Zácek P, Kunes P, Kobzová E, Dominik J
Department of Cardiac Surgery, Faculty of Medicine, Charles University, Prague, Hradec Králové.
Acta Medica (Hradec Kralove). 1999;42(1):19-23.
Thoracic electrical bioimpedance cardiography is a non-invasive, continuous and low-cost method of estimation of cardiac output and other haemodynamic parameters. Though subject to continuous technological refinement controversial opinions exist on its validity in subsets of critically ill patients, patients with heart disease or after cardiac surgery. A comparison study between thermodilution (TD) and bioimpedance (TEB) was performed in 28 patients undergoing elective cardiac surgery (CABG, aortic or mitral valve replacement or combined procedures). 128 pairs of cardiac index estimates at specific time points during 20 hours at the postoperative ICU were evaluated. A poor correlation (r = 0.26, p < 0.05, bias -0.07 l.min-1.m2, precision + 1.1 l.min-1.m-2, 95% limits of agreement -2.27-2.13 l.min-1.m-2) between TD and TEB cannot support the routine use of TEB monitoring in early postoperative period after open-heart surgery. Possible reasons of lack of agreement in this population are discussed. Further studies with technically improved bioimpedance cardiographs will be needed.
胸部电阻抗心动描记术是一种无创、连续且低成本的估计心输出量及其他血流动力学参数的方法。尽管该技术在不断完善，但对于其在重症患者亚组、心脏病患者或心脏手术后患者中的有效性仍存在争议。对28例接受择期心脏手术（冠状动脉搭桥术、主动脉或二尖瓣置换术或联合手术）的患者进行了热稀释法（TD）和生物阻抗法（TEB）的比较研究。评估了术后重症监护病房20小时内特定时间点的128对心指数估计值。TD和TEB之间的相关性较差（r = 0.26，p < 0.05，偏差 -0.07 l.min-1.m2，精密度 + 1.1 l.min-1.m-2，95%一致性界限 -2.27 - 2.13 l.min-1.m-2），这无法支持在心脏直视手术后早期常规使用TEB监测。讨论了该人群中缺乏一致性的可能原因。需要使用技术改进的电阻抗心动描记仪进行进一步研究。
