Zhang Yun, Wang Yan, Ji Dongdong, Qian Jiyin, Xu Jinyu, Shi Jing
Department of Emergency, Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China. Corresponding author: Shi Jing, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Dec;31(12):1462-1468. doi: 10.3760/cma.j.issn.2095-4352.2019.12.006.
To assess the differences between ultrasound cardiac output monitor (USCOM) and thermodilution (TD) systematically in cardiac function monitoring of critically ill patients.
The Chinese and English literatures about the clinical trials which using USCOM and TD to monitor cardiac function published in CNKI, Wanfang database, China biomedical literature database, VIP database, China Clinical Trial Registration Center, PubMed, Embase and Cochrane Library were searched by computer from the establishment to December 2018. Some indicators, like cardiac output (CO), cardiac index (CI), stroke volume (SV) and other parameters were used to evaluate cardiac function. Literature search, quality evaluation and data extraction were conducted independently by two authors. The tailored Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used for literature quality evaluation. EndNote X6 was used for literature screening and management. RevMan 5.3 was used for Meta-analysis. Funnel chart analysis was used for publication bias.
A total of 26 studies involving 772 patients were included. Among them, there were 5 literatures found that the agreements of cardiac function between the USCOM and TD methods were poor. Meta-analysis showed that there was no significant difference between the two methods in CO and CI monitoring [CO: mean difference (MD) = -0.06, 95% confidence interval (95%CI) was -0.17 to 0.05, P = 0.31; CI: MD = -0.04, 95%CI was -0.13 to 0.05, P = 0.38]. Subgroup analysis of different TD methods [pulmonary artery catheter (PAC), pulse indicator continuous cardiac output (PiCCO)] and different windows of USCOM ultrasonic probe [aorta (AA), pulmonary artery (PA)] in CO monitoring was not shown significant difference yet (PAC: MD = -0.07, 95%CI was -0.18 to 0.04, P = 0.23; PiCCO: MD = 0.09, 95%CI was -0.31 to 0.50, P = 0.65; AA windows: MD = -0.14, 95%CI was -0.31 to 0.02, P = 0.09; PA windows: MD = -0.00, 95%CI was -0.15 to 0.14, P = 0.95; AA/PA windows: MD = 0.23, 95%CI was -0.40 to 0.86, P = 0.47). However, the difference in SV was statistically significant between the USCOM and TD method (MD = 1.48, 95%CI was 0.04 to 2.92, P = 0.04). Funnel chart showed that the literature distribution of CO and CI monitoring were basically symmetrical, indicating that the bias of literature publication is small.
USCOM has good consistency with TD method in monitoring the cardiac function parameters of CO and CI, and different windows of ultrasonic probe of USCOM have no significant influence on the monitoring results, but there is significant difference in the consistency of the two methods in SV monitoring.
系统评价超声心输出量监测仪（USCOM）与热稀释法（TD）在危重症患者心功能监测中的差异。
通过计算机检索中国知网、万方数据库、中国生物医学文献数据库、维普数据库、中国临床试验注册中心、PubMed、Embase及Cochrane图书馆中自建库至2018年12月发表的关于采用USCOM和TD监测心功能的临床试验中英文文献。采用心输出量（CO）、心脏指数（CI）、每搏输出量（SV）等指标评价心功能。由两名作者独立进行文献检索、质量评价及数据提取。采用诊断准确性研究的质量评估工具（QUADAS-2）进行文献质量评价。使用EndNote X6进行文献筛选及管理。采用RevMan 5.3进行Meta分析。采用漏斗图分析评价发表偏倚。
共纳入26项研究，涉及772例患者。其中，5篇文献发现USCOM与TD方法在心功能方面的一致性较差。Meta分析显示，两种方法在CO和CI监测方面无显著差异[CO：平均差值（MD）=-0.06，95%置信区间（95%CI）为-0.17至0.05，P=0.31；CI：MD=-0.04，95%CI为-0.13至0.05，P=0.38]。不同TD方法[肺动脉导管（PAC）、脉搏指示连续心输出量监测（PiCCO）]及USCOM超声探头不同窗口[主动脉（AA）、肺动脉（PA）]在CO监测方面的亚组分析也未显示出显著差异（PAC：MD=-0.07，95%CI为-0.18至0.04，P=0.23；PiCCO：MD=0.09，95%CI为-0.31至0.50，P=0.65；AA窗口：MD=-0.14，95%CI为-0.31至0.02，P=0.09；PA窗口：MD=-0.00，95%CI为-0.15至0.14，P=0.95；AA/PA窗口：MD=0.23，95%CI为-0.40至0.86，P=0.47）。然而，USCOM与TD方法在SV方面的差异具有统计学意义（MD=1.48，95%CI为0.04至2.92，P=0.04）。漏斗图显示，CO和CI监测的文献分布基本对称，表明文献发表偏倚较小。
USCOM与TD方法在监测CO和CI心功能参数方面具有良好的一致性，USCOM超声探头不同窗口对监测结果无显著影响，但两种方法在SV监测的一致性方面存在显著差异。
