PiCCO血流动力学监测在肺移植患者中的应用

Hemodynamic Monitoring by Pulse-Indicated Continuous Cardiac Output Analysis During Lung Transplantation

目的评价脉搏指示连续心排出量(PiCCO)技术在肺移植术中血流动力学监测的作用。方法20例终末期肺病患者行肺移植术,同时运用PiCCO和Swan-Ganz肺动脉漂浮导管(PAC)对术中6个时间点的血流动力学指标进行监测。分别比较胸腔内血容量指数(ITBVI)、肺动脉嵌顿压(PAWP)与每搏量指数(SVIpa)的相关性,以及相邻时间点变化值间(分别用Δ1～Δ5表示)的相关性,并运用Bland-Altman法对两种方法测得的心排指数(CI)进行一致性检验。结果ITBVI与SVIpa呈正相关(r=0.654,P<0.05),而PAWP与SVIpa无显著相关性(P>0.05)。术中相邻时间点ITBVI的变化也与SVIpa变化成正相关(Δ1,r=0.621;Δ2,r=0.784;Δ3,r=0.713;Δ4,r=0.740;Δ5,r=0.747;P均<0.05),PAWP的变化与SVIpa变化无明显相关性(P>0.05)。两种方法测得的CI平均偏离度为(0.09±0.5)L·min-1.m-2,一致性界限为(-0.89～1.07)L·min-1.m-2。结论在肺移植手术中PiCCO和PAC监测心脏前负荷的变化具有较好的相关性,PiCCO能够反映肺移植中血流动力学的变化。

Objective To explore the hemodynamic monitoring value of pulse-indicated continuous cardiac output（PiCCO）during lung transplantation.Methods Twenty patients with end-stage lung disease undergone lung transplantation were enrolled.Hemodynamic states were monitored by PiCCO and Swan-Ganz standard thermodilution pulmonary artery catheter（PAC）simultaneously at six stages throughout the study.Changes in the variables were calculated by subtracting the first from the second measurement（Δ1）and so on（Δ1 to Δ5）.Results The linear correlation between intra-thoracic blood volume index（ITBVI）and stroke volume index（SVIpa）was significant（r=0.654,P0.05）,whereas pulmonary artery wedge pressure（PAWP）poorly correlated with SVIpa（P0.05）.Changes in ITBVI correlated with changes in SVIpa（Δ1,r=0.621;Δ2,r=0.784;Δ3,r=0.713;Δ4,r=0.740;Δ5,r=0.747;all P0.05）,whereas PAWP failed.The mean bias between CIart and CIpa was（0.09±0.5）L·min-1·m-2;the limit of agreement was（-0.89~1.07）L·min-1·m-2.Conclusions There is good correlation between the two methods of PiCCO and PAC for reflecting the change of heart preload.PiCCO is reliable in hemodynamic monitoring in patients undergone lung transplantation.