Ostergaard M, Nielsen J, Rasmussen J P, Berthelsen P G
Department of Anaesthesiology, Copenhagen University Hospital, Gentofte, Hellerup, Denmark.
Acta Anaesthesiol Scand. 2006 Oct;50(9):1044-9. doi: 10.1111/j.1399-6576.2006.01080.x.
The aims of this study were to determine the agreement between pulmonary artery thermodilution (PA-TD), transpulmonary thermodilution (TP-TD) and the pulse contour method, and to test the ability of the pulse contour method to track changes in cardiac output.
Cardiac output was determined twice before cardiac surgery with both PA-TD and TP-TD. The precision (two standard deviations of the difference between repeated measurements) and agreement of the two methods were calculated. Post-operatively, cardiac output was determined with the PA-TD and pulse contour methods, and the bias and limits of agreement were again calculated. Finally, in patients with heart rates below 60 beats/min or a cardiac index of less than 2.5 l/min/m2, atrial pacing was started and the haemodynamic consequences were monitored with the PA-TD and pulse contour methods.
Twenty-five patients were included. The precisions of PA-TD and TP-TD were 0.41 l/min [95% confidence interval (CI), +/- 0.07] and 0.48 l/min (95% CI, +/- 0.08), respectively. The bias and limits of agreement between PA-TD and TP-TD were - 0.46 l/min (95% CI, +/- 0.11) and +/- 1.10 l/min (95% CI, +/- 0.19), respectively. Post-operatively, the bias and limits of agreement between the PA-TD and pulse contour methods were 0.07 l/min and +/- 2.20 l/min, respectively. The changes in cardiac output with atrial pacing were in the same direction and of the same magnitude in 15 of the 16 patients.
The precision of cardiac output measurements with PA-TD and TP-TD was very similar. The transpulmonary method, however, overestimated the cardiac output by 0.46 l/min. Post-operatively, cardiac output measurements with the PA-TD and pulse contour methods did not agree, but the pulse contour method reliably tracked pacing-induced changes in cardiac output.
本研究的目的是确定肺动脉热稀释法（PA - TD）、经肺热稀释法（TP - TD）与脉搏轮廓分析法之间的一致性，并测试脉搏轮廓分析法追踪心输出量变化的能力。
在心脏手术前，使用PA - TD和TP - TD两种方法对心输出量进行两次测定。计算两种方法的精密度（重复测量差值的两个标准差）和一致性。术后，使用PA - TD和脉搏轮廓分析法测定心输出量，并再次计算偏差和一致性界限。最后，对于心率低于60次/分钟或心脏指数小于2.5升/分钟/平方米的患者，开始心房起搏，并使用PA - TD和脉搏轮廓分析法监测血流动力学后果。
纳入25例患者。PA - TD和TP - TD的精密度分别为0.41升/分钟[95%置信区间（CI），±0.07]和0.48升/分钟（95%CI，±0.08）。PA - TD和TP - TD之间的偏差和一致性界限分别为 - 0.46升/分钟（95%CI，±0.11）和±1.10升/分钟（95%CI，±0.19）。术后，PA - TD和脉搏轮廓分析法之间的偏差和一致性界限分别为0.07升/分钟和±2.20升/分钟。16例患者中有15例心房起搏时心输出量的变化方向相同且幅度相同。
PA - TD和TP - TD测量心输出量的精密度非常相似。然而，经肺法高估心输出量0.46升/分钟。术后，PA - TD和脉搏轮廓分析法测量的心输出量不一致，但脉搏轮廓分析法能可靠地追踪起搏引起的心输出量变化。
