de Wilde R B P, Geerts B F, van den Berg P C M, Jansen J R C
Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands.
Anaesthesia. 2009 Sep;64(9):1004-9. doi: 10.1111/j.1365-2044.2009.06009.x.
The aim of this study was to compare the accuracy of stroke volume variation (SVV) as measured by the LiDCOplus system (SVVli) and by the FloTrac-Vigileo system (SVVed). We measured SVVli and SVVed in 15 postoperative cardiac surgical patients following five study interventions; a 50% increase in tidal volume, an increase of PEEP by 10 cm H2O, passive leg raising, a head-up tilt procedure and fluid loading. Between each intervention, baseline measurements were performed. 136 data pairs were obtained. SVVli ranged from 1.4% to 26.8% (mean (SD) 8.7 (4.6)%); SVVed from 2.0% to 26.0% (10.2 (4.7)%). The bias was found to be significantly different from zero at 1.5 (2.5)%, p < 0.001, (95% confidence interval 1.1-1.9). The upper and lower limits of agreement were found to be 6.4 and -3.5% respectively. The coefficient of variation for the differences between SVVli and SVVed was 26%. This results in a relative large range for the percentage limits of agreement of 52%. Analysis in repeated measures showed coefficients of variation of 21% for SVVli and 22% for SVVed. The LiDCOplus and FloTrac-Vigileo system are not interchangeable. Furthermore, the determination of SVVli and SVVed are too ambiguous, as can be concluded from the high values of the coefficient of variation for repeated measures. These findings underline Pinsky's warning of caution in the clinical use of SVV by pulse contour techniques.
本研究旨在比较LiDCOplus系统（SVVli）和FloTrac-Vigileo系统（SVVed）测量每搏量变异度（SVV）的准确性。我们对15例心脏外科术后患者在五项研究干预措施后测量了SVVli和SVVed；潮气量增加50%、呼气末正压增加10 cm H2O、被动抬腿、头高位倾斜程序和液体负荷。在每次干预之间进行基线测量。共获得136对数据。SVVli范围为1.4%至26.8%（均值（标准差）8.7（4.6）%）；SVVed范围为2.0%至26.0%（10.2（4.7）%）。发现偏差为1.5（2.5）%，显著不同于零，p < 0.001，（95%置信区间1.1 - 1.9）。一致性界限的上限和下限分别为6.4%和 - 3.5%。SVVli和SVVed之间差异的变异系数为26%。这导致一致性百分比界限的相对范围较大，为52%。重复测量分析显示SVVli的变异系数为21%，SVVed的变异系数为22%。LiDCOplus系统和FloTrac-Vigileo系统不可互换。此外，从重复测量变异系数的高值可以得出，SVVli和SVVed的测定过于不明确。这些发现强调了平斯基关于在临床中使用脉搏轮廓技术测量SVV时需谨慎的警告。
