Dubost Clément, Bouglé Adrien, Hallynck Calliope, Le Dorze Matthieu, Roulleau Philippe, Baujard Catherine, Benhamou Dan
Départment of Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
Surgical Intensive Care Unit, Institut of Cardiology, Groupe Hospitalier Pitié-Salpêtrière, Réanimation Médicale Polyvalente, Paris, France.
Indian J Crit Care Med. 2015 Jan;19(1):3-8. doi: 10.4103/0972-5229.148630.
Cardiac output (CO) monitoring and goal-directed therapy during major abdominal surgery is currently used to decrease postoperative complications. However, few monitors are currently available for pediatric patients. Nicom(®) is a noninvasive CO monitoring technique based on the bioreactance principle (analysis of frequency variations of a delivered oscillating current traversing the thoracic cavity). Nicom(®) may be a useful monitor for pediatric patients.
Pediatric patients undergoing major abdominal surgery under general anesthesia with cardiac monitoring by transesophageal Doppler (TED) were included. Continuously recorded hemodynamic variables obtained from both bioreactance and TED were compared. Data were analyzed using the Bland-Altman method.
A total of 113 pairs of cardiac index (CI) measurments from 16 patients were analyzed. Mean age was 59 months (95% CI: 42-75) and mean weight was 17 kg (95% CI: 15-20). In the overall population, Bland-Altman analysis revealed a bias of 0.4 L/min/m(2), precision of 1.55 L/min/m(2), limits of agreement of -1.1 to 1.9 L/min/m(2) and a percentage error of 47%. For children weighing >15 kg, results were: Bias 0.51 L/min/m(2), precision 1.17 L/min/m(2), limits of agreement -0.64 to 1.66 L/min/m(2) and percentage error 34%.
Simultaneous CI estimations made by bioreactance and TED showed high percentage of errors that is not clinically acceptable. Bioreactance cannot be considered suitable for monitoring pediatric patients.
目前，在腹部大手术期间进行心输出量（CO）监测和目标导向治疗，以减少术后并发症。然而，目前适用于儿科患者的监测仪很少。Nicom（®）是一种基于生物反应原理（分析通过胸腔的输送振荡电流的频率变化）的无创CO监测技术。Nicom（®）可能是一种适用于儿科患者的有用监测仪。
纳入在全身麻醉下接受腹部大手术并经食管多普勒（TED）进行心脏监测的儿科患者。比较通过生物反应和TED连续记录获得的血流动力学变量。使用Bland-Altman方法分析数据。
分析了16例患者的113对心脏指数（CI）测量值。平均年龄为59个月（95%CI：42 - 75），平均体重为17kg（95%CI：15 - 20）。在总体人群中，Bland-Altman分析显示偏差为0.4L/min/m²，精密度为1.55L/min/m²，一致性界限为-1.1至1.9L/min/m²，百分比误差为47%。对于体重>15kg的儿童，结果为：偏差0.51L/min/m²，精密度1.17L/min/m²，一致性界限-0.64至1.66L/min/m²，百分比误差34%。
通过生物反应和TED同时进行的CI估计显示出较高的误差百分比，这在临床上是不可接受的。生物反应不能被认为适用于监测儿科患者。
