动脉压力波形分析法和二氧化碳重复吸入法监测神经外科手术患者心排出量的相关性研究

Comparison of Cardiac Output Measurements between FloTrac/Vigileo and NICO during Neurosurgery

目的比较神经外科手术患者使用动脉压力波形分析法(FloTrac)和二氧化碳重复吸入法(NICO)监测心排出量(CO)的一致性和相关性。方法 7例择期行神经外科手术患者,在麻醉维持期间每隔30分钟同步使用上述两种监测方法测定CO、每搏量(SV)和心指数(CI)。结果共得到56组数据,FloTrac法测得的CO值明显低于NICO法,分别为4.1±0.7L/min和4.7±0.8L/min,两者比较有显著性差异;Bland-Altman分析两种方法测得的CO值偏差为0.57L/min,精确度为0.60L/min,95%可信区间为(-0.60,1.73);一元线性回归方程为CO_(Flo)=1.28+0.61CO_(NICO)。结论 FloTrac法测量的CO低于NICO法,但两者之间具有良好的一致性和相关性,均可为神经外科手术提供可靠的CO测定手段。

Objective The aim of this study is to compare cardiac output （CO） measurements between a new analysis technique of radial artery pressure waves （FloTrac） and non-invasive partial CO2 absorption （NICO） technique during neurosurgery. Methods Seven patients undergoing neurosurgery were included in this prospective observational study. A standard protocol was followed for induction, endotracheal intubation and maintenance of anesthesia. After endotracheal intubation, the left radial artery catheter was connected to the FloTrac senser and CO2 absorption set was attached in the respiratory circuit. Data were collected simultaneously every 30 min until patients were extu- bated. Results Fifty-six simultaneous measurement sets were obtained. CO measured with Flotrac varied from 2.6 to 5.7 L/min and NICO varied from 3.4 to 6.8 L/min with great difference（4.1±0. 7 L/min vs 4.7±0. 8 L/min）. Bland-Ahman analysis revealed the overall difference between the two methods was 0.57 ± 0.6 L/min （ bias ± 1 SD）. The regression equation was COFlo = 1.28 ±0.61CONiCO （r^2 =0.695 ）. Conclusion Cardiac output measured with Flotrac is significantly lower than with NICO but well correlated and both can provide effective CO measurements for neurosurgery.