Notterman D A, Castello F V, Steinberg C, Greenwald B M, O'Loughlin J E, Gold J P
Department of Pediatrics, Cornell University Medical College, New York, NY 10021.
J Pediatr. 1989 Oct;115(4):554-60. doi: 10.1016/s0022-3476(89)80280-x.
To evaluate the pulsed Doppler cardiac output method as a noninvasive means for determining cardiac output in critically ill children, we performed paired pulsed Doppler and thermodilution cardiac output determinations in 17 critically ill children. Commercially available equipment, specifically designed for this purpose, was employed. Forty paired thermodilution and pulsed Doppler determinations were made. There was a significant correlation between the two measurements (pulsed Doppler = 0.84 thermodilution + 0.39; r = 0.79, p less than 0.01). The ranges of thermodilution measurements (1.02 to 6.26 L/min; median 2.77 L/min) and pulsed Doppler measurements (1.13 to 6.35 L/min; median 2.57 L/min) were not different (p = 0.25). However, differences between individual paired thermodilution and pulsed Doppler measurements were large (-3.13 to 2.03 L/min; median 0.12 L/min), and the percentage difference between individual paired thermodilution and pulsed Doppler measurements ranged from 0.41% to 102.5% (median 12.7%). A discrepancy of 15% or more between thermodilution and pulsed Doppler was encountered in 18 (45%) of 40 of paired measurements (95% confidence interval: 29% to 61%), and one fourth of the paired measurements differed by more than 25%. We conclude that, as employed in this study, pulsed Doppler cardiac output determination is not sufficiently representative of the thermodilution output to be employed for hemodynamic monitoring in critically ill children.
为评估脉冲多普勒心输出量测定法作为一种用于确定危重症患儿心输出量的非侵入性方法，我们对17名危重症患儿进行了脉冲多普勒和热稀释法心输出量的配对测定。使用了专门为此目的设计的商用设备。共进行了40次热稀释法和脉冲多普勒法的配对测定。两种测量方法之间存在显著相关性（脉冲多普勒 = 0.84×热稀释法 + 0.39；r = 0.79，p < 0.01）。热稀释法测量范围（1.02至6.26升/分钟；中位数2.77升/分钟）和脉冲多普勒法测量范围（1.13至6.35升/分钟；中位数2.57升/分钟）无差异（p = 0.25）。然而，个体配对的热稀释法和脉冲多普勒法测量值之间差异较大（-3.13至2.03升/分钟；中位数0.12升/分钟），个体配对的热稀释法和脉冲多普勒法测量值之间的百分比差异范围为0.41%至102.5%（中位数12.7%）。在40次配对测量中的18次（45%）出现热稀释法和脉冲多普勒法之间相差15%或更多的情况（95%置信区间：29%至61%），并且四分之一的配对测量相差超过25%。我们得出结论，如本研究中所采用的，脉冲多普勒心输出量测定法不足以充分代表热稀释法输出量，不能用于危重症患儿的血流动力学监测。
