Felbinger Thomas W, Reuter Daniel A, Eltzschig Holger K, Bayerlein Julian, Goetz Alwin E
Department of Anesthesiology, Grosshadern Medical Center, University of Munich, 81377 Munich, Germany.
J Clin Anesth. 2005 Jun;17(4):241-8. doi: 10.1016/j.jclinane.2004.06.013.
To compare cardiac index (CI) values obtained by pulmonary artery thermodilution (CIPA), arterial thermodilution (CITD), and arterial pulse contour analysis (CIPC) during rapid fluid administration, as accurate and rapid detection of CI changes is critical during acute preload changes for guiding volume and vasopressor therapy in critically ill patients, and the accuracy of CIPC during acute changes in loading condition is currently unknown.
Prospective clinical study.
Cardiac surgical intensive care unit of a university hospital.
Seventeen American Society of Anesthesiologists (ASA) physical status II and III patients, aged 32 to 76 years, with normal left ventricular function during the early postoperative period after elective coronary artery bypass graft surgery.
After baseline determinations of CIPA, CIPC, and CITD were made, fluid loading was performed using 10 mL times body mass index of hydroxyethyl starch 6%. CIPA, CIPC, and CITD were determined, and changes in CI (DeltaCI) were calculated. Fluid load was repeated until no increase in stroke volume index (DeltaSVI <10%) was achieved.
Regression analysis between CIPA/CIPC, CIPA/CITD, and CIPC/CITD revealed r2 = 0.92, r2 = 0.92, and r2 = 0.98. Regression analysis between DeltaCIPA/DeltaCIPC, DeltaCIPA/DeltaCITD, and DeltaCIPC/DeltaCITD revealed r2 = 0.57, r2 = 0.67, and r2 = 0.74, respectively. Bland-Altman analysis was used to determine accuracy and precision of the 3 methods compared. The mean differences (m) and SD between DeltaCIPA/DeltaCIPC, DeltaCIPA/DeltaCITD, and DeltaCIPC/DeltaCITD resulted in m = -1.01%, SD = 6.51%; m = -0.83%, SD = 5.80%; and m = -0.33%, SD = 4.65%, respectively.
Compared with pulmonary artery thermodilution, arterial pulse contour analysis reflects relative changes in CI during rapid changes of preload with clinically acceptable accuracy.
比较在快速补液期间通过肺动脉热稀释法（CIPA）、动脉热稀释法（CITD）和动脉脉搏轮廓分析法（CIPC）获得的心脏指数（CI）值，因为在急性前负荷变化期间准确快速地检测CI变化对于指导重症患者的容量和血管加压药治疗至关重要，而在负荷状态急性变化期间CIPC的准确性目前尚不清楚。
前瞻性临床研究。
一所大学医院的心脏外科重症监护病房。
17例美国麻醉医师协会（ASA）身体状况为II级和III级的患者，年龄32至76岁，在择期冠状动脉搭桥手术后早期左心室功能正常。
在对CIPA、CIPC和CITD进行基线测定后，使用10 mL乘以体重指数的6%羟乙基淀粉进行液体负荷试验。测定CIPA、CIPC和CITD，并计算CI的变化（DeltaCI）。重复液体负荷试验，直到每搏量指数不再增加（DeltaSVI <10%）。
CIPA/CIPC、CIPA/CITD和CIPC/CITD之间的回归分析显示r2 = 0.92、r2 = 0.92和r2 = 0.98。DeltaCIPA/DeltaCIPC、DeltaCIPA/DeltaCITD和DeltaCIPC/DeltaCITD之间的回归分析显示r2分别为0.57、0.67和0.74。采用Bland-Altman分析来确定所比较的3种方法的准确性和精密度。DeltaCIPA/DeltaCIPC、DeltaCIPA/DeltaCITD和DeltaCIPC/DeltaCITD之间的平均差异（m）和标准差分别为m = -1.01%，SD = 6.51%；m = -0.83%，SD = 5.80%；m = -0.33%，SD = 4.65%。
与肺动脉热稀释法相比，动脉脉搏轮廓分析法在急性前负荷变化期间以临床可接受的准确性反映CI的相对变化。
