急性心肌梗死患者血流动力学和血氧测量变量的实测值与通过菲克法得出的值之间的比较。

Comparison between measured and fick-derived values of hemodynamic and oxymetric variables in patients with acute myocardial infarction.

作者信息

Pomés Iparraguirre H, Giniger R, Garber V A, Quiroga E, Jorge M A

机构信息

Coronary Care Unit, Policlinica Bancaria, Buenos Aires, Argentina.

出版信息

Am J Med. 1988 Sep;85(3):349-52. doi: 10.1016/0002-9343(88)90585-2.

DOI:10.1016/0002-9343(88)90585-2

PMID:3414730

Abstract

PURPOSE

Previous studies have compared the relationship between directly measured values for cardiac output, systemic oxygen consumption (VO2), and arteriovenous oxygen difference (D(A-v)O2) with those calculated by the Fick principle. However, the validity of Fick's principle in critically ill patients undergoing physiologic changes and pharmacologic interventions is unknown. The purpose of our study was to compare directly measured values for hemodynamic and oxymetric variables with those calculated by the Fick equation in patients with acute myocardial infarction, at baseline and after the hemodynamic changes produced by pharmacologic interventions.

PATIENTS AND METHODS

Cardiac output, (VO2), and (D(A-v)O2) were measured in 33 patients with acute myocardial infarction, at baseline (50 +/- 30 hours after the onset of symptoms) and after pharmacologic intervention to relieve pulmonary congestion. These values were then compared with indirect values derived from the Fick equation.

RESULTS

High and significant correlations were found between thermodilution and Fick-derived cardiac output at baseline (r = 0.91, p less than 0.001) and post-intervention (r = 0.92, p less than 0.001). Similarly, VO2 values measured by expired gas analysis showed a significant correlation with VO2 calculated by the Fick principle, at baseline (r = 0.85, p less than 0.001) and post-intervention (r = 0.84, p less than 0.001). Lastly, when D(A-v)O2 of arterial and mixed venous samples was measured by spectrophotometry and compared with calculated values, there was a significant correlation at baseline (r = 0.85, p less than 0.001) and after intervention (r = 0.85, p less than 0.001). Analysis of variance revealed no difference between measured and calculated values for the three variables under those two conditions.

CONCLUSION

In patients with acute myocardial infarction, cardiac output, VO2, and D(A-v)O2 indirectly calculated by the Fick principle are equivalent to directly measured values, despite the various degrees of hemodynamic dysfunction and the currently used therapeutic interventions.

摘要

目的

以往研究比较了心输出量、全身氧耗（VO2）和动静脉氧差（D(A-v)O2）的直接测量值与通过菲克原理计算得出的值之间的关系。然而，菲克原理在经历生理变化和药物干预的重症患者中的有效性尚不清楚。我们研究的目的是比较急性心肌梗死患者在基线时以及药物干预引起血流动力学变化后，血流动力学和氧测量变量的直接测量值与通过菲克方程计算得出的值。

患者与方法

对33例急性心肌梗死患者在基线时（症状发作后50±30小时）以及药物干预缓解肺充血后测量心输出量、VO2和D(A-v)O2。然后将这些值与从菲克方程得出的间接值进行比较。

结果

在基线时（r = 0.91，p<0.001）和干预后（r = 0.92，p<0.001），热稀释法与菲克法得出的心输出量之间存在高度显著相关性。同样，通过呼出气体分析测量的VO2值与通过菲克原理计算得出的VO2在基线时（r = 0.85，p<0.001）和干预后（r = 0.84，p<0.001）显示出显著相关性。最后，当通过分光光度法测量动脉和混合静脉样本的D(A-v)O2并与计算值进行比较时，在基线时（r = 0.85，p<0.001）和干预后（r = 0.85，p<0.001）存在显著相关性。方差分析显示在这两种情况下，三个变量的测量值和计算值之间没有差异。