两种方法评估冠状动脉旁路移植术患者心脏收缩功能的比较  

Comparison of two methods for determining cardiac systolic function in patients undergoing coronary artery bypass grafting

作　　者：缪娟娟[1] 史宏伟[1] 王振红[1] 赵雅梅[1] 葛亚力[1] 魏海燕[1] 

机构地区：[1]南京医科大学附属南京医院麻醉科,江苏南京210006

出　　处：《南京医科大学学报（自然科学版）》2014年第7期981-985,990,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：南京市卫生青年人才培养工程(第一层次)[宁卫科(2011)42号]

摘　　要：目的：评估经食管超声心动图（TEE）左室流出道（LVOT）测量心脏排血量（COLVOT）和经Swan-Ganz肺动脉导管测量心脏排血量（COPAC）的一致性及左室射血分数（LVEF）、左室面积变化分数（LVFAC）、右室射血分数（RVEF）之间的相关性。方法：择期行冠状动脉旁路移植术的患者12例,性别不限,年龄18-70岁,体重56-84 kg,ASA分级Ⅱ或Ⅲ级,术前NYHA心功能分级Ⅱ级或Ⅲ级。麻醉诱导及术中维持均采用全静脉麻醉。麻醉诱导气管插管后置入Swan-Ganz肺动脉导管并放置TEE探头,于插管后（T0）、停止体外循环转机后或非体外循环手术血管吻合完成后15 min（T1）、30 min（T2）和60 min（T3）的数据。统计分析采用Bland-Altman一致性检验和Pearson相关系数检验。结果：COPAC为（4.82±1.32）L/min,COLVOT为（4.57±1.30）L/min,两者具有良好的相关性（r=0.655,P〈0.001）,COPAC和COLVOT的偏差为0.28 L/min（95%CI为-0.04-0.60 L/min）,一致性界限为-1.90-2.46 L/min。LVEF与LVFAC呈正相关（r=0.662,P〈0.001）,而与RVEF无相关性（r=-0.218,P〉0.05）。LVEF与LVFAC偏差为15.36%（95%CI为12.46%-18.29%）,一致性界限为4.68%-35.43%,LVEF与RVEF的偏差为34.40%（95%CI为29.69%-39.10%）,一致性界限为-2.01%-66.78%。结论：TEE经左室流出道测量心脏排血量和Swan-Ganz肺动脉导管测量心脏排血量之间有较强的相关性但一致性较差,TEE和PAC不能互相替代,而左室射血分数与左室面积变化分数之间存在明显偏差但有较好的相关性。Objective：To determine if the cardiac output（CO） measured by transesophageal echocardiography（TEE） through the left ventricular outflow tract（LVOT） is consistent with that measured by pulmonary artery catheter（PAC）. The correlation between left ventricular ejection fraction（LVEF）,left ventricular fractional area change（LVFAC） and right ventricular ejection fraction（RVEF） was analyzed. Methods：Twelve patients with ASA Ⅱ-Ⅲ（NYHA Ⅱ or Ⅲ）,aged 18-70 years,weighing 46-72 kg and undergoing coronary artery bypass grafting were studied. Anesthesia induction and intraoperative maintenance were performed by intravenous anesthesia. After tracheal intubation,the Swan-Ganz catheter and TEE probe were placed. The data were measured and recorded after tracheal intubation（T0）,15（T1）,30（T2） and 60（T2） min after termination of cardiopulmonary bypass（CPB） or finished vascular anastomosis in off-pump CABG. Statistical analysis was performed by Bland-Altman plot and Pearson correlation coefficient method. Results：COPACwas（4.82 ± 1.32） L / min and COLVOTwas（4.57 ± 1.30）L / min. COLVOTwas highly correlated with COPAC（r = 0.655,P〈0.001）. The bias between COPACand COLVOTwas 0.28 L / min（95% CI：-0.04 -0.60 L / min）,and limits of agreement were-1.90-2.46 L / min. LVEF was positively correlated with LVFAC（r = 0.662,P〈0.001）,while it was not significantly correlated with RVEF（r =-0.218,P〈0.001）. The bias between LVEF and LVFAC was 15.36%（95%CI：12.46%-18.29%）,and limits of agreement was 4.68%-35.43%,while that between LVEF and RVEF was 34.40%（95%CI：29.69%-39.10%）,and limits of agreement was-2.01% -66.78%. Conclusion：The results showed that CO measured by TEE through the LVOT was significantly correlated but poorly consistent with that measured by Swan-Ganz PAC. Both methods for CO measurement cannot replace each other.Moreover,there was an obviously bias but a good correlation between LVFAC and LVFAC.

关 键 词：经食道超声心动图 心排血量 肺动脉导管 左室流出道 射血分数 面积变化分数 

分 类 号：R445.1[医药卫生—影像医学与核医学]