脉冲功率、食管多普勒及动脉脉压评估人体每搏量快速变化的能力。
Ability of pulse power, esophageal Doppler, and arterial pulse pressure to estimate rapid changes in stroke volume in humans.
作者信息
Marquez José, McCurry Kenneth, Severyn Donald A, Pinsky Michael R
机构信息
Departments of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
出版信息
Crit Care Med. 2008 Nov;36(11):3001-7. doi: 10.1097/CCM.0b013e31818b31f0.
INTRODUCTION
Measures of arterial pulse pressure variation and left ventricular stroke volume variation induced by positive-pressure breathing vary in proportion to preload responsiveness. However, the accuracy of commercially available devices to report dynamic left ventricular stroke volume variation has never been validated.
METHODS
We compared the accuracy of measured arterial pulse pressure and estimated left ventricular stroke volume reported from two Food and Drug Administration-approved aortic flow monitoring devices, one using arterial pulse power (LiDCOplus) and the other esophageal Doppler monitor (HemoSonic). We compared estimated left ventricular stroke volume and their changes during a venous occlusion and release maneuver to a calibrated aortic flow probe placed around the aortic root on a beat-to-beat basis in seven anesthetized open-chested cardiac surgery patients.
RESULTS
Dynamic changes in arterial pulse pressure closely tracked left ventricular stroke volume changes (mean r .96). Both devices showed good agreement with steady-state apneic left ventricular stroke volume values and moderate agreement with dynamic changes in left ventricular stroke volume (esophageal Doppler monitor -1 +/- 22 mL, and pulse power -7 +/- 12 mL, bias +/- 2 sd). In general, the pulse power signals tended to underestimate left ventricular stroke volume at higher left ventricular stroke volume values.
CONCLUSION
Arterial pulse pressure, as well as, left ventricular stroke volume estimated from esophageal Doppler monitor and pulse power reflects short-term steady-state left ventricular stroke volume values and tract dynamic changes in left ventricular stroke volume moderately well in humans.
引言
正压通气引起的动脉脉压变化和左心室每搏量变化的测量值与前负荷反应性成比例变化。然而，市售设备报告动态左心室每搏量变化的准确性从未得到验证。
方法
我们比较了两种经美国食品药品监督管理局批准的主动脉血流监测设备报告的测量动脉脉压和估计左心室每搏量的准确性，一种使用动脉脉搏功率（LiDCOplus），另一种是食管多普勒监测仪（HemoSonic）。我们在七名麻醉开胸心脏手术患者中，将估计的左心室每搏量及其在静脉闭塞和松开操作期间的变化与放置在主动脉根部周围的校准主动脉血流探头逐搏进行比较。
结果
动脉脉压的动态变化与左心室每搏量变化密切相关（平均r值为0.96）。两种设备与稳态无呼吸左心室每搏量值均显示出良好的一致性，与左心室每搏量的动态变化显示出中等程度的一致性（食管多普勒监测仪为-1±22 mL，脉搏功率为-7±12 mL，偏差±2标准差）。一般来说，在较高的左心室每搏量值时，脉搏功率信号往往会低估左心室每搏量。
结论
动脉脉压以及通过食管多普勒监测仪和脉搏功率估计的左心室每搏量在人体中能较好地反映短期稳态左心室每搏量值，并能适度追踪左心室每搏量的动态变化。
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