Bergstra A, van Dijk R B, Hillege H L, Lie K I, Mook G A
Department of Cardiology, University Hospital, Groningen, The Netherlands.
Eur Heart J. 1995 May;16(5):698-703. doi: 10.1093/oxfordjournals.eurheartj.a060976.
This study was performed because of observed differences between dye dilution cardiac output and the Fick cardiac output, calculated from estimated oxygen consumption according to LaFarge and Miettinen, and to find a better formula for assumed oxygen consumption. In 250 patients who underwent left and right heart catheterization, the oxygen consumption VO2 (ml.min-1) was calculated using Fick's principle. Either pulmonary or systemic flow, as measured by dye dilution, was used in combination with the concordant arteriovenous oxygen concentration difference. In 130 patients, who matched the age of the LaFarge and Miettinen population, the obtained values of oxygen consumption VO2(dd) were compared with the estimated oxygen consumption values VO2(lfm), found using the LaFarge and Miettinen formulae. The VO2(lfm) was significantly lower than VO2(dd); -21.8 +/- 29.3 ml.min-1 (mean +/- SD), P < 0.001, 95% confidence interval (95% CI) -26.9 to -16.7, limits of agreement (LA) -80.4 to 36.9. A new regression formula for the assumed oxygen consumption VO2(ass) was derived in 250 patients by stepwise multiple regression analysis. The VO2(dd) was used as a dependent variable, and body surface area BSA (m2). Sex (0 for female, 1 for male), Age (years), Heart rate (min-1) and the presence of a left to right shunt as independent variables. The best fitting formula is expressed as: VO2(ass) = (157.3 x BSA + 10.0 x Sex - 10.5 x In Age + 4.8) ml.min-1, where ln Age = the natural logarithm of the age. This formula was validated prospectively in 60 patients. A non-significant difference between VO2(ass) and VO2(dd) was found; mean 2.0 +/- 23.4 ml.min-1, P = 0.771, 95% Cl = -4.0 to +8.0, LA -44.7 to +48.7. In conclusion, assumed oxygen consumption values, using our new formula, are in better agreement with the actual values than those found according to LaFarge and Miettinen's formulae.
本研究的开展是因为观察到染料稀释法心输出量与根据拉法热和米耶蒂宁方法由估计的耗氧量计算得出的菲克心输出量之间存在差异，旨在找到一个更适用于假定耗氧量的公式。在250例行左右心导管检查的患者中，采用菲克原理计算耗氧量VO2（ml·min⁻¹）。染料稀释法测得的肺循环或体循环血流量与相应的动静脉血氧浓度差相结合使用。在130例年龄与拉法热和米耶蒂宁研究人群匹配的患者中，将所获得的耗氧量VO2(dd)值与使用拉法热和米耶蒂宁公式得出的估计耗氧量VO2(lfm)值进行比较。VO2(lfm)显著低于VO2(dd)；为-21.8±29.3 ml·min⁻¹（均值±标准差），P<0.001，95%置信区间（95%CI）为-26.9至-16.7，一致性界限（LA）为-80.4至36.9。通过逐步多元回归分析在250例患者中推导出一个用于假定耗氧量VO2(ass)的新回归公式。以VO2(dd)作为因变量，体表面积BSA（m²）、性别（女性为0，男性为1）、年龄（岁）、心率（次/分钟）以及存在左向右分流作为自变量。最佳拟合公式表示为：VO2(ass) = (157.3×BSA + 10.0×性别 - 10.5×ln年龄 + 4.8) ml·min⁻¹，其中ln年龄为年龄的自然对数。该公式在60例患者中进行了前瞻性验证。发现VO2(ass)与VO2(dd)之间无显著差异；均值为2.0±23.4 ml·min⁻¹，P = 0.771，95%CI为-4.0至+8.0，LA为-44.7至+48.7。总之，使用我们的新公式得出的假定耗氧量值与实际值的一致性优于根据拉法热和米耶蒂宁公式得出的结果。
