[胸腔内血容量与肺动脉闭塞压作为危重症患者心脏前负荷评估指标的比较]

[Intrathoracic blood volume versus pulmonary artery occlusion pressure as estimators of cardiac preload in critically ill patients].

作者信息

Tomicic Vinko, Graf Jerónimo, Echevarría Ghislaine, Espinoza Mauricio, Abarca Juan, Montes José Miguel, Torres Javier, Núñez Gastón, Guerrero Julia, Luppi Mario, Canals Claudio

机构信息

Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.

出版信息

Rev Med Chil. 2005 Jun;133(6):625-31. doi: 10.4067/s0034-98872005000600001. Epub 2005 Jul 22.

DOI:10.4067/s0034-98872005000600001

PMID:16075124

Abstract

BACKGROUND

Monitoring of cardiac preload by determination of pulmonary artery occlusion pressure (PAOP) has been traditionally used to guide fluid therapy to optimize cardiac output (CO). Since factors such as intrathoracic pressure and ventricular compliance may modify PAOP, volumetric estimators of preload have been developed. The PiCCO system is able to measure CO and intrathoracic blood volume (ITBV) by transpulmonary thermodilution.

AIM

To compare a volumetric (ITBV) versus a pressure (PAOP) determination to accurately estimate cardiac preload in severely ill patients.

PATIENTS AND METHODS

From June 2001 to October 2003, 22 mechanically ventilated patients with hemodynamic instability underwent hemodynamic monitoring with pulmonary artery catheter (PAC) and PiCCO system. ITBV index (ITBVI), PAOP and CI were measured simultaneously by both methods. One hundred thirty eight deltas (D) were obtained from the difference of ITBVI, PAOP, CI-PAC and CI-PiCCO between 6-12 am and 6-12 pm. Linear regression analysis of DITBVI versus Eth CI-PiCCO and Eth PAOP versus DCI-PAC were made.

RESULTS

Mean age of patients was 60.8 +/- 19.4 years. APACHE II was 23.9 +/- 7. Fifteen patients met criteria for acute respiratory distress syndrome (ARDS). Delta ITBVI significantly correlated with DCI-PiCCO (r=0.54; 95% confidence interval = 0.41-0.65; p <0.01). There was no correlation between DPAOP and DCI-PAC.

CONCLUSION

ITBVI correlated better with CI than PAOP, and therefore it seems to be a more accurate estimator of preload in unstable, mechanically ventilated patients.

摘要

背景

传统上通过测定肺动脉闭塞压（PAOP）来监测心脏前负荷，以指导液体治疗从而优化心输出量（CO）。由于诸如胸内压和心室顺应性等因素可能会改变PAOP，因此已开发出前负荷的容量评估指标。脉搏指示连续心输出量（PiCCO）系统能够通过经肺热稀释法测量心输出量和胸内血容量（ITBV）。

目的

比较容量测定法（ITBV）与压力测定法（PAOP）在准确评估重症患者心脏前负荷方面的效果。

患者与方法

2001年6月至2003年10月，22例机械通气且血流动力学不稳定的患者接受了肺动脉导管（PAC）和PiCCO系统的血流动力学监测。两种方法同时测量ITBV指数（ITBVI）、PAOP和心脏指数（CI）。从上午6点至12点与下午6点至12点之间ITBVI、PAOP、CI - PAC和CI - PiCCO的差值中获取138个差值（D）。对DITBVI与Eth CI - PiCCO以及Eth PAOP与DCI - PAC进行线性回归分析。

结果

患者的平均年龄为60.8±19.4岁。急性生理与慢性健康状况评分系统（APACHE II）评分为23.9±7。15例患者符合急性呼吸窘迫综合征（ARDS）标准。DITBVI与DCI - PiCCO显著相关（r = 0.54；95%置信区间 = 0.41 - 0.65；p <0.01）。DPAOP与DCI - PAC之间无相关性。