两种方法在危重症患者心输出量测量中的比较。

Comparison of two methods for cardiac output measurement in critically ill patients.

机构信息

Istituto di Anestesia e Rianimazione, Università degli Studi di Padova, Via C. Battisti 267, 35100 Padova, Italy.

出版信息

Br J Anaesth. 2011 May;106(5):690-4. doi: 10.1093/bja/aer030. Epub 2011 Mar 17.

DOI:10.1093/bja/aer030

PMID:21414982

Abstract

BACKGROUND

The aim of recent haemodynamic monitoring has been to obtain continuous and reliable measures of cardiac output (CO) and indices of preload responsiveness. Many of these methods are based on the arterial pressure waveform analysis. The aim of our study was to assess the accuracy of CO measurements obtained by FloTrac/Vigileo, software version 1.07 and the new version 1.10 (Edwards Lifesciences LLC, Irvine, CA, USA), compared with CO measurements obtained by bolus thermodilution by pulmonary artery catheterization (PAC) in the intensive care setting.

METHODS

In 21 critically ill patients (enrolled in two University Hospitals), requiring invasive haemodynamic monitoring, PAC and FloTrac/Vigileo transducers connected to the arterial pressure line were placed. Simultaneous measurements of CO by two methods (FloTrac/Vigileo and thermodilution) were obtained three times a day for 3 consecutive days, when possible. The level of concordance between the two methods was assessed by the procedure suggested by Bland and Altman.

RESULTS

One hundred and forty-one pairs of measurements (provided by thermodilution and by both 1.07 and 1.10 FloTrac/Vigileo versions) were obtained in 21 patients (seven of them were trauma patients) with a mean (sd) age of 59 (16) yr. The Pearson product moment coefficient was 0.62 (P<0.001). The bias was -0.18 litre min(-1). The limits of agreement were 4.54 and -4.90 litre min(-1), respectively.

CONCLUSIONS

Our data show a poor level of concordance between measures provided by the two methods. We found an underestimation of CO values measured with the 1.07 software version of FloTrac for supranormal values of CO. The new software (1.10) has been improved in order to correct this bias; however, its reliability is still poor. On the basis of our data, we can therefore conclude that both software versions of FloTrac/Vigileo did not still provide reliable estimation of CO in our intensive care unit setting.

摘要

背景

最近血流动力学监测的目的是获得连续可靠的心输出量（CO）和前负荷反应性指数的测量值。其中许多方法都基于动脉压力波形分析。我们的研究目的是评估在重症监护环境中，通过 FloTrac/Vigileo（爱德华兹生命科学公司，欧文，加利福尼亚州，美国）软件版本 1.07 和新版本 1.10 获得的 CO 测量值与通过肺动脉导管（PAC）热稀释法获得的 CO 测量值的准确性。

方法

在 21 名需要侵入性血流动力学监测的危重症患者（在两所大学医院入组）中，放置了 PAC 和 FloTrac/Vigileo 换能器连接到动脉压线上。当可能时，每天三次连续三天获得两种方法（FloTrac/Vigileo 和热稀释法）同时测量 CO。两种方法之间的一致性程度通过 Bland 和 Altman 提出的程序进行评估。

结果

在 21 名患者（其中 7 名是创伤患者）中获得了 141 对测量值（由热稀释法和 1.07 版和 1.10 版 FloTrac/Vigileo 两种方法提供），平均（标准差）年龄为 59（16）岁。Pearson 乘积矩系数为 0.62（P<0.001）。偏差为-0.18 升/分钟。一致性界限分别为 4.54 和-4.90 升/分钟。

结论

我们的数据显示两种方法提供的测量值之间一致性程度较差。我们发现 FloTrac 的 1.07 软件版本测量的 CO 值对于 CO 的超正常值存在低估。新软件（1.10）已进行改进以纠正此偏差；然而，其可靠性仍然较差。基于我们的数据，我们可以得出结论，FloTrac/Vigileo 的两个软件版本在我们的重症监护病房环境中仍然无法提供可靠的 CO 估计。