Lafanechère Aurélie, Albaladejo Pierre, Raux Mathieu, Geeraerts Thomas, Bocquet Rémi, Wernet Anne, Castier Yves, Marty Jean
Department of Anaesthesiology and Intensive Care, University Hospital Beaujon, Clichy, France.
J Cardiothorac Vasc Anesth. 2006 Feb;20(1):26-30. doi: 10.1053/j.jvca.2005.07.029.
Aortic surgery is associated with various hemodynamic and cardiac output modifications. These disorders may be partly caused by blood flow redistribution between supra-aortic and descending aorta regions during clamping and unclamping. A new echo-esophageal Doppler (Hemosonic 100; Arrow, Reading, PA) calculates cardiac output from a simultaneous measurement of blood flow velocity and diameter of the descending aorta. This calculation may be affected by blood redistribution during aortic clamping. The aim of this study was to compare cardiac output measured by echo-esophageal Doppler and by bolus thermodilution catheter during infrarenal aortic surgery.
Prospective, observational study.
University hospital, single institution.
Twenty-two adult patients.
Infrarenal aortic surgery.
Cardiac outputs monitored by both devices were highly correlated during the whole surgical procedure (r2 ranging from 0.54 to 0.76). Bland and Altman analysis showed absence of significant bias before and after clamping (ranging from 0.1 +/- 0.73 L/min to 0.18 +/- 1 L/min, p > 0.05) and a significant bias of 0.5 +/- 1.05 L/min (p < 0.05) during aortic clamping. Limits of agreement did not differ significantly during the whole surgical procedure (ranging from -1.36/2.19 to -2.23/2.49). During clamping and unclamping, changes in cardiac output obtained by both methods were positively correlated (r2 = 0.7).
Bias between both methods was clinically acceptable, and limits of agreement were not significantly modified by aortic clamping. However, larger studies including homogenous aortic pathologies are necessary to validate this method during infrarenal aortic surgery.
主动脉手术与多种血流动力学和心输出量改变相关。这些紊乱可能部分是由于夹闭和松开过程中主动脉弓上和降主动脉区域之间的血流重新分布所致。一种新的食管超声多普勒（Hemosonic 100；Arrow，雷丁，宾夕法尼亚州）通过同时测量降主动脉的血流速度和直径来计算心输出量。这种计算可能会受到主动脉夹闭期间血流重新分布的影响。本研究的目的是比较肾下腹主动脉手术期间通过食管超声多普勒和团注热稀释导管测量的心输出量。
前瞻性观察性研究。
大学医院，单一机构。
22名成年患者。
肾下腹主动脉手术。
在整个手术过程中，两种设备监测的心输出量高度相关（r2范围为0.54至0.76）。Bland和Altman分析显示，夹闭前后无显著偏差（范围为0.1±0.73 L/min至0.18±1 L/min，p>0.05），而在主动脉夹闭期间有显著偏差0.5±1.05 L/min（p<0.05）。在整个手术过程中，一致性界限无显著差异（范围为-1.36/2.19至-2.23/2.49）。在夹闭和松开期间，两种方法获得的心输出量变化呈正相关（r2 = 0.7）。
两种方法之间的偏差在临床上是可接受的，并且一致性界限不会因主动脉夹闭而显著改变。然而，需要进行更大规模的研究，包括同质的主动脉病变，以在肾下腹主动脉手术期间验证该方法。
