去氧肾上腺素对Vigileo／Flotrac系统测量心指数准确性影响的临床研究  

The clinical research of the accuracy of Vigileo/Flotrac system to measure cadiac index induced by phenylephrine

作　　者：储靖[1] 李宏[1] 沈爱华[1] 蔡春姝 

机构地区：[1]武警后勤学院附属医院麻醉科,天津300162

出　　处：《中国急救复苏与灾害医学杂志》2015年第12期1147-1149,共3页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：武警后勤学院面上项目（FYM201550）

摘　　要：目的研究去氧肾上腺素对第三代Vigileo／Flotrac系统测量心指数（cardiacindex，CI）准确性的影响，以及其准确性与外周阻力改变大小的关系。方法20例拟行冠脉搭桥手术患者，为每位患者予以去氧肾上腺素100mg干预3次。监护并记录在予以去氧肾上腺素之前（T。）和之后2min（T：）时，由Vigileo／Flotrac系统测得的CIfCIFV），由肺动脉导管测得的CI（CITD），以及外周血管阻力（systemicvascularresistance，SVR）。用Bland—Altman法分析‘r：点CIFV与CITD的偏倚，用直线回归分析法对两者改变值偏倚与SVR改变进行相关性分析。结果在予以去氧肾上腺素后CIFV与CITD间的偏倚为（0．31~0．93）L／（min·m-2），百分误为54％。CIFV与CITD改变值之间的偏倚与SVR改变大小显著相关（P〈0．01）。在SVR改变〈15％的数据组中，CIFV与CITD改变值的偏倚为（0．12±0．43）L／（min·m。），偏倚值与SVR改变的大小无相关性。在SVR改变〉15％的数据组中，CIFV与CITD改变值的偏倚为（O．22±0．89）／（min·m-2），偏倚值与SVR改变的大小呈相关性。结论去氧肾上腺素可严重影响Vigileo／Flotrac系统测量CI准确性，其结果不能为临床接受。在SVR改变〉15％时，其准确性与SVR改变大小明显相关。Objective To explore the ability of Vigileo/ Flotrac system to measure cardiac index （CI） induced by phenylephrine as well as the correlation between the accuracy and the change of systemic vascular resistance （$VR）. Methods 20 patients undergoing coronary artery bypass graft were enrolled. Each patient was administrated phenylephrine 100rag three times and their CI was measured by Vigileo/Flotrac system （version 3.06） （CIFV）, CI measured by a pulmonary artery catheter （CITD）, and SVR were recorded before （T1） and 2 minutes after phenylephrine administration （T2）. Bland-Altman analysis was used to compare CIFV and CITD at %. Linear regression was used to analysis the correlation between the bias of the change of CIFV and CITD and the change of SVR. Results The bias between CIFV and CITD after administrating phenylephrine was 0.31 ±0.931/min/m2 with a percentage error of 54%. The bias between the change of CIFV and CITD significantly correlated with the changes in SVR （P〈 0.01）. In the subset of subjects in which SVR changed by less than 15%, the bias between change of CIFV and CITD was O.12：t：0.431/min/m2. In these subjects, there was no significant correlation between SVR and the bias of the change of CIFV and CITD （P〉 0.05）. In the subset of subjects in which SVR changed by more than 15%, the bias between change of CIFV and CITD was 0.22±0.891/min/m2. In these patients, the bias between the change of CIFV and CITD significantly correlated with the changes in SVR （P〈 0.01）. Conclusion It reflected that Vigileo/Flotrac system measuring CI induced by phenylephrine administration is not clinically acceptable. In addition, its accuracy was significantly affected by the changes in SVR.

关 键 词：Vigileo/Flotrac 外周血管阻力 去氧肾上腺素 心指数 

分 类 号：R972[医药卫生—药品] R445[医药卫生—药学]