Department of Anaesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
J Cardiothorac Vasc Anesth. 2011 Feb;25(1):48-52. doi: 10.1053/j.jvca.2010.09.013. Epub 2010 Nov 19.
The authors evaluated the ability of 2 pulse contour cardiac output (CO) techniques to track CO changes during passive leg raising (PLR) to assess fluid loading responsiveness.
A prospective study.
An intensive care unit in a university hospital.
Twenty mechanically ventilated postoperative cardiac surgery patients.
Thirty-degree PLR.
The authors estimated CO by 3 techniques: thermodilution (COtd), arterial pulse power (Coli; LiDCO, London, UK), and pulse contour method (Com; FMS, Amsterdam, The Netherlands) based on uncalibrated Modelflow. The authors measured heart rate (HR), central venous pressure, arterial pulse pressure (PP), systolic pressure (SP), and mean arterial pressure (MAP). Stroke volume (SV), SP, PP, and SV variation (PPV and SVV, respectively) were calculated over 5 breaths. SVV was measured by both LiDCO (SVVli) and Modelflow (SVVm) devices. PLR-induced changes in COtd correlated with COli (p < 0.001) and COm (p < 0.001). Preload dependence was predicted with an area under the ROC curve of 0.968 for ΔCOm, 0.841 for ΔCOli, 0.825 for SVVm, 0.873 for SVVli, 0.808 for PPV, 0.778 for ΔSP, 0.714 for ΔPP, and 0.873 for ΔMAP.
Changes in COm, COli, SVV, and PPV track COtd changes during PLR with a high degree of accuracy in sedated, ventilated, postoperative cardiac surgery patients. Changes in pulse contour CO after PLR can be used to predict fluid loading responsiveness.
作者评估了 2 种脉波轮廓心输出量（CO）技术在被动抬腿（PLR）期间跟踪 CO 变化的能力，以评估液体负荷反应性。
前瞻性研究。
大学医院的重症监护病房。
20 例机械通气的心脏手术后患者。
30°PLR。
作者使用 3 种技术估计 CO：热稀释法（COtd）、动脉脉搏压力（Coli；LiDCO，英国伦敦）和基于未校准 Modelflow 的脉波轮廓法（Com；FMS，荷兰阿姆斯特丹）。作者测量了心率（HR）、中心静脉压、动脉脉搏压（PP）、收缩压（SP）和平均动脉压（MAP）。在 5 次呼吸中计算了每搏量（SV）、SP、PP 和 SV 变异（PPV 和 SVV，分别）。LiDCO（SVVli）和 Modelflow（SVVm）设备均测量 SVV。PLR 诱导的 COtd 变化与 COli（p < 0.001）和 COm（p < 0.001）相关。COm、COli、SVVm、SVVli、PPV、ΔSP、ΔPP 和 ΔMAP 的 ROC 曲线下面积预测了前负荷依赖性，分别为 0.968、0.841、0.825、0.873、0.808、0.778、0.714 和 0.873。
在镇静、通气、心脏手术后患者中，COm、COli、SVV 和 PPV 的变化可高度准确地跟踪 PLR 期间的 COtd 变化。PLR 后脉波轮廓 CO 的变化可用于预测液体负荷反应性。
