de Wilde R B P, Geerts B F, Cui J, van den Berg P C M, Jansen J R C
Department of Intensive Care, Leiden University Medical Center, Leiden, the Netherlands.
Anaesthesia. 2009 Jul;64(7):762-9. doi: 10.1111/j.1365-2044.2009.05934.x.
We evaluated cardiac output (CO) using three new methods - the auto-calibrated FloTrac-Vigileo (CO(ed)), the non-calibrated Modelflow (CO(mf) ) pulse contour method and the ultra-sound HemoSonic system (CO(hs)) - with thermodilution (CO(td)) as the reference. In 13 postoperative cardiac surgical patients, 104 paired CO values were assessed before, during and after four interventions: (i) an increase of tidal volume by 50%; (ii) a 10 cm H(2)O increase in positive end-expiratory pressure; (iii) passive leg raising and (iv) head up position. With the pooled data the difference (bias (2SD)) between CO(ed) and CO(td), CO(mf) and CO(td) and CO(hs) and CO(td) was 0.33 (0.90), 0.30 (0.69) and -0.41 (1.11) l.min(-1), respectively. Thus, Modelflow had the lowest mean squared error, suggesting that it had the best performance. CO(ed) significantly overestimates changes in cardiac output while CO(mf) and CO(hs) values are not significantly different from those of CO(td). Directional changes in cardiac output by thermodilution were detected with a high score by all three methods.
我们使用三种新方法评估心输出量（CO）——自动校准的FloTrac-Vigileo（CO(ed)）、未校准的Modelflow（CO(mf)）脉搏轮廓法和超声HemoSonic系统（CO(hs)），并以热稀释法（CO(td)）作为参考。在13例心脏外科术后患者中，在四种干预措施的前、中、后评估了104对CO值：（i）潮气量增加50%；（ii）呼气末正压增加10 cm H₂O；（iii）被动抬腿；（iv）头高位。汇总数据显示，CO(ed)与CO(td)、CO(mf)与CO(td)以及CO(hs)与CO(td)之间的差异（偏差（2SD））分别为0.33（0.90）、0.30（0.69）和-0.41（1.11）l·min⁻¹。因此，Modelflow的均方误差最低，表明其性能最佳。CO(ed)显著高估心输出量的变化，而CO(mf)和CO(hs)的值与CO(td)的值无显著差异。所有三种方法都能以高分检测到热稀释法测得的心输出量的方向性变化。
