LiDCO与PiCCO连续监测重症患者心输出量的一致性观察  

Consistent observation of cardiac output in severe patients monitored continuously by LiDCO and PiCCO

作　　者：徐亚奇 陈咏怡 任德志 李晨[2] 段军[2] Xu Yaqi;Chen Yongyi;Ren Dezhi;Li Chen;Duan Jun(China-Japan Friendship Hospital(Institute of Clinical Medical Sciences),Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Intensive Care Unit,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院(中日友好临床医学研究所)/北京协和医学院/中国医学科学院,北京100730 [2]中日友好医院重症医学科,北京100029

出　　处：《中国医师杂志》2025年第3期373-376,381,共5页Journal of Chinese Physician

基　　金：中央高水平医院临床科研业务费资助(2022-NHLHCRF-LX-03)。

摘　　要：目的探究应用LiDCO对重症患者进行血流动力学监测时所获得的连续心输出量(CO)参数是否与PiCCO具有一致性。方法前瞻性收集2024年5月18日—2025年1月10日在中日友好医院重症医学科行PiCCO监测的重症患者12例。将PiCCO和LiDCO系统同时连接同一重症患者,注射冰盐水进行外部校准后,采集配对连续CO测量值的平均值。通过Bland-Altman分析二者是否具有一致性,并采用Spearman法分析去甲肾上腺素用量与偏倚的相关性。结果70组配对数据序列中,PiCCO的CO测量值为5.55±1.74,LiDCO的CO测量值为4.40(2.90,6.50),二者偏倚为0.52(95%CI:0.07~0.96),一致性限上限为4.2(95%CI:3.4~4.9),一致性限下限为-3.1(95%CI:-3.9~-2.4),百分比误差为66%,超出临床可接受的45%。在采集数据时存在去甲肾上腺素持续泵入的数据序列中,去甲肾上腺素用量与偏倚绝对值之间存在中等程度正相关(r=0.47,P<0.05);以0.5μg/(kg·min)、1μg/(kg·min)为界分组,组间偏倚绝对值差异均有统计学意义(均P<0.05)。结论LiDCO与PiCCO对重症患者同时进行连续CO监测时,并没有体现出临床可接受的一致性,偏倚大小可能与去甲肾上腺素用量有关。ObjectiveTo investigate whether continuous cardiac output(CO)parameters obtained by LiDCO in hemodynamic monitoring of severe patients are consistent with pulse index continuous cardiac output(PiCCO).MethodsFrom May 18,2024 to January 10,2025,12 critically ill patients who were monitored by PiCCO in the Intensive Care Unit Department of China-Japan Friendship Hospital were prospectively collected.The PiCCO and LiDCO systems were simultaneously connected to the same critically ill patient,injected with ice saline for external calibration,and the average of paired continuous CO measurements were collected.Bland-Altman was used to analyze whether the two were consistent,and Spearman was used to analyze the correlation between norepinephrine dosage and bias.ResultsIn the data series of 70 pairs,the CO measured by PiCCO was 5.55±1.74,and the CO measured by LiDCO was 4.40(2.90,6.50),with a bias of 0.52(95%CI:0.07-0.96)and an upper limit of agreement of 4.2(95%CI:3.4-4.9),the lower limit of the conformance limit was-3.1(95%CI:-3.9 to-2.4),and the percentage error was 66%,exceeding the clinically acceptable 45%.In the data series where norepinephrine was continuously pumped at the time of data collection,there was a moderate positive correlation between norepinephrine dosage and absolute bias(r=0.47,P<0.05).There were statistically significant differences in absolute values of bias between groups defined as 0.5μg/(kg·min)and 1μg/(kg·min)(P<0.05).ConclusionsThere is no clinically acceptable consistency between LiDCO and PiCCO for continuous CO monitoring in severe patients,and the size of bias may be related to the dosage of norepinephrine.

关 键 词：血流动力学监测 脉搏波分析 心输出量 

分 类 号：R459.7[医药卫生—急诊医学]