心脏手术患者中自动校准脉搏轮廓分析的准确性：一项双中心临床试验。
Accuracy of an autocalibrated pulse contour analysis in cardiac surgery patients: a bi-center clinical trial.
作者信息
Broch Ole, Carbonell Jose, Ferrando Carlos, Metzner Malte, Carstens Arne, Albrecht Martin, Gruenewald Matthias, Höcker Jan, Soro Marina, Steinfath Markus, Renner Jochen, Bein Berthold
机构信息
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, D-24105, Kiel, Germany.
Department of Anaesthesiology and Critical Care, University Hospital Valencia, Avenida Blasco Ibanez 17, 46010, Valencia, Spain.
出版信息
BMC Anesthesiol. 2015 Nov 26;15:171. doi: 10.1186/s12871-015-0153-2.
BACKGROUND
Less-invasive and easy to install monitoring systems for continuous estimation of cardiac index (CI) have gained increasing interest, especially in cardiac surgery patients who often exhibit abrupt haemodynamic changes. The aim of the present study was to compare the accuracy of CI by a new semi-invasive monitoring system with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB).
METHODS
Sixty-five patients (41 Germany, 24 Spain) scheduled for elective coronary surgery were studied before and after CPB, respectively. Measurements included CI obtained by transpulmonary thermodilution (CITPTD) and autocalibrated semi-invasive pulse contour analysis (CIPFX). Percentage changes of CI were also calculated.
RESULTS
There was only a poor correlation between CITPTD and CIPFX both before (r (2) = 0.34, p < 0.0001) and after (r (2) = 0.31, p < 0.0001) CPB, with a percentage error (PE) of 62 and 49 %, respectively. Four quadrant plots revealed a concordance rate over 90 % indicating an acceptable correlation of trends between CITPTD and CIPFX before (concordance: 93 %) and after (concordance: 94 %) CPB. In contrast, polar plot analysis showed poor trending before and an acceptable trending ability of changes in CI after CPB.
CONCLUSIONS
Semi-invasive CI by autocalibrated pulse contour analysis showed a poor ability to estimate CI compared with transpulmonary thermodilution. Furthermore, the new semi-invasive device revealed an acceptable trending ability for haemodynamic changes only after CPB.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT02312505 Date: 12.03.2012.
背景
用于持续评估心脏指数（CI）的侵入性较小且易于安装的监测系统越来越受到关注，特别是在经常出现突然血流动力学变化的心脏手术患者中。本研究的目的是比较一种新型半侵入性监测系统与经肺热稀释法在体外循环（CPB）前后测量CI的准确性。
方法
分别对65例计划进行择期冠状动脉手术的患者（41例来自德国，24例来自西班牙）在CPB前后进行研究。测量包括经肺热稀释法获得的CI（CITPTD）和自动校准半侵入性脉搏轮廓分析获得的CI（CIPFX）。还计算了CI的百分比变化。
结果
CPB前（r² = 0.34，p < 0.0001）和CPB后（r² = 0.31，p < 0.0001），CITPTD与CIPFX之间的相关性均较差，百分比误差（PE）分别为62%和49%。四象限图显示一致性率超过90%，表明CPB前（一致性：93%）和CPB后（一致性：94%）CITPTD与CIPFX之间的趋势具有可接受的相关性。相比之下，极坐标图分析显示CPB前趋势较差，CPB后CI变化的趋势能力可接受。
结论
与经肺热稀释法相比，自动校准脉搏轮廓分析的半侵入性CI估计CI的能力较差。此外，这种新型半侵入性设备仅在CPB后显示出对血流动力学变化具有可接受的趋势监测能力。
试验注册
ClinicalTrials.gov：NCT02312505 日期：2012年3月12日。
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