非体外循环冠状动脉旁路移植术患者FloTrac—Vigileo系统与肺动脉导管技术监测心指数的一致性

Agreement between cardiac index measured with FloTrac-Vigileo system and pulmonary artery catheter in patients undergoing off-pump coronary artery bypass grafting

目的评价非体外循环冠状动脉旁路移植术患者FloTrac—Vigileo（FV）系统与肺动脉导管（PAC）技术监测心指数（CI）的一致性。方法拟行非体外循环冠状动脉旁路移植术患者43例，年龄53～75岁，身高150．183cm，体重46～100kg，ASA分级Ⅱ或Ⅲ级。静脉注射咪达唑仑、舒芬太尼、异丙酚和罗库溴铵行麻醉诱导，麻醉维持：静脉输注异丙酚和瑞芬太尼，间断静脉注射阿曲库铵。于锯胸骨后至搭桥开始前和搭桥完成后至闭合胸骨前，吸入1MAC七氟醚，其余时间不吸入七氟醚。采用FV系统和PAC技术监测CI。于锯胸骨后未吸入七氟醚时、吸入七氟醚5、15min时，冠状动脉搭桥完成后未吸入七氟醚时、吸入七氟醚5、15min时记录两种方法监测的CI数据对，进行一致性分析。结果FV系统和PAC技术测定CI共计258次配对数据，配对数据平均值的均数（2．8±0．6）L·min^-1·m^-1。配对数据差值的均数（平均偏差）为0．23L·min^-1·m^-1，一致性限度（-0．57，1．02）L·min^-1·m^-1，百分误差为28．6％，Kappa系数为0．546。结论FV系统与PAC技术监测CI的一致性尚可，可替代PAC技术用于非体外循环冠状动脉旁路移植术患者CI的监测。

Objective To determine if the cardiac index （CI） measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter （PAC）. Methods Forty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study. Anesthesia was induced with midazolam, sufentanil, propofol and rocuronium and maintained with propofol, remifentanil and atracurium. One MAC sevoflurane was inhaled at breast bone splitting and closing. CI was mea sured with FloTrac-Vigileo system and PAC before, and at 5, 15 min of sevoflurane inhalation and recorded. All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated. Results Bland-Altman comparison of FloTrac-Vigileo system and PAC： matching data of 258 measurements： CI （2.8 ± 0.6）L·min^-1 ·m^-2 , bias was 0.23 L·min^-1 ·m^-2 and limit of agreement was （ - 0.57, 1.02） L· min^- 1· m^- 2, resulting in k = 0. 546 and an overall percentage error of 28.6 %. Conclusion CI values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.