Freund P R
Am J Surg. 1987 May;153(5):490-4. doi: 10.1016/0002-9610(87)90800-2.
Measurement of cardiac output has become an essential feature of anesthetic management of patients with cardiac disease requiring operation. Thermodilution by way of a Swan-Ganz catheter is the current popular technique for cardiac output determination. Unfortunately, this method is costly and has an associated irreducible morbidity rate and has, in rare instances, resulted in death. The suprasternal ultrasonographic Doppler technique has shown promise for measuring cardiac output noninvasively; however, it is too cumbersome for continuous intraoperative use. In an effort to overcome this limitation, the esophageal stethoscope was modified to accept a Doppler probe. Herein, we have reported an initial comparison of transesophageal Doppler scanning and thermodilution in 23 adult men during general anesthesia. The average difference between thermodilution and descending cardiac output was 0.16 +/- 0.81 liters/min. The correlation between thermodilution and descending cardiac output increased with operator experience. In the last 13 patients, there was an average correlation of 0.85. After the equipment was mastered and improvements in design were made, descending cardiac output had a high correlation with thermodilution and appeared to track the dynamic changes during general anesthesia.
心输出量的测量已成为需要手术的心脏病患者麻醉管理的一项基本内容。通过 Swan-Ganz 导管进行热稀释法是目前测定心输出量的常用技术。不幸的是，这种方法成本高昂，且有不可避免的发病率，在极少数情况下还导致了死亡。胸骨上超声多普勒技术已显示出无创测量心输出量的前景；然而，它在术中连续使用时过于繁琐。为了克服这一局限性，对食管听诊器进行了改进，以接纳多普勒探头。在此，我们报告了在全身麻醉期间对 23 名成年男性进行经食管多普勒扫描和热稀释法的初步比较。热稀释法与降主动脉心输出量之间的平均差值为 0.16±0.81 升/分钟。热稀释法与降主动脉心输出量之间的相关性随着操作者经验的增加而提高。在最后 13 名患者中，平均相关性为 0.85。在掌握了设备并进行了设计改进后，降主动脉心输出量与热稀释法具有高度相关性，并且似乎能够追踪全身麻醉期间的动态变化。
