Mayer J, Boldt J, Schöllhorn T, Röhm K D, Mengistu A M, Suttner S
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen, Germany.
Br J Anaesth. 2007 Feb;98(2):176-82. doi: 10.1093/bja/ael341. Epub 2007 Jan 11.
Thermodilution technique using a pulmonary artery catheter (PAC) is a widely used method to determine cardiac output (CO). It is increasingly criticized because of its invasiveness and its unclear risk-benefit ratio. Thus, less invasive techniques for measuring CO are highly desirable. We compared a new, semi-invasive device (FloTrac/Vigileo) using arterial pressure waveform analysis for CO measurement in patients undergoing cardiac surgery with bolus thermodilution measurements.
Forty patients undergoing coronary artery bypass grafting or valve repair were enrolled. A PAC was inserted and routine radial arterial access was used for semi-invasive determination of CO with the Vigileo. CO was measured simultaneously by bolus thermodilution and the Vigileo technique after induction of anaesthesia (T1), before cardiopulmonary bypass (CPB) (T2), after CPB (T3), after sternal closure (T4), on arrival in the intensive care unit (ICU) (T5), and 4 h (T6), 8 h (T7), and 24 h after surgery (T8). CO was indexed to the body surface area (cardiac index, CI).
A total of 244 pairs of CI measurements were analysed. Bias and precision (1.96 sd of the bias) were 0.46 litre min(-1) m(-2) and +/- 1.15 litre min(-1) m(-2) (r = 0.53) resulting in an overall percentage error of 46%. Subgroup analysis revealed a percentage error of 51% for data pairs obtained intraoperatively (T1-T4), 42% in ICU (T5-T8), and 56% for values obtained during low CI (T1-T8).
In cardiac surgery patients, CO measured by a new semi-invasive arterial pressure waveform analysis device showed only moderate agreement with intermittent pulmonary artery thermodilution measurement.
使用肺动脉导管（PAC）的热稀释技术是一种广泛用于测定心输出量（CO）的方法。由于其侵入性以及风险效益比不明确，该技术受到越来越多的批评。因此，非常需要侵入性较小的CO测量技术。我们将一种使用动脉压波形分析来测量CO的新型半侵入性设备（FloTrac/Vigileo）与接受心脏手术患者的团注热稀释测量结果进行了比较。
纳入40例接受冠状动脉搭桥术或瓣膜修复术的患者。插入PAC，并使用常规桡动脉通路通过Vigileo进行CO的半侵入性测定。在麻醉诱导后（T1）、体外循环（CPB）前（T2）、CPB后（T3）、胸骨关闭后（T4）、进入重症监护病房（ICU）时（T5）以及术后4小时（T6）、8小时（T7）和24小时（T8），通过团注热稀释和Vigileo技术同时测量CO。将CO校正为体表面积（心脏指数，CI）。
共分析了244对CI测量值。偏差和精密度（偏差的1.96倍标准差）分别为0.46升·分钟⁻¹·米⁻²和±1.15升·分钟⁻¹·米⁻²（r = 0.53），总体百分比误差为46%。亚组分析显示，术中获得的数据对（T¹-T⁴）的百分比误差为51%，ICU中（T⁵-T⁸）为42%，低CI期间（T¹-T⁸）获得的值的百分比误差为56%。
在心脏手术患者中，通过新型半侵入性动脉压波形分析设备测量的CO与间歇性肺动脉热稀释测量结果仅具有中等程度的一致性。
