Judge Onkar, Ji Fuhai, Fleming Neal, Liu Hong
Department of Anesthesiology and Pain Medicine, University of California, Davis, California.
Department of Anesthesiology and Pain Medicine, University of California, Davis, California; Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
J Cardiothorac Vasc Anesth. 2015 Feb;29(1):69-75. doi: 10.1053/j.jvca.2014.07.016. Epub 2014 Oct 30.
Because of its invasive nature, debated effect on patient outcome, and the development of alternative hemodynamic monitoring technologies, the intraoperative use of the pulmonary artery catheter (PAC) has significantly decreased. The authors conducted a survey of the members of the Society of Cardiovascular Anesthesiologists (SCA) to assess current use of the PAC and alternative hemodynamic monitoring technologies in patients undergoing cardiac surgery.
A survey study.
Hospitals in North America, Europe, Asia, Australia, New Zealand, and South America.
SCA members in North America, Europe, Asia, Australia, New Zealand, and South America.
The survey was e-mailed by the SCA to roughly 6,000 of its members.
The survey was left open for 30 days. Respondents accessed the survey via a secured web-based database. A total of 854 questionnaires were completed. A total of 705 (82.6%) were from North American members. Four hundred twelve of the respondents (48.1%) worked in a private practice setting, while 350 (40.9%) were from an academic practice. A majority of the respondents (57.9%) were from hospitals that performed more than 400 cardiac surgeries a year, a subset of which (29.6%) did more than 800 cases annually. For cases using cardiopulmonary bypass, 583 (68.2%) of the respondents used a PAC more than 75% of the time, while 30 (3.5%) did not use the PAC at all. Ninety-four percent of respondents used transesophageal echocardiography (TEE) as part of the intraoperative monitoring. When not using a PAC, FloTrac/Vigileo was the alternative cardiac monitoring modality in 15.2% of the responses. Similar trends in monitor preferences were seen in off-pump coronary artery bypass grafting and minimally invasive/robotic heart surgery.
The results of this study suggested that a majority of the respondents still prefer to use the PAC for most cardiac surgeries. Subgroup analysis of the data revealed that geographical location, type of practice, and surgeon support played a significant role in the decision to use a PAC. Although most respondents prefer to use TEE as a complimentary tool, TEE also remains the most popular supplemental/alternative hemodynamic monitoring technology.
由于肺动脉导管（PAC）具有侵入性、对患者预后的影响存在争议以及替代血流动力学监测技术的发展，其在术中的使用已显著减少。作者对心血管麻醉医师协会（SCA）的成员进行了一项调查，以评估PAC及替代血流动力学监测技术在心脏手术患者中的当前使用情况。
一项调查研究。
北美、欧洲、亚洲、澳大利亚、新西兰和南美洲的医院。
北美、欧洲、亚洲、澳大利亚、新西兰和南美洲的SCA成员。
SCA通过电子邮件向其约6000名成员发送了调查问卷。
调查问卷开放30天。受访者通过一个安全的基于网络的数据库访问该调查问卷。共完成了854份问卷。其中705份（82.6%）来自北美成员。412名受访者（48.1%）在私人诊所工作，而350名（40.9%）来自学术机构。大多数受访者（57.9%）来自每年进行超过400例心脏手术的医院，其中一部分（29.6%）每年进行超过800例手术。对于使用体外循环的病例，583名受访者（68.2%）在超过75%的时间使用PAC，而30名（3.5%）根本不使用PAC。94%的受访者将经食管超声心动图（TEE）作为术中监测的一部分。当不使用PAC时，15.2%的受访者选择FloTrac/Vigileo作为替代心脏监测方式。在非体外循环冠状动脉搭桥术和微创/机器人心脏手术中，监测偏好也呈现类似趋势。
本研究结果表明，大多数受访者在大多数心脏手术中仍倾向于使用PAC。数据的亚组分析显示，地理位置、执业类型和外科医生的支持在决定是否使用PAC方面发挥了重要作用。尽管大多数受访者倾向于将TEE作为辅助工具，但TEE仍然是最受欢迎的补充/替代血流动力学监测技术。
