Bein Berthold, Worthmann Frank, Tonner Peter H, Paris Andrea, Steinfath Markus, Hedderich Jürgen, Scholz Jens
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein Campus, Kiel, Germany.
J Cardiothorac Vasc Anesth. 2004 Apr;18(2):185-9. doi: 10.1053/j.jvca.2004.01.025.
Continuous measurement of cardiac output (CCO) is of great importance in the critically ill. However, pulmonary artery thermodilution has been questioned for possible complications associated with right heart catheterization. Furthermore, measurements are delayed in the continuous mode during rapid hemodynamic changes. A new pulmonary artery catheter CCO device (Aortech, Bellshill, Scotland) enabling real-time update of cardiac output was compared with 2 different, less-invasive methods of CCO determination, esophageal Doppler and pulse contour analysis.
Prospective, observational study.
University hospital, single institution.
Patients scheduled for elective coronary artery bypass grafting (CABG).
None.
CCO measurements were analyzed using a Bland-Altman plot. Bias between CCO and pulse contour cardiac output (PCCO), and Doppler-derived cardiac output (UCCO) was (mean +/- 1 SD) -0.71 +/- 1 L/min versus -0.15 +/- 1.09 L/min, and between UCCO and PCCO -0.58 +/- 1.06 L/min. Bias was not significantly different among methods, nor were comparative values before and after cardiopulmonary bypass (p > 0.05).
Agreement between the CCO method and both less-invasive measurements was clinically acceptable. There were no adverse events associated with the use of either device.
连续测量心输出量（CCO）对危重症患者至关重要。然而，肺动脉热稀释法因与右心导管插入术相关的可能并发症而受到质疑。此外，在血流动力学快速变化期间，连续模式下的测量会延迟。将一种能够实时更新心输出量的新型肺动脉导管CCO装置（Aortech，苏格兰贝尔希尔）与两种不同的、侵入性较小的心输出量测定方法，即食管多普勒法和脉搏轮廓分析法进行比较。
前瞻性观察性研究。
大学医院，单一机构。
计划进行择期冠状动脉旁路移植术（CABG）的患者。
无。
使用Bland-Altman图分析CCO测量值。CCO与脉搏轮廓心输出量（PCCO）以及多普勒衍生心输出量（UCCO）之间的偏差（均值±1标准差）分别为-0.71±1升/分钟与-0.15±1.09升/分钟，UCCO与PCCO之间的偏差为-0.58±1.06升/分钟。各方法之间的偏差无显著差异，体外循环前后的比较值也无显著差异（p>0.05）。
CCO方法与两种侵入性较小的测量方法之间的一致性在临床上是可接受的。使用任何一种装置均未出现不良事件。
