评价三种心输出量测量技术在心血管手术后成年患者护理期间的一致性。

Evaluation of concordance among three cardiac output measurement techniques in adult patients during cardiovascular surgery postoperative care.

机构信息

Anestesiólogo Cardiovascular, Instructor Asociado, Anestesiología Cardiovascular, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Calle 10, No. 18-75, Bogotá, Colombia.

Anestesiólogo Cardiovascular, Instructor Asociado, Anestesiología Cardiovascular, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Calle 10, No. 18-75, Bogotá, Colombia; Anestesiólogo Cardiovascular, Hospital Cardiovascular del Niño de Cundinamarca, Carrera 1E No. 31-58, Soacha, Colombia.

出版信息

Med Intensiva. 2017 Dec;41(9):539-545. doi: 10.1016/j.medin.2017.08.001. Epub 2017 Sep 30.

DOI:10.1016/j.medin.2017.08.001

PMID:28969922

Abstract

INTRODUCTION

The standard method for cardiac output measuring is thermodilution although it is an invasive technique. Transesophageal Echocardiography (TEE) offers a dynamic and functional alternative to thermodilution.

OBJECTIVE

Analyze concordance between two TEE methods and thermodilution for cardiac output assessment.

METHODS

Observational concordance study in cardiovascular surgery patients that required pulmonary artery catheter. TEE cardiac output measurement at both mitral annulus (MA) and left ventricle outflow tract (LVOT) were performed. Results were compared with thermodilution. Correlation was evaluated by Lin's concordance correlation coefficient and Bland-Altman analysis. Statistical analysis was undertaken in STATA 13.0.

RESULTS

Twenty-five patients were enrolled. Fifty two percent of patients were male, median age and ejection fraction was 63 years and 35% respectively. Median thermodilution, LVOT and MA -measured cardiac output was 3.25 L/min, 3.46 L/min and 8.4 L/min respectively. Different values between thermodilution and MA measurements were found (Lin concordance=0.071; Confidence Interval 95%=-0.009 to 0.151; Spearman's correlation=0.22) as values between thermodilution and LVOT (Lin concordance=0.232; Confidence Interval 95%=-0.12 a 0.537; Spearman's correlation 0.28). Bland-Altman analysis showed greater difference between MA measurements and thermodilution (DM=-0.408; Bland-Altman Limits=-0.809 to -0.007), than the other echocardiographic findings (DM=0.007; Bland-Altman Limits=-0.441 to 0.428).

CONCLUSION

Results from cardiac output measurement by doppler and 2D-TEE on both MA and LVOT do not correlate with those obtained by thermodilution.

摘要

介绍

尽管热稀释法是一种有创技术，但它是测量心输出量的标准方法。经食管超声心动图（TEE）为热稀释法提供了一种动态和功能性的替代方法。

目的

分析两种 TEE 方法与热稀释法评估心输出量的一致性。

方法

对需要肺动脉导管的心血管手术患者进行观察性一致性研究。在二尖瓣环（MA）和左心室流出道（LVOT）进行 TEE 心输出量测量。将结果与热稀释法进行比较。通过林氏一致性相关系数和 Bland-Altman 分析评估相关性。统计分析采用 STATA 13.0 进行。

结果

共纳入 25 例患者。52%的患者为男性，中位年龄和射血分数分别为 63 岁和 35%。中位热稀释法、LVOT 和 MA 测量的心输出量分别为 3.25L/min、3.46L/min 和 8.4L/min。发现热稀释法与 MA 测量值之间存在差异（Lin 一致性=0.071；95%置信区间=-0.009 至 0.151；Spearman 相关系数=0.22），与热稀释法与 LVOT 之间的差异（Lin 一致性=0.232；95%置信区间=-0.12 至 0.537；Spearman 相关系数 0.28）。Bland-Altman 分析显示 MA 测量值与热稀释法之间的差异较大（DM=-0.408；Bland-Altman 界限=-0.809 至-0.007），大于其他超声心动图发现（DM=0.007；Bland-Altman 界限=-0.441 至 0.428）。