Jarvis S S, Levine B D, Prisk G K, Shykoff B E, Elliott A R, Rosow E, Blomqvist C G, Pawelczyk J A
Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania 16802, USA.
J Appl Physiol (1985). 2007 Sep;103(3):867-74. doi: 10.1152/japplphysiol.01106.2006. Epub 2007 Jun 7.
Foreign and soluble gas rebreathing methods are attractive for determining cardiac output (Q(c)) because they incur less risk than traditional invasive methods such as direct Fick and thermodilution. We compared simultaneously obtained Q(c) measurements during rest and exercise to assess the accuracy and precision of several rebreathing methods. Q(c) measurements were obtained during rest (supine and standing) and stationary cycling (submaximal and maximal) in 13 men and 1 woman (age: 24 +/- 7 yr; height: 178 +/- 5 cm; weight: 78 +/- 13 kg; Vo(2max): 45.1 +/- 9.4 ml.kg(-1).min(-1); mean +/- SD) using one-N(2)O, four-C(2)H(2), one-CO(2) (single-step) rebreathing technique, and two criterion methods (direct Fick and thermodilution). CO(2) rebreathing overestimated Q(c) compared with the criterion methods (supine: 8.1 +/- 2.0 vs. 6.4 +/- 1.6 and 7.2 +/- 1.2 l/min, respectively; maximal exercise: 27.0 +/- 6.0 vs. 24.0 +/- 3.9 and 23.3 +/- 3.8 l/min). C(2)H(2) and N(2)O rebreathing techniques tended to underestimate Q(c) (range: 6.6-7.3 l/min for supine rest; range: 16.0-19.1 l/min for maximal exercise). Bartlett's test indicated variance heterogeneity among the methods (P < 0.05), where CO(2) rebreathing consistently demonstrated larger variance. At rest, most means from the noninvasive techniques were +/-10% of direct Fick and thermodilution. During exercise, all methods fell outside the +/-10% range, except for CO(2) rebreathing. Thus the CO(2) rebreathing method was accurate over a wider range (rest through maximal exercise), but was less precise. We conclude that foreign gas rebreathing can provide reasonable Q(c) estimates with fewer repeat trials during resting conditions. During exercise, these methods remain precise but tend to underestimate Q(c). Single-step CO(2) rebreathing may be successfully employed over a wider range but with more measurements needed to overcome the larger variability.
外源性和可溶性气体重呼吸法在测定心输出量(Q(c))方面颇具吸引力,因为与直接Fick法和热稀释法等传统侵入性方法相比,它们的风险更低。我们比较了在静息和运动期间同时获得的Q(c)测量值,以评估几种重呼吸法的准确性和精密度。在13名男性和1名女性(年龄:24±7岁;身高:178±5厘米;体重:78±13千克;最大摄氧量:45.1±9.4毫升·千克⁻¹·分钟⁻¹;均值±标准差)中,采用单N₂O、四C₂H₂、单CO₂(单步)重呼吸技术以及两种标准方法(直接Fick法和热稀释法),在静息状态(仰卧位和站立位)和固定自行车运动(次最大和最大强度)期间获取Q(c)测量值。与标准方法相比,CO₂重呼吸法高估了Q(c)(仰卧位:分别为8.1±2.0与6.4±1.6和7.2±1.2升/分钟;最大运动强度:27.0±6.0与24.0±3.9和23.3±3.8升/分钟)。C₂H₂和N₂O重呼吸技术往往低估Q(c)(范围:仰卧位静息时为6.6 - 7.3升/分钟;最大运动强度时为16.0 - 19.1升/分钟)。Bartlett检验表明各方法之间存在方差异质性(P < 0.05),其中CO₂重呼吸法始终表现出更大的方差。在静息状态下,大多数无创技术的测量均值与直接Fick法和热稀释法相差±10%。在运动期间,除CO₂重呼吸法外,所有方法的测量值均超出了±10%的范围。因此,CO₂重呼吸法在更广泛的范围(从静息到最大运动强度)内是准确的,但精密度较低。我们得出结论,外源性气体重呼吸法在静息状态下通过较少的重复试验就能提供合理的Q(c)估计值。在运动期间,这些方法仍然具有一定精密度,但往往会低估Q(c)。单步CO₂重呼吸法可能在更广泛的范围内成功应用,但需要更多测量来克服较大的变异性。