部分CO_2重吸入与经食管超声测定的连续心排血量相关性比较  

Comparison of clinical performance of fick partial rebreathing CO_2 CO and transesophageal dual echo-Doppler CO in monitoring

作　　者：毕素萍[1] 米卫东[1] 张宏[1] 李文广[1] 孙立[1] 

机构地区：[1]解放军总医院麻醉科,北京100853

出　　处：《军医进修学院学报》2005年第2期90-92,共3页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的:比较部分CO2重吸入法和经食管超声多普勒测定的连续心排血量相关性。方法:ASAII级择期腹部手术患者9例,全麻插管后同时用两种方法连续测量每例患者心排量并每3min同步记录。部分CO2重吸入法使用NICO2 监护仪,将重吸入环接于气管导管和螺纹管Y接口之间,其引起CO2部分重吸入,每3min为一测量周期,通过示踪测量周期内正常呼吸期与重吸入期呼吸末CO2浓度和CO2产量变化,推算参与气体交换的肺毛细血管血流量,补偿肺内分流得总心排量;经食管超声法用HemosonicTM100血液动力学监测仪,将超声探头经口放入食管内,探头位置相当于第三、四肋骨间隙,调节探头柄使探头刚好面向后方的降主动脉中心血流,连续监测心排量。应用偏差和相关分析,重吸入法与经食管超声心排量的差值称之偏差。结果:两种测量方法的一致性较好,偏差是-0. 27±0. 46L/min,重吸入法测出的心排量略小于经食管超声心排量,偏差的95. 9%区间是0. 65^-1. 19L/min;两种测量方法高度相关(r=0. 76,P<0. 01,n=278),一元线性回归方程式:重吸入法心排量=0. 76×经食管超声心排量+0. 95。结论:部分CO2重吸入法与经食管超声测定的连续心排血量相关性很好,其操作简单、无创伤,无风险,患者适应症宽,在临床麻醉中有重要应用价值。Objective:To compare the performance of partial rebreathing CO 2 CO in monitoring and transesophageal dual echo-Doppler CO.Methods:Nine patients undergoing elective abdominal surgery were studied. Following anesthetic induction, CO was measured using partial rebreathing CO 2 monitor (NICO 2) and transesophageal dual echo-Doppler(Hemosonic TM100) synchronously. Data were simultaneously recorded every 3min. NICO 2 continuously measures airway flow,pressure and CO 2 concentration. Pulmonary blood flow is estimated by tracking the CO 2 concentration and CO 2 elimination. CO is calculated from pulmonary blood flow by correcting for shunt.The sensor of transesophageal dual echo-Doppler was placed into the esophagus at the level of T3-4 interrib after tracheal intubation. The sensor faced backward toward descending aorta. Hemosonic TM100 can measure aorta blood flow(ABF)and ABF is closedly related to CO(CO=ABF/70%). Linear regression and Bland-altman statistics were used to compare the degree of agreement between concurrent measurements of rebreathing CO and transesophageal CO. Results:The overall difference between rebreathing CO and transesophageal CO was -0.27±0.46L/min(bias±1SD).The weighted correlation coefficient between rebreathing CO and transesophageal CO was r=0.76 (P<0.01, n=278).The regression equation was Rebreathing CO =0.76(Transesophageal CO +0.95. Conclusion:There was a significant correlation between CO values obtained with NICO 2 and Hemosonic TM100.Our data show that partial rebreathing CO 2 technique offers a good alternative to invasive and micro-invasive CO measurement.

关 键 词：经食管超声 吸入法 心排血量 患者 相关性 气管导管 肺内分流 区间 结论 量变 

分 类 号：R654.2[医药卫生—外科学] R614[医药卫生—临床医学]