Neath Sean-Xavier, Lazio Lucia, Guss David A
Department of Emergency Medicine, University of California, San Diego, 200 W. Arbor Drive, San Diego, CA 92103, USA.
Congest Heart Fail. 2005 Jan-Feb;11(1):17-20. doi: 10.1111/j.1527-5299.2005.03898.x.
Emergency physicians must often make assessments of complex hemodynamic parameters. To assess the utility of impedance cardiography (ICG) in the emergency department, the authors examined treating physicians' abilities to assess stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR) by comparing the clinicians' estimates of these values to ICG measurements. Treating physicians were asked to estimate the SV, CO, and SVR of acutely ill patients as being low, normal, or high. ICG measurements of SV, CO, and SVR were also categorized as low, normal, or high. Physician estimates were compared with ICG measures for concordance. Changes of therapy initiated as a result of discordance between physician's estimates and ICG measurements were recorded. The treating physician assessments and ICG hemodynamic measurements were concordant in 62 of 101 (62%) cases for SV (kappa=0.068), in 53 of 101 (53%) cases for CO (p=0.125), and in 50 of 101 (50%) measurements for SVR (p=0.148). The low concordance suggests that treating physicians did not consistently estimate SV, CO, and SVR accurately. ICG provides noninvasive hemodynamic measurements of SV, CO, and SVR that offer clinical utility and potential value in the emergency department.
急诊医生常常需要对复杂的血流动力学参数进行评估。为了评估阻抗心动图（ICG）在急诊科的效用，作者通过将临床医生对这些值的估计与ICG测量结果进行比较，来检验治疗医生评估每搏输出量（SV）、心输出量（CO）和全身血管阻力（SVR）的能力。要求治疗医生估计急症患者的SV、CO和SVR是低、正常还是高。ICG对SV、CO和SVR的测量结果也分为低、正常或高。将医生的估计与ICG测量结果进行比较以确定一致性。记录因医生估计与ICG测量结果不一致而启动的治疗变化。在101例病例中，治疗医生对SV的评估与ICG血流动力学测量结果在62例（62%）中一致（kappa=0.068），对CO的评估在101例中的53例（53%）中一致（p=0.125），对SVR的测量在101例中的50例（50%）中一致（p=0.148）。一致性较低表明治疗医生不能始终准确估计SV、CO和SVR。ICG提供了对SV、CO和SVR的无创血流动力学测量，在急诊科具有临床效用和潜在价值。
