Mekis D, Kamenik M, Starc V, Jeretin S
Maribor Teaching Hospital, Department of Anaesthesiology, Intensive Care and Pain Management, Maribor, Slovenia.
Eur J Anaesthesiol. 2008 Mar;25(3):237-42. doi: 10.1017/S0265021507002669. Epub 2007 Sep 13.
The purpose was to study the agreement between cardiac output measurements with electrical velocimetry vs. intermittent thermodilution before and after coronary artery bypass graft surgery.
Cardiac output was measured simultaneously with electrical velocimetry and intermittent thermodilution before and immediately after coronary artery bypass graft surgery, and in the intensive care unit. Measurements were performed in three different body positions. The results were analysed according to Bland and Altman.
The mean bias of all 150 paired measurements in 16 patients was 0.21 +/- 0.78 L min(-1), and the mean error was 40%. Before skin incision the mean bias was 0.04 +/- 0.41 L min(-1), and the mean error was 25%. After skin closure the mean bias was 0.57 +/- 0.92 L min(-1), and the mean error was 42%. In the intensive care unit the mean bias was 0.26 +/- 0.68 L min(-1), and the mean error was 32%.
The agreement between cardiac output measurements with electrical velocimetry and intermittent thermodilution was clinically acceptable only before skin incision in coronary artery bypass graft surgery. The mean error was unacceptably high immediately after skin closure and was at a borderline level in the intensive care unit. Thus, the overall accuracy of cardiac output measurements with the electrical velocimetry technique during coronary artery bypass graft surgery is not clinically unacceptable.
本研究旨在探讨冠状动脉搭桥手术前后采用电测速法与间歇热稀释法测量心输出量的一致性。
在冠状动脉搭桥手术前、术后即刻以及重症监护病房,同时采用电测速法和间歇热稀释法测量心输出量。测量在三种不同体位下进行。结果依据布兰德和奥特曼法进行分析。
16例患者的150对测量值的平均偏差为0.21±0.78L·min⁻¹,平均误差为40%。皮肤切开前平均偏差为0.04±0.41L·min⁻¹,平均误差为25%。皮肤缝合后平均偏差为0.57±0.92L·min⁻¹,平均误差为42%。在重症监护病房平均偏差为0.26±0.68L·min⁻¹,平均误差为32%。
在冠状动脉搭桥手术中,仅在皮肤切开前,采用电测速法与间歇热稀释法测量心输出量的一致性在临床上可接受。皮肤缝合后平均误差过高,在重症监护病房处于临界水平。因此,在冠状动脉搭桥手术期间,采用电测速法测量心输出量的总体准确性在临床上不可接受。