改良二氧化碳费克法心排出量测定的临床研究  

A Clinical Study of Cardiac Output Measurement Using a Modified Carbon Dioxide Fick Method in Ventilated Patients

作　　者：叶远玲[1] 李彤[2] 王国彬[2] 陈红娟[2] 章渭方[2] 

机构地区：[1]杭州市中医院急诊科,310006 [2]浙江大学医学院附属第一医院外科重症加强治疗科(SICU),杭州310003

出　　处：《医学研究杂志》2012年第11期161-165,共5页Journal of Medical Research

摘　　要：目的通过对机械通气血流动力学不稳定的危重患者应用改良二氧化碳费克法(mCO2F)监测心排出量(CO),并与Swan-Ganz肺动脉漂浮导管法(PAC)、脉搏指示持续心排出量测定法(PiCCO)进行比较,分析其相关性,评价改良二氧化碳费克法测定心排出量的准确性。方法 34例进行机械通气患者均处于全麻未醒或完全镇静状态下,随机分成两组,当达到稳定状态时,每例患者均于0、4h进行2次心排出量测定,采集血流动力学数据,计算mCO2F心排出量(QmCO2F),分别与PAC法心排出量(QPAC)和PiCCO法心排出量(QPiCCO)进行比较。在应用PAC法监测时,同时取右心房中心静脉血样和肺动脉混合静脉血样做血气分析,比较其CO2分压结果。结果 PAC对照组患者中混合静脉血CO2分压(P v-CO2)与右心房中心静脉血CO2分压(Pv-CO2)水平差异无显著性(P>0.05),其0、4h相关系数分别为0.780、0.696,相关性显著(P<0.05)。在各种方法所测心排出量时:PAC法与mCO2F法0、4h相关系数分别为0.939、0.908,PiCCO法与mCO2F法0、4h相关系数分别为0.791、0.745,mCO2F法与PAC法、与PiCCO法均有显著的相关性(P<0.01)。结论改良二氧化碳费克法与热稀释技术之间存在良好的相关性,对于机械通气危重患者而言是一种可靠的心排出量监测方法,该方法费用低,不增加患者原有的创伤。Objective To evaluate the validity of cardiac output measurement with the modified carbon dioxide Fick （mCO2F） method. Mechanical ventilated and critically ill patients with unstable hemodynamics were studied and analyzed. Compared with the cardi- ac output results of the patients that using invasive Swan -Ganz pulmonary artery catheter （PAC） method and pulse indicated continuous cardiac output （PiCCO） method as well as mCO2F method, correlation analysis of the three was illustrated. Methods All 34 mechanical ventilated and critically ill patients were divided into two groups. In the state of complete sedation when cardiac output was measured, 9 patients using mCO2F method （QmCO2F） and PAC method （QPAC） simultaneously, while the rest 25 were measured with mCO2F method （QmCO2F） and PiCCO method （QPiCCO）. When steady state was reached, QmCO2F was measured, being compared with QPACand QPiCCO at Oh and 4h moment respectively. Gas analysis was also performed for central venous blood samples and mixed venous blood samples simultane- ously when cardiac output was measured with PAC method. Results Significant coherence was observed between QmCO2F and QPAC, QmCO2F and QPiCCO. There was no statistical difference in partial carbon dioxide pressure （ PCO2 ） between central venous blood sampies and mixed venous blood samples （P 〉 0.05） , with good correlation found in PCO2 from two different venous samples at Oh and 4h moment （r = 0. 780 ; 0. 696, P 〈 0. 05 ）. Correlation between QmCO2F and QPAC at two moment was observed （ r = 0. 939 ; 0. 908, P 〈 0.01 ） so as corre- lation between QmCO2F and QPiCCO （r = 0. 791 ;0. 745,P 〈 0.01 ）. Conclusion There was good correlation between cardiac output meas- urement using mCO2 F method and thermodilution techniques, which suggestes that cardiac output can be reliably measured in mechanical ventilated patients using mCO2F method. And this method may be cost- effective with no risk of additional morbidity or mortality.

关 键 词：心排出量 机械通气 改良二氧化碳费克法 肺动脉漂浮导管法 脉搏指示持续心排出量测定法 

分 类 号：R654.2[医药卫生—外科学]