心脏手术中应用脉波轮廓分析法校准心排血量指数变化的评估：一项前瞻性观察研究。

Assessment of changes in cardiac index with calibrated pulse contour analysis in cardiac surgery: A prospective observational study.

机构信息

Pôle réanimations anesthésie Samu/Smur, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14000 Caen, France; EA 4650, université de Caen Basse-Normandie, Esplanade de la Paix, CS 14032, 14000 Caen, France.

Pôle réanimations anesthésie Samu/Smur, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14000 Caen, France.

出版信息

Anaesth Crit Care Pain Med. 2016 Aug;35(4):261-7. doi: 10.1016/j.accpm.2015.12.010. Epub 2016 Apr 13.

DOI:10.1016/j.accpm.2015.12.010

PMID:27083307

Abstract

OBJECTIVES

To assess the trending ability of calibrated pulse contour cardiac index (CIPC) monitoring during haemodynamic changes (passive leg raising [PLR] and fluid loading) compared with transpulmonary thermodilution CI (CITD).

METHOD

Seventy-eight mechanically-ventilated patients admitted to intensive care with calibrated pulse contour following cardiac surgery were prospectively included and investigated during PLR, and after fluid loading. Fluid responsiveness was defined as a≥15% CITD increase after a 500ml bolus. Areas under the empiric receiver operating characteristic curves (ROCAUC) for changes in CIPC (ΔCIPC) during PLR to predict fluid responsiveness and after fluid challenge to predict an increase at least 15% in CITD after fluid loading were calculated.

RESULTS

Fifty-five patients (71%) were classified as responders, 23 (29%) as non-responders. ROCAUC for ΔCIPC during PLR in predicting fluid responsiveness, its sensitivity, specificity, and percentage of patients within the inconclusive class of response were 0.67 (95% CI=0.55-0.77), 0.76 (95% CI=0.63-0.87), 0.57 (95% CI=0.34-0.77) and 68%, respectively. Bias, precision and limits of agreements and percentage error between CIPC and CITD after fluid challenge were 0.14 (95% CI: 0.08-0.20), 0.26, -0.37 to 0.64 l min(-1)m(-2), and 20%, respectively. The concordance rate was 97% and the polar concordance at 30° was 91%. ROCAUC for ΔCIPC in predicting an increase of at least 15% in CITD after fluid loading was 0.85 (95% CI: 0.76-0.92).

CONCLUSION

Although ΔCIPC after fluid loading could track the direction of changes of CITD and was interchangeable with bolus transpulmonary thermodilution, PLR could not predict fluid responsiveness in cardiac surgery patients.

摘要

目的

评估校准脉搏轮廓心指数（CIPC）监测在血流动力学变化（被动抬腿[PLR]和液体负荷）期间的趋势能力，与经肺温度稀释心指数（CITD）相比。

方法

前瞻性纳入 78 例心脏手术后接受校准脉搏轮廓监测的机械通气患者，并在 PLR 期间和液体负荷后进行研究。液体反应性定义为 500ml 推注后 CITD 增加≥15%。计算 PLR 期间 CIPC（ΔCIPC）变化预测液体反应性的经验接收者操作特征曲线（ROC）下面积（ROCAUC），以及液体负荷后预测 CITD 增加至少 15%的 ROCAUC。

结果

55 例（71%）患者被分类为有反应者，23 例（29%）为无反应者。PLR 期间ΔCIPC 预测液体反应性的 ROCAUC 为 0.67（95%CI=0.55-0.77），敏感性为 0.76（95%CI=0.63-0.87），特异性为 0.57（95%CI=0.34-0.77），无反应者比例为 68%。液体负荷后 CIPC 和 CITD 之间的偏差、精度、一致性区间和误差百分比分别为 0.14（95%CI：0.08-0.20）、0.26、-0.37 至 0.64 l min(-1)m(-2)和 20%。一致性率为 97%，30°极性一致性为 91%。PLR 期间ΔCIPC 预测液体负荷后 CITD 增加至少 15%的 ROCAUC 为 0.85（95%CI：0.76-0.92）。