大型腹部手术期间非侵入性超声心输出量监测仪（USCOM）与食管多普勒监测仪的比较。
A comparison of the non-invasive ultrasonic cardiac output monitor (USCOM) with the oesophageal Doppler monitor during major abdominal surgery.
作者信息
Hodgson Luke E, Forni Lui G, Venn Richard, Samuels Theophilus L, Wakeling Howard G
机构信息
Anaesthetics & Intensive Care Department, Western Sussex NHS Foundation Trust, Worthing, UK.
Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
出版信息
J Intensive Care Soc. 2016 May;17(2):103-110. doi: 10.1177/1751143715610785. Epub 2015 Oct 14.
BACKGROUND
Perioperative interventions, targeted to increase global blood flow defined by explicit measured goals, reduce postoperative complications. Consequently, reliable non-invasive estimation of the cardiac output could have far-reaching benefit.
METHODS
This study compared a non-invasive Doppler device - the ultrasonic cardiac output monitor (USCOM) - with the oesophageal Doppler monitor (ODM), on 25 patients during major abdominal surgery. Stroke volume was determined by USCOM (SV) and ODM (SV) pre and post fluid challenges.
RESULTS
A ≥ 10% change (Δ) SV had a sensitivity of 94% and specificity of 88% to detect a ≥ 10% Δ SV; the area under the receiver operating curve was 0.94 (95% CI 0.90-0.99). Concordance was 98%, using an exclusion zone of <10% Δ SV. 135 measurements gave median SV 80 ml (interquartile range 65-93 ml) and SV 86 ml (69-100 ml); mean bias was 5.9 ml (limits of agreement -20 to +30 ml) and percentage error 30%.
CONCLUSIONS
Following fluid challenges SV showed good concordance and accurately discriminated a change ≥10% in SV.
背景
围手术期干预旨在通过明确测量目标来增加全身血流量，从而减少术后并发症。因此，可靠的无创心输出量估计可能具有深远的益处。
方法
本研究在25例接受大型腹部手术的患者中，将一种无创多普勒设备——超声心输出量监测仪（USCOM）与食管多普勒监测仪（ODM）进行了比较。在液体负荷前后，通过USCOM（SV）和ODM（SV）测定每搏输出量。
结果
每搏输出量变化（Δ）≥10%时，检测每搏输出量变化≥10%的敏感度为94%，特异度为88%；受试者工作特征曲线下面积为0.94（95%可信区间0.90 - 0.99）。使用<10%ΔSV的排除区时，一致性为98%。135次测量得出每搏输出量中位数为80 ml（四分位间距65 - 93 ml）和86 ml（69 - 100 ml）；平均偏差为5.9 ml（一致性界限为-20至+30 ml），百分比误差为30%。
结论
在液体负荷后，每搏输出量显示出良好的一致性，并且能够准确区分每搏输出量≥10%的变化。
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