先天性心脏病并重度肺动脉高压孕妇围手术期两种监测心指数方法的评估  

Evaluation on cardiac index measured with arterial pressure-based cardiac output and pulmonary artery catheter during cesarean section in parturients with congenital heart disease combined with severe pulmonary hypertension

作　　者：莫志伟 韦华[2] 徐康清[3] 

机构地区：[1]广东省高州市中医院麻醉科,525200 [2]广东省高州市人民医院麻醉科,525200 [3] 中山医科大学附属第一医院麻醉科

出　　处：《中国医师进修杂志》2014年第35期41-44,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 评价动脉波形分析心输出量法（APCO）及肺动脉导管法（PAC）监测先天性心脏病并重度肺动脉高压孕妇行剖宫产围手术期心指数（CI）的一致性.方法 选取择期行剖宫产术的先天性心脏病并重度肺动脉高压孕妇45例,术中均同时采用APCO及PAC监测.采取连续硬膜外麻醉,于硬膜外给药前即刻（T1）、硬膜外给药后5 min（T2）、硬膜外给药后10 min（T3）、胎儿娩出前即刻（T4）、胎儿娩出后2 min（T5）、胎儿娩出后5 min（T6）记录CI.APCO及PAC监测的CI（分别为A-CI和P-CI）进行Pearson相关性分析和一致性检验.结果 各时点P-CI均高于A-CI,差异有统计学意义（P＜0.05）;与T1时比较,T2～T4、T6时A-CI和P-CI差异均无统计学意义（P＞0.05）,T5时A-CI[（4.5±1.1） L/（min ·m2）比（4.2±0.8）L/（min ·m2）]和P-CI [（6.2±1.5） L/（min ·m2）比（5.4±1.2）L/（min＆#183;m2）]均升高,差异有统计学意义（P＜ 0.05）;T1～T6时两种方法监测的CI均呈正相关（r值分别为0.931,0.955,0.945,0.892,0.960,0.913;P＜ 0.05）.Bland-Atlman一致性分析结果显示两种监测方法的一致性较差.结论 APCO与PAC监测先天性心脏病并重度肺动脉高压孕妇剖宫产围手术期CI的一致性较差,但在监测CI变化趋势上是相同的.Objective To evaluate the concordance on cardiac index （CI） measured with arterial pressure based cardiac output （APCO） and pulmonary artery catheter （PAC） during cesarean section in parturients with congenital heart disease combined with severe pulmonary hypertension.Methods Forty-five congenital heart disease combined with severe pulmonary hypertension parturient who scheduled for cesarean section were selected,APCO and PAC were used for cardiac output and other parameters of hemodynamics monitoring during operation in all patients.Continuous epidural anesthesia was performed.CI was recorded immediately before epidural administration （T1）,at 5 and 10 min after epidural administration （T2,T3）,immediately before delivery （T4）,and at 2 and 5 min after delivery （T5,T6）.The correlation of CI between APCO and PAC （A-CI and P-CI,respectively） was tested by Pearson correlation analysis and agreement test.Results The P-CI was significantly higher than A-CI,there was statistical difference （P 〈 0.05）.Compared with T1,no significant differences between A-CI and P-CI were found at T2-T4 and T6 （P 〉 0.05）,The A-CI at T5 [（4.5 ± 1.1） L/（min·m2） vs.（4.2 ± 0.8） L/（min ·m2）] and P-CI [（6.2 ± 1.5） L/（min·m2） vs.（5.4 ± 1.2） L/ （min· m2）] were significantly higher,there were statistical differences （P 〈 0.05）.The correlation analysis showed that there was positive correlation between A-CI and P-CI at T1-6 （r =0.931,0.955,0.945,0.892,0.960,0.913 ; P 〈 0.05）.Bland-Altman analysis showed poor agreement between CI measured with the two methods.Conclusion CI value obtained with APCO agrees poorly with that obtained with PAC during cesarean section in parents with congenital heart disease combined with severe pulmonary hypertension,but agrees well in monitoring the changing trend of CI.

关 键 词：心脏缺损 先天性 高血压 肺性 监测 手术中 剖宫产术 

分 类 号：R541.1[医药卫生—心血管疾病] R544.1[医药卫生—内科学]