Buffington Charles W, Nystrom Elisabet U M
*Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, and the †Department of Anesthesiology, Creighton University, Omaha, Nebraska.
Anesth Analg. 2004 Apr;98(4):884-890. doi: 10.1213/01.ANE.0000105923.09732.93.
Whether measurement of cardiac output using the thermal dilution technique (TDCO) is valid in the presence of tricuspid regurgitation (TR) is controversial. We assessed the accuracy and precision of the technique in pigs by comparison with data from an electromagnetic flowmeter on the aorta (EMCO). TR was created with sutures that immobilized the free-wall leaflets of the tricuspid valve, and cardiac output was adjusted with dobutamine to give values comparable to control measurements. TR reduced forward stroke volume from 17.2 to 12.6 mL/beat and caused the right atrium to dilate and pulse in synchrony with the right ventricle. Acute TR did not affect the linear regression relation between TDCO and EMCO and did not alter the correlation coefficient (r = 0.94 during both control and TR). These data demonstrate that acute TR does not affect the accuracy or precision of TDCO in pigs.
Cardiac output is a valuable measurement that guides the medical care of patients with heart and lung disease. This study demonstrates that the thermal dilution technique of determining cardiac output is valid when acute tricuspid valve regurgitation is present in pigs.
在存在三尖瓣反流(TR)的情况下,使用热稀释技术(TDCO)测量心输出量是否有效存在争议。我们通过与主动脉电磁流量计(EMCO)的数据进行比较,评估了该技术在猪身上的准确性和精密度。通过缝合固定三尖瓣游离壁小叶来制造TR,并使用多巴酚丁胺调节心输出量,使其值与对照测量值相当。TR使前向搏出量从17.2 mL/次降至12.6 mL/次,并导致右心房扩张并与右心室同步搏动。急性TR不影响TDCO与EMCO之间的线性回归关系,也不改变相关系数(对照和TR期间r均为0.94)。这些数据表明,急性TR不影响猪TDCO的准确性或精密度。
心输出量是指导心肺疾病患者医疗护理的一项重要测量指标。本研究表明,在猪存在急性三尖瓣反流时,热稀释技术测定心输出量是有效的。