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经肺温度稀释监测与传统方法在心脏手术中临床结果的比较:一项观察性研究。

Comparison of clinical results between transpulmonary thermodilution monitoring and conventional methods in cardiac surgery: An observational study.

作者信息

Ertugay Serkan, Kahraman Ümit, Oğuz Emrah, Demir Emre, Öztürk Esin, Kocabaş Nüzhet Seden, Tuncer Osman Nuri, Öztürk Pelin, Özbaran Mustafa

机构信息

Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey.

Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey.

出版信息

Medicine (Baltimore). 2024 Dec 20;103(51):e40884. doi: 10.1097/MD.0000000000040884.

Abstract

The Pulse Index Contour Continuous Cardiac Output (PICCO) module provides advanced and continuous monitoring of cardiac output through the use of arterial pulse contour analysis and transpulmonary thermodilution. The objective of this study was to compare the early postoperative outcomes of patients who were monitored using the conventional method and the pulse contour analysis method. A prospective observational study was conducted involving 45 patients who underwent cardiac surgery between 2020 and 2022. Patients were randomly assigned to either Group P (PICCO) or Group C (conventional). In the PICCO cohort, a femoral artery cannula was inserted for the continuous recording and management of hemodynamic data, in accordance with the decision-making algorithm of the module. In the conventional group, cannulation of the radial artery and jugular vein was performed. The postoperative hemodynamic and clinical data are subjected to analysis. The utilization of dopamine was markedly diminished in Group P at both the 0- and 6-hour postoperative intervals, whereas the administration of dobutamine was observed to be elevated (P = .008). The frequency of red packed cell transfusions was higher in Group C at postoperative hour 0. Hemodynamic data indicated a 42% increase in cardiac index and a 33% decrease in systemic vascular resistance, along with a 33% increase in global ejection fraction in patients monitored with PICCO. The mortality rates observed in the 2 groups were not statistically different. The implementation of advanced monitoring techniques, specifically the PICCO module, led to notable enhancements in hemodynamic parameters. The utilization of this technique may prove advantageous in guiding inotrope selection and transfusion decisions during the initial postoperative period. However, it is important to note that morbidity and mortality rates remain comparable.

摘要

脉搏指示连续心输出量(PICCO)模块通过动脉脉搏轮廓分析和经肺热稀释技术,对心输出量进行先进的连续监测。本研究的目的是比较使用传统方法和脉搏轮廓分析方法监测的患者术后早期结局。进行了一项前瞻性观察性研究,纳入了2020年至2022年间接受心脏手术的45例患者。患者被随机分为P组(PICCO组)或C组(传统组)。在PICCO队列中,根据模块的决策算法,插入股动脉插管以连续记录和管理血流动力学数据。在传统组中,进行桡动脉和颈内静脉插管。对术后血流动力学和临床数据进行分析。P组在术后0小时和6小时使用多巴胺的情况均显著减少,而多巴酚丁胺的使用则有所增加(P = 0.008)。C组在术后0小时红细胞输注频率更高。血流动力学数据显示,使用PICCO监测的患者心脏指数增加42%,全身血管阻力降低33%,整体射血分数增加33%。两组观察到的死亡率无统计学差异。先进监测技术的实施,特别是PICCO模块,使血流动力学参数有显著改善。在术后初期,使用该技术可能有利于指导血管活性药物的选择和输血决策。然而,需要注意的是,发病率和死亡率仍然相当。

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