肺内分流量对部分CO_2重复吸入法测定心输出量的影响  

Effect of intrapulmonary shunt on the accuracy of partial CO_2 rebreathing technique for cardiac output monitoring

作　　者：刘玲[1] 邱海波[1] 杨毅[1] 郭凤梅[1] 

机构地区：[1]东南大学附属中大医院危重病医学科

出　　处：《中华急诊医学杂志》2005年第9期731-734,共4页Chinese Journal of Emergency Medicine

基　　金：江苏省卫生厅重大课题(H200102)

摘　　要：目的探讨部分CO2重复吸入法测定危重病患者心输出量的准确性及肺内分流量对其影响。方法26例机械通气患者接无创心输出量监测仪(NICO监测仪),利用部分CO2重复吸入法测定心脏指数(CINICO),同时置入肺动脉漂浮导管,以热稀释法测定心脏指数(CITD)。公式法与NICO监测仪同时计算肺内分流量并进行比较。公式法计算的肺内分流量≤15%的患者为低分流组,>15%为高分流组。结果低分流组(n=16)NICO监测仪计算的肺内分流量与公式法测定的肺内分流量无显著差异;CINICO与CITD相关性良好(r=0·91,P<0·01),CINICO为(2·24±0·42)L/(min·m2),CITD为(2·25±0·40)L/(min·m2),两者差异无显著性。高分流组(n=10)NICO监测仪计算的肺内分流量明显低于公式法计算的肺内分流量(P<0·01);CINICO与CITD亦显著相关(r=0·81,P<0·01),但CINICO明显低于CITD(P<0·01),两者分别为(2·56±0·64)L/(min·m2)和(2·87±0·64)L/(min·m2)。结论CINICO与CITD相关性良好,肺内分流量是影响CINICO准确性的重要因素。Objective To evaluate the accuracy of partial CO2 rebreathing technique, and the effect of intrapulmonary shunt. Methods In 26 mechanically-ventilated patients, cardiac index was measured by noninvasive cardiac output monitor （NICO monitor） based on the partial CO2 rebreathing method （CINICO）, and by pulmonary artery catheter based on thermodilution method （CITD）. Intrapulmonary shunt （Qs/Qt） was calculated by the shunt formula and NICO monitor. Accroding to the Qs/Qt calculated by the shunt formula, patients were divided into low Qs/Qt group （Qs/Q≤15 % ） and high Qs/Qt group （Qs/Qt 〉 15 % ）. Results In low Qs/Qt group （ n = 16）, no significant difference was found between the Qs/Qt calculated by NICO monitor and the shunt formula. In this group, a good correlation was found between CINICO and CITD （ r = 0.91, P 〈 0.01）, and the difference between CINICO and CITD Was not significant [ （2.24 ± 0.42） L/ （min·m^2） vs. （2.25±0.40） L/ （min·m^2）, P = 0.84]. In high Qs/Qt group （ n = 10）, the Qs/Qt calculated by NICO monitor was markedly lower than the shunt formula （ P 〈 0.01 ）. A significant correlation was also found between CINICO and CITD （ r = 0.81, P 〈 0.01 ） in this group, with CINICO significantly lower than CITD [ （2.56 ± 0.64） L/ （min · m^2 ） vs. （2.87 ± 0.64） L/ （ min· m^2 ）, P 〈 0.01 ]. Conclusions Correlation between CINICO and CITD is significant. Qs/Qt is an important factor affecting the accuracy of CINICO.

关 键 词：部分CO2重复吸入法 心输出量 肺内分流量 无创心输出量 测定 肺动脉漂浮导管 危重病患者 CITD 机械通气患者 心脏指数 

分 类 号：R446[医药卫生—诊断学]