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体温对神经外科患者外周静脉压测量的影响及其与中心静脉压的一致性

Effect of body temperature on peripheral venous pressure measurements and its agreement with central venous pressure in neurosurgical patients.

作者信息

Sahin Altan, Salman M Alper, Salman A Ebru, Aypar Ulka

机构信息

Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

出版信息

J Neurosurg Anesthesiol. 2005 Apr;17(2):91-6. doi: 10.1097/01.ana.0000158387.80678.bf.

Abstract

Previous studies suggest a correlation of central venous pressure (CVP) with peripheral venous pressure (PVP) in different clinical settings. The effect of body temperature on PVP and its agreement with CVP in patients under general anesthesia are investigated in this study. Fifteen American Society of Anesthesiologists I-II patients undergoing elective craniotomy were included in the study. CVP, PVP, and core (Tc) and peripheral (Tp) temperatures were monitored throughout the study. A total of 950 simultaneous measurements of CVP, PVP, Tc, and Tp from 15 subjects were recorded at 5-minute intervals. The measurements were divided into low- and high-Tc and -Tp groups by medians as cutoff points. Bland-Altman assessment for agreement was used for CVP and PVP in all groups. PVP measurements were within range of +/-2 mm Hg of CVP values in 94% of the measurements. Considering all measurements, mean bias was 0.064 mm Hg (95% confidence interval -0.018-0.146). Corrected bias for repeated measurements was 0.173 +/- 3.567 mm Hg (mean +/- SD(corrected)). All of the measurements were within mean +/- 2 SD of bias, which means that PVP and CVP are interchangeable in our setting. As all the measurements were within 1 SD of bias when Tc was > or = 35.8 degrees C, even a better agreement of PVP and CVP was evident. The effect of peripheral hypothermia was not as prominent as core hypothermia. PVP measurement may be a noninvasive alternative for estimating CVP. Body temperature affects the agreement of CVP and PVP, which deteriorates at lower temperatures.

摘要

以往研究表明,在不同临床情况下中心静脉压(CVP)与外周静脉压(PVP)之间存在相关性。本研究调查了体温对全身麻醉患者PVP的影响及其与CVP的一致性。15例美国麻醉医师协会I-II级择期开颅手术患者纳入本研究。在整个研究过程中监测CVP、PVP、核心体温(Tc)和外周体温(Tp)。以5分钟为间隔,共记录了15名受试者同时进行的950次CVP、PVP、Tc和Tp测量。以中位数作为分界点,将测量值分为低体温和高体温的Tc和Tp组。所有组均采用Bland-Altman一致性评估法评估CVP和PVP。94%的测量中,PVP测量值在CVP值的±2 mmHg范围内。考虑所有测量值,平均偏差为0.064 mmHg(95%置信区间-0.018-0.146)。重复测量的校正偏差为0.173±3.567 mmHg(平均±标准差(校正))。所有测量值均在偏差的平均±2标准差范围内,这意味着在我们的研究环境中PVP和CVP可相互替代。当Tc≥35.8℃时,所有测量值均在偏差的1标准差范围内,此时PVP和CVP的一致性甚至更明显。外周体温过低的影响不如核心体温过低突出。PVP测量可能是估计CVP的一种非侵入性替代方法。体温会影响CVP和PVP的一致性,在较低温度下这种一致性会变差。

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