Estagnasié P, Djedaini K, Mier L, Coste F, Dreyfuss D
Service de Réanimation Médicine, Hôpital Louis Mourier Faculté Xavier Bichat, Colombes, France.
Intensive Care Med. 1997 Jul;23(7):753-9. doi: 10.1007/s001340050405.
The determination of basal cardiac output (CO) and of its variations during different therapeutic interventions liable to increase or decrease it in mechanically ventilated patients using transesophageal echocardiography (TEE).
To compare CO measurements simultaneously obtained by transmitral single-plane TEE and thermodilution.
Medical intensive care unit.
Twenty-two consecutive mechanically ventilated patients hospitalized for various medical conditions were included.
The comparisons between transmitral single-plane TEE and thermodilution measurements were made at baseline and after different therapeutic interventions affecting CO (fluids or dobutamine infusion or positive end-expiratory pressure titration).
Seventy-four measurements were obtained. Cardiac output using TEE was the product of the mitral valve area, the time-velocity integral of flow at the same site and the heart rate.
A significant correlation was observed between thermodilution and TEE measurements of CO (n = 74, r = 0.78, p < 0.001) despite wide limits of agreement (mean +/- 2SD = -0.3 +/- 3.1 l/min). Thermodilution and TEE CO determinations both had significant inverse correlation with the arterial-venous oxygen content difference in ten consecutive patients (r = 0.77, p < 0.01 and r = 0.71, p < 0.01, respectively). The correlation between variations of CO greater than 20% obtained by thermodilution and TEE was significant (r = 0.89, p < 0.001). The operative characteristics implied the ability of TEE to predict significant variations of thermodilution CO (sensitivity 85% and negative predictive values 86%). Moreover, arterial-venous oxygen content difference changes of 5% or more were better detected using TEE than thermodilution.
These results suggest that although transesophageal CO measurements cannot replace thermodilution ones, the determination of CO variations obtained using TEE may be useful in the management of critically ill mechanically ventilated patients. This technique may make it possible to monitor hemodynamics during initial therapeutic interventions in those patients in whom right heart catheterization cannot be performed immediately.
采用经食管超声心动图（TEE）测定机械通气患者的基础心输出量（CO）及其在不同治疗干预措施（这些措施可能增加或降低心输出量）期间的变化。
比较经二尖瓣单平面TEE和热稀释法同时测得的CO值。
医疗重症监护病房。
纳入22例因各种病症住院的连续机械通气患者。
在基线时以及在影响CO的不同治疗干预措施（液体输注或多巴酚丁胺输注或呼气末正压滴定）后，对经二尖瓣单平面TEE和热稀释法测量结果进行比较。
共获得74次测量值。TEE测得的心输出量是二尖瓣面积、同一部位血流时间速度积分与心率的乘积。
尽管一致性界限较宽（平均±2标准差=-0.3±3.1升/分钟），但热稀释法和TEE测得的CO值之间仍存在显著相关性（n = 74，r = 0.78，p < 0.001）。在连续10例患者中，热稀释法和TEE测定的CO值均与动静脉血氧含量差呈显著负相关（分别为r = 0.77，p < 0.01和r = 0.71，p < 0.01）。热稀释法和TEE测得的CO变化大于20%之间的相关性显著（r = 0.89，p < 0.001）。其操作特性表明TEE能够预测热稀释法测得的CO的显著变化（敏感性85%，阴性预测值86%）。此外，与热稀释法相比，TEE能更好地检测出动静脉血氧含量差变化达5%或更多的情况。
这些结果表明，虽然经食管CO测量不能替代热稀释法测量，但使用TEE测定CO变化可能对危重症机械通气患者的管理有用。对于那些不能立即进行右心导管检查的患者，该技术可能有助于在初始治疗干预期间监测血流动力学。
