动脉压力波形法和间断热稀释法监测心排血量技术的对照研究  

Comparative study on the arterial pressure-based cardiac output measurement and the intermittent thermodilution

作　　者：沈伟军[1] 傅舒昆[1] 于布为[2] 

机构地区：[1]同济大学附属第十人民医院麻醉科,上海200072 [2]上海交通大学医学院附属瑞金医院麻醉科

出　　处：《上海医学》2012年第4期273-276,共4页Shanghai Medical Journal

摘　　要：目的比较经动脉压力波形分析法(FloTrac系统)与传统经肺动脉导管间断热稀释法(Swan-Ganz导管技术)监测心排血量(CO)之间的相关性和一致性。方法选择10例行择期非停跳冠状动脉旁路移植术(OPCAB)的患者,美国麻醉医师学会(ASA)分级为Ⅱ～Ⅲ级,年龄62～76岁。所有患者均连接FloTrac传感器(Vigileo监测仪)监测外周动脉血CO(APCO);同时放置肺动脉漂浮导管,接Ewards VigilanceTM监护仪监测间断CO(ICO)。结果一元线性回归分析结果显示,患者术中在放置肺动脉导管后、第1次容量负荷后开胸前、开胸后、搭前降支固定器放置稳定后5min、搭回旋支固定器放置稳定后5min、搭后降支固定器放置稳定后5min、近端吻合时、关胸后第2次容量负荷之前及第2次容量负荷之后9个时间点的APCO与ICO之间均高度相关(相关系数分别为0.81、0.73、0.86、0.78、0.79、0.90、0.80、0.77、0.76,P值分别<0.01、0.05)。Bland-Altman散点图分析结果显示,各时间点APCO与ICO之间的偏差和一致性差异分别为-0.35(±1.08)、-0.21(±1.06)、-0.25(±0.88)、-0.43(±0.98)、-0.47(±0.72)、-0.27(±0.62)、-0.35(±0.94)、-0.26(±0.90)、-0.39(±1.04)L/min,两种监测方法有较好的一致性。结论 FloTrac系统测量的APCO与Swan-Ganz导管技术测量的ICO之间存在良好的相关性和一致性。Objective To compare the measurements of cardiac output by arterial pressure-based cardiac output （APCO） analysis method and conventional intermittent thermodilution cardiac output （leo） vie pulmonary artery catheter. Methods Ten patients with American Society of Anesthesiologists （ASA） IT - m, aged 62- 76 years old and scheduled for off-pump coronary artery bypass （OPCAB） surgery, were enrolled in this study. APCO and ICO were determined by the FIoTrac/VigileoTM system and Swan-Ganz catheter （Ewards VigilanceTM）, respectively. Results The results of linear regression revealed a significant correlation between APCO and ICO at 9 time points （after the placement of a pulmonary artery catheter, between the first volume load and opening chest, after opening chest, 5 min after putting fixator of anterior descending branch, 5 min after putting flxator of circumflex branch, 5 min after putting fixator of posterior descending branch, at the connection of proximal end, between closing chest and the second volume load, and after the second volume load, with the correlation coefficients being 0.81, 0.73, 0.86, 0.78, 0.79, 0.90, 0.80, 0.77, and 0.76,respectively （P〈 0.01 or 0.05）. Bland-Altman analysis showed that the mean bias between APCO and ICO were - 0.35（±1.08）, -0.21（±1.06）, -0.25（±0.88）, -0.43（±0.98）, -0.47（±0.72）, -0.27（±0.61）, -0.35（±0.94）, -0.26（±0.90） and -0.39 （±1. 04） L/min at the 9 time points. Conclusion There is much agreement between the measurements of cardiac output by APCO （the FIoTrac/VigileoTM system） and ICO （the Swan-Ganz catheter）. （Shanghai Med J, 2012, 35： 273-276）

关 键 词：心排血量 SWAN-GANZ导管 监测 脉搏图法 温度稀释法 

分 类 号：R614[医药卫生—麻醉学]