连续温度稀释法测定心排血量的临床应用及评价

Clinical Evaluation of Continuous Thermodilution Cardiac Output/mixed Venous O 2 Measurement

目的与方法：２０例心脏手术病人采用连续温度稀释法进行围术期ＣＯ和ＳｖＯ２测定。结果：（１）ＣＣＯ从诱导后至ＣＰＢ启动明显降低，ＣＰＢ后升高，关胸后下降，术后２ｈ降至最低，随后缓慢升高，４８ｈ后显著升高；（２）ＣＣＯ和ＩＣＯ高度相关，ｒ＝０９３２（ｎ＝４０）；（３）机器ＳｖＯ２和血气ＳｖＯ２高度相关，ｒ＝０９５４（ｎ＝３１）。结论：（１）本法测定ＣＯ和ＳｖＯ２准确可靠；（２）动态观察ＣＯ，可及早发现意外情况，在ＩＣＵ中协助诊断，指导治疗；（３）影响因素：导管位置和体温。其优点是连续测定、准确可靠、影响因素少；缺点是操作较复杂、仪器和导管价格昂贵。此法适用于重症心肺疾患、休克和高危病人行大手术等。

Objective and Methods: The clinical performance of a combined continuous cardiac output(CCO)/mixed venous oxygen saturation (SO 2) pulmonary artery system (Baxter Healthcare Corp, Santa Ana, CA) was evaluated in 20 patients with poor function undergoing open heart surgery perioperatively. Results:There were a good correlation between CCO and intermittent thermodilution (ICO) ( r= 0 932, P< 0 01, n= 40) and a significant correlation between continuous SO 2 (CSO 2) and cooximetry SO 2(OSO 2) ( r= 0 954, P< 0 01, n= 31). Conclusion:CCO is reliable, time saving and is not user dependent. However, its accuracy can be affected by catheter location and body temperature. It provided accurate CO information to be used to guide fluid and drug therapy when a potentially life threatening decline in hemodynamic status occurres and can not be detected by routine montoring procedures.