USCOM与热稀释法监测重症患者心功能比较的Meta分析  

Ultrasound cardiac output monitor and thermodilution for cardiac function monitoring in critical patients:a Meta-analysis

作　　者：张云 王琰 季冬东 钱际银 徐进宇 时兢 Zhang Yun;Wang Yan;Ji Dongdong;Qian Jiyin;Xu Jinyu;Shi Jing(Department of Emergency,Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,Jiangsu,China)

机构地区：[1]南京医科大学附属无锡人民医院急诊科,214023

出　　处：《中华危重病急救医学》2019年第12期1462-1468,共7页Chinese Critical Care Medicine

摘　　要：目的系统评价超声心排血量监测(USCOM)与热稀释法(TD)在重症患者心功能监测中的差异.方法检索中国知网(CNKI)、万方数据库、中国生物医学文献数据库、维普数据库、中国临床试验注册中心、美国国立医学图书馆(PubMed)、荷兰医学文摘(Embase)、Cochrane图书馆关于USCOM与TD方法监测心功能临床试验的中文或英文文献,检索时间为建库至2018年12月.研究指标为心排血量(CO)、心排血指数(CI)、每搏量(SV)等评价心功能的参数.文献筛选、质量评价和数据提取由2名评价员独立进行.使用裁剪的诊断试验准确性研究的偏倚评估工具(QUADAS-2)进行文献质量评价,使用EndNote X6软件进行文献筛选管理,使用RevMan 5.3软件进行Meta分析,采用漏斗图分析文献是否存在发表偏倚.结果共纳入26篇文献涉及772例患者,其中5篇文献作者认为USCOM与TD监测的一致性较差.Meta分析显示:USCOM与TD监测的CO、CI差异无统计学意义〔CO:均数差(MD)=-0.06,95%可信区间(95%CI)为-0.17~0.05,P=0.31;CI:MD=-0.04,95%CI为-0.13~0.05,P=0.38〕.对不同TD方法〔肺动脉导管(PAC)、脉搏指示连续心排血量监测(PiCCO)〕及USCOM超声探头的不同视窗〔主动脉(AA)、肺动脉(PA)〕进行监测的亚组分析也未发现二者在CO结果方面存在明显差异(PAC:MD=-0.07,95%CI为-0.18~0.04,P=0.23;PiCCO:MD=0.09,95%CI为-0.31~0.50,P=0.65;AA视窗:MD=-0.14,95%CI为-0.31~0.02,P=0.09;PA视窗:MD=-0.00,95%CI为-0.15~0.14,P=0.95;AA/PA视窗:MD=0.23,95%CI为-0.40~0.86,P=0.47);但USCOM与TD监测的SV差异却具有统计学意义(MD=1.48,95%CI=0.04~2.92,P=0.04).漏斗图显示,CO、CI监测的文献分布基本对称,说明文献发表偏倚较小.结论USCOM监测重症患者心功能CO、CI指标与TD方法具有较好的一致性,USCOM不同采样点对监测结果无明显影响,但在SV监测上两种方法的一致性较差.Objective To assess the differences between ultrasound cardiac output monitor(USCOM)and thermodilution(TD)systematically in cardiac function monitoring of critically ill patients.Methods The Chinese and English literatures about the clinical trials which using USCOM and TD to monitor cardiac function published in CNKI,Wanfang database,China biomedical literature database,VIP database,China Clinical Trial Registration Center,PubMed,Embase and Cochrane Library were searched by computer from the establishment to December 2018.Some indicators,like cardiac output(CO),cardiac index(CI),stroke volume(SV)and other parameters were used to evaluate cardiac function.Literature search,quality evaluation and data extraction were conducted independently by two authors.The tailored Quality Assessment of Diagnostic Accuracy Studies(QUADAS-2)was used for literature quality evaluation.EndNote X6 was used for literature screening and management.RevMan 5.3 was used for Meta-analysis.Funnel chart analysis was used for publication bias.Results A total of 26 studies involving 772 patients were included.Among them,there were 5 literatures found that the agreements of cardiac function between the USCOM and TD methods were poor.Meta-analysis showed that there was no significant difference between the two methods in CO and CI monitoring[CO:mean difference(MD)=-0.06,95%confidence interval(95%CI)was-0.17 to 0.05,P=0.31;CI:MD=-0.04,95%CI was-0.13 to 0.05,P=0.38].Subgroup analysis of different TD methods[pulmonary artery catheter(PAC),pulse indicator continuous cardiac output(PiCCO)]and different windows of USCOM ultrasonic probe[aorta(AA),pulmonary artery(PA)]in CO monitoring was not shown significant difference yet(PAC:MD=-0.07,95%CI was-0.18 to 0.04,P=0.23;PiCCO:MD=0.09,95%CI was-0.31 to 0.50,P=0.65;AA windows:MD=-0.14,95%CI was-0.31 to 0.02,P=0.09;PA windows:MD=-0.00,95%CI was-0.15 to 0.14,P=0.95;AA/PA windows:MD=0.23,95%CI was-0.40 to 0.86,P=0.47).However,the difference in SV was statistically significant between the USCOM and TD method(M

关 键 词：超声心排血量监测 热稀释法 心功能 心排血量 META分析 

分 类 号：R45[医药卫生—治疗学]