Bock M, Sturm T, Motsch J
Anästhesieabteilung I, Zentralkrankenhaus Bozen, Bozen, Italien.
Anaesthesist. 2007 Jul;56(7):656-64. doi: 10.1007/s00101-007-1189-6.
Cardiac output and the cardiac index (CI) are not routinely monitored during major abdominal surgery for economic as well as medical reasons. This practice, however, might be changed by the application of newer non-invasive technologies like the partial CO(2) rebreathing method based on the inverse Fick's principle. In this prospective randomized study we investigated the impact of a non-invasive monitoring of CI on the incidence of hemodynamic instability and interventions by the attending anesthesiologist during major abdominal surgery.
Additionally to routine hemodynamic monitoring we measured CI using the partial CO(2) rebreathing method in 28 patients (9 female, 19 male) undergoing major abdominal surgery. In group I the anesthesiologists were aware of the results of the extended hemodynamic monitoring and in group II the attending anesthesiologist was blinded to the information obtained by these measurements of CI.
Groups did not differ with regard to the baseline hemodynamic parameters. We obtained 923 measurements in both groups and 95 situations of hemodynamic instability (CI<2.5 l/minxm(2)) were detected in group I compared to 147 situations in group II (p<0.05). There were significantly more hemodynamic interventions in group I than in group II (p<0.0001). The cardiac index remained higher in group I in comparison to group II (p<0.0001). Measurement of CI was the only method to detect situations of hemodynamic instability in our setting.
The incidence of hemodynamic instability was significantly reduced during major abdominal surgery when anesthesiologists were aware of the measurement results of extended hemodynamic monitoring.
出于经济和医学原因，在腹部大手术期间通常不会常规监测心输出量和心脏指数（CI）。然而，基于逆菲克原理的新型无创技术（如部分二氧化碳重吸入法）的应用可能会改变这种做法。在这项前瞻性随机研究中，我们调查了在腹部大手术期间无创监测CI对血流动力学不稳定发生率以及主治麻醉医生进行干预的影响。
在28例接受腹部大手术的患者（9例女性，19例男性）中，除了常规血流动力学监测外，我们使用部分二氧化碳重吸入法测量CI。在第一组中，麻醉医生知晓扩展血流动力学监测的结果，而在第二组中，主治麻醉医生对通过这些CI测量获得的信息不知情。
两组在基线血流动力学参数方面无差异。两组均获得923次测量结果，第一组检测到95次血流动力学不稳定情况（CI<2.5 l/min·m²），而第二组为147次（p<0.05）。第一组的血流动力学干预明显多于第二组（p<0.0001）。与第二组相比，第一组的心脏指数仍然更高（p<0.0001）。在我们的研究中，CI测量是检测血流动力学不稳定情况的唯一方法。
当麻醉医生知晓扩展血流动力学监测的测量结果时，腹部大手术期间血流动力学不稳定的发生率显著降低。
