异氟烷麻醉的小马中锂稀释法与脉搏轮廓分析法测量心输出量的比较：不同正性肌力药物的影响

Comparison between lithium dilution and pulse contour analysis techniques for cardiac output measurement in isoflurane anaesthetized ponies: influence of different inotropic drugs.

作者信息

Schauvliege Stijn, Van den Eede Annelies, Duchateau Luc, Pille Frederik, Vlaminck Lieven, Gasthuys Frank

机构信息

Department of Surgery and Anaesthesia of Domestic Animals, University of Ghent, Merelbeke, Belgium.

出版信息

Vet Anaesth Analg. 2009 May;36(3):197-208. doi: 10.1111/j.1467-2995.2009.00446.x.

DOI:10.1111/j.1467-2995.2009.00446.x

PMID:19397771

Abstract

OBJECTIVE

To compare cardiac output () measurements using lithium dilution (LiDCO) and pulse contour analysis (PulseCO) techniques in isoflurane-anaesthetized ponies before and during the administration of different inotropic/vasoactive drugs.

STUDY DESIGN

Prospective randomized experimental cross-over trial.

ANIMALS

Six ponies aged 5.0 +/- 1.6 (4-6.5) years and weighing 286 +/- 53 (212-368) kg.

METHODS

After sedation (romifidine) and induction (midazolam + ketamine), anaesthesia was maintained with isoflurane in oxygen. After 90 minutes (= T0), one of four treatments was administered: saline 0.1 mL kg(-1) (S), enoximone 0.5 mg kg(-1) IV (E), enoximone followed by dobutamine (0.5 microg kg(-1) minute(-1) for 120 minutes) (ED) or enoximone followed by a calcium chloride infusion (0.5 mg kg(-1) minute(-1) for 10 minutes) (EC). Data were recorded for 120 minutes after T0. The PulseCO (recorded from carotid artery) was calibrated before T0, no further recalibrations were performed. was determined with LiDCO ((LiDCO)) and PulseCO ((PulseCO)) simultaneously at T5, T10, T20, T40, T60, T80, T100 and T120. Systemic vascular resistances (SVR(LiDCO) and SVR(PulseCO)) were calculated.

RESULTS

In the saline group, (PulseCO) was 4.9 +/- 12.3% lower than LiDCO (p < 0.01), whereas SVR(PulseCO) was 6.9 +/- 14.4% higher than SVR(LiDCO) (p < 0.01). These differences increased over time (mean +/- SEM), by 0.06 +/- 0.03% minute(-1) (p = 0.042) and SVR by 0.08 +/- 0.03% minute(-1) (p = 0.018). (PulseCO) was higher than (LiDCO) in the EC group (1.8 +/- 23.3%), but lower than (LiDCO) in groups E (-11.7 +/- 20.4%) and ED (-10.0 +/- 25.9%) (significant difference between treatments, p < 0.01). The differences in SVR in groups E (20.4 +/- 32.0%) and ED (20.7 +/- 35.3%) were significantly higher than in groups S (6.9 +/- 14.4%) and EC (3.1 +/- 22.2%) (p < 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Pulse contour analysis values deviated significantly from LiDCO measurements in isoflurane-anaesthetized ponies. This difference was influenced by inotropic/vasoactive drugs.

摘要

目的

比较在异氟烷麻醉的小马驹中，在给予不同的正性肌力药/血管活性药物之前及期间，使用锂稀释法（LiDCO）和脉搏轮廓分析法（PulseCO）测量心输出量（CO）的情况。

研究设计

前瞻性随机实验性交叉试验。

动物

6匹年龄为5.0±1.6（4 - 6.5）岁、体重为286±53（212 - 368）kg的小马驹。

方法

在给予镇静剂（罗米非定）和诱导剂（咪达唑仑 + 氯胺酮）后，用异氟烷在氧气中维持麻醉。90分钟后（=T0），给予四种处理之一：0.1 mL kg⁻¹生理盐水（S）、0.5 mg kg⁻¹依诺昔酮静脉注射（E）、依诺昔酮后接着给予多巴酚丁胺（0.5 μg kg⁻¹分钟⁻¹，持续120分钟）（ED）或依诺昔酮后接着给予氯化钙输注（0.5 mg kg⁻¹分钟⁻¹，持续10分钟）（EC）。在T0后记录数据120分钟。在T0前对PulseCO（从颈动脉记录）进行校准，之后不再进行重新校准。在T5、T10、T20、T40、T60、T80、T100和T120同时用LiDCO（（LiDCO））和PulseCO（（PulseCO））测定CO。计算全身血管阻力（SVR(LiDCO)和SVR(PulseCO)）。

结果

在生理盐水组，（PulseCO）比LiDCO低4.9±12.3%（p < 0.01），而SVR(PulseCO)比SVR(LiDCO)高6.9±14.4%（p < 0.01）。这些差异随时间增加（均值±标准误），CO以0.06±0.03%分钟⁻¹增加（p = 0.042），SVR以0.08±0.03%分钟⁻¹增加（p = 0.018）。在EC组（PulseCO）高于（LiDCO）（1.8±23.3%），但在E组（-11.7±20.4%）和ED组（-10.0±25.9%）低于（LiDCO）（处理间差异显著，p < 0.01）。E组（20.4±32.0%）和ED组（20.7±35.3%）的SVR差异显著高于S组（6.9±14.4%）和EC组（3.1±22.2%）（p < 0.01）。