodynamic monitoring in heart failure: utilization of impedance cardiography. Congest Heart Fail 2003; 9(5):241-50.
21. Stojanov V, Jakovljević B, Avramović MD, Petrović M. Significance of new non-invasive diagnostic procedures in the estimation of the efficiency of therapy with cilasaprile. ICN Galenika za medicinu, farmaciju i stomatologiju – Kardiovaskularna oboljenja 1996; 7:60-5.
22. Weiss SJ, Ernst AA, Godorov G, Diercks DB, Jergenson J, Kirk JD. Bioimpedance-derived differences in cardiac physiology during exercise stress testing in low-risk chest pain patients. South Med J 2003; 96(11):1121-7.
23. Belojevic G, Stojanov V, Jakovljevic B. Thoracic electrical bio-impedance monitoring of cardiovascular effects of noise. In: Prash-er D, editor. Noise pollution and health. London: Noise Research Network Publications; 2003. p.77-80.
24. Strobeck JE, Silver M, Ventura H. Impedance cardiography: Non-invasive measurement of cardiac stroke volume and thoracic fluid content. Congest Heart Fail 2000; 6:3-6.
25. Stojanov V, Avramović DM, Jakovljević B, Kozarević Đ, Janošević S, Avramović DD. High-normal values of the arterial blood pres-sure as a risk factor for the occurrence of cardiovascular diseases. Jugoslovenski žurnal za hipertenziju 1997; 1:27-30.
26. Lasater M. Managing inotrope therapy noninvasively. AACN Clin Issues 1999; 10(3):406-13.
27. Ziegler D, McReynolds D, Webber C, Eisenstein C, Parker W, Gar-cia F. Comparison of the use of the pulmonary artery catheter ver-sus thoracic electrical bioimpedance in a surgical intensive care unit (SICU). Crit Care Med 2000; 28:A158.
28. Taler SJ, Textor SC, Augustine J. Resistant hypertension; compar-ing hemodynamic management to specialist care. Hypertension 2002; 39(5):982-8.
29. Stojanov V, Avramović DM. Application of the thoracic electrical bioimpedance in the choice of antihypertensive therapy. In: Nedeljković S, Kanjuh V, Vuković M, editors. Kardiologija 2000. Beograd: Medicinski fakultet Univerziteta u Beogradu; 2000. p.642-5.
30. Belott P. Bioimpedance in the pacemaker clinic. AACN Clin Issues 1999; 10(3):414-8.
31. Weinhold C, Reichenspurner H, Fulle P, Nollert G, Reichert B. Registration of thoracic electrical bioimpedance for early diagno-sis of rejection after heart transplantation. J Heart Lung Transplant 1993; 12(5):832-6.
32. Moshkovitz Y, Kaluski E, Milo O, Vered Z, Cotter G. Recent devel-opments in cardiac output determination by bioimpedance: com-parison with invasive cardiac output and potential cardiovascular applications. Curr Opin Cardiol 2004; 19:229-37.
ABSTRACT
Thoracic electrical bioimpedance is a new non-invasive technique for obtaining haemodynamic parameters. The method involves the passing of low amperage, high frequen-cy current through the thorax. The current induces a change of resistance within the thorax, which is registered by elec-trodes. The overall impedance of the thorax is a measure of the electrical resistance of the thorax to this high frequency, low amplitude current. In clinical practice, thoracic electrical bio-impedance has been applied in diagnostic, therapeutic, and prognostic use in patients with heart failure and hypertension, patients with pacemakers, within the scope of early diagno-sis of implant rejection following heart transplantation, as well
as in patients with kidney disorders, before and after dialysis. However, one of its most important applications is in the deter-mination of antihypertensive therapy, because it provides the parameters that reflect the genesis of arterial blood pressure. In assessing these parameters, optimal therapy adjusted to the haemodynamic status of each patient can be prescribed.
Key words: thoracic electrical bioimpedance; electrophysiolo-gy; heart failure; hypertension
Branko JAKOVLJEVIĆ
Kralja Vladimira 8, 11000 Beograd E-mail: [email protected]
THORACIC ELECTRICAL BIOIMPEDANCE IN THE FOLLOW-UP OF
PATIENTS WITH CARDIOVASCULAR DISORDERS
Vesna STOJANOV1, Mirko ŠARANOVIĆ2, Branko JAKOVLJEVIĆ3, Katarina PAUNOVIĆ3 1Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade; 2General Hospital “B. Orlandić”, Bar;
3Institute for Hygiene and Medical Ecology, School of Medicine, University of Belgrade, Belgrade
