连续动脉心排量监测在冠脉搭桥术后危重患者中的应用

Validation of continuous arterial pressure-based cardiac output measurement in critical patients after coronary bypass surgery

目的观察连续动脉心排量监测（FloTrac／Vigileo系统）对冠脉搭桥术后危重患者血流动力学监测的可行性，分析其与肺动脉导管心排量监测结果的相关性和一致性。方法非体外循环心脏不停跳下冠脉搭桥手术12例，术后经颈内静脉放置肺动脉导管，并将桡动脉连接至FloTracTM传感器和VigileoTM监测仪。在既定时间点以及患者血流动力学发生明显变化时，通过热稀释法间断测量心指数（ici）和外周血管阻力（tSVR），并同时记录动脉压法测得的心指数（APCI）和外周血管阻力（APSVR）。根据ISVR测得值，将所测得的数据分为1SVR正常组和ISVR异常组，分析两组结果的相关性和一致性。结果共记录数据267组。ISVR正常组160组数据，cI相关值r=O．76。Bland—Altman分析两方法一致性良好：偏倚为0．003L·min-Im-2精确度为0．5L·min-1·m-2，95％置信区间为（-0．99～0．98）。1SVR异常组107组数据，cI相关值r=0．21。Bland—Ahman分析两方法一致性较差：偏倚为0．17L-1min-m-2，精确度为0．82L·min-1．m-295％置信区间为（-1．79～1．44）。结论危重患者术后监护中，在患者外周血管阻力正常时，FloTrac／Vigileo系统能连续动态地反映血流动力学变化；在患者外周血管阻力异常时，FloTrac／Vigileo系统的准确性需进一步评估。

Objective To observe the feasibility of continuous arterial pressure-based cardiac output measurement （FloTrac/Vigileo system） in critical patients after coronary bypass surgery, and to evaluate the correlation and agreement of monitoring results between FloTrac/Vigileo system and pulmonary artery catheter. Methods Twelve patients after off-pump coronary bypass surgery were cruited in this study. After operation, each patient was palced pulmonary artery catheter through internal jugular vein, and connecting the radial artery catheter to FloTrac pressure transducer and Vigileo monitor. The intermittent cardiac index （ICI） and intermittent systemic vascular resistance （ISVR） were measured by thermodilution throught pulmonary artery catheter. At the same time, the arterial pressure-based cardiac index （APCI） and arterial pressure-based systemic vascular resistance （APSVR） were recorded by FloTrac/Vigileo system. The recording points were predetermined and the moments when the patients hemodynamics varied distinctly. According to the ISVR value, we divided the records into two groups： the group in which ISVR was normal （group A）, the group in which ISVR was abnormal （group B）. Thecorrelation and agreement of two groups were evaluated. Results 267 simihaneous measurement sets were obtained. Group A had 160 set of data, the correlation index of both monitoring methods of CI measurements was 0.76. Bland-Altman plots show good agreement： the bias was 0.003 L＇min-m-2, the precision was 0.5 L＇min-m-2, and 95%CI was -0.99-0.98. Group B had 107 set of data, the correlation index of both monitoring methods of CI mea- surements was 0.21. Bland-Ahman plots showed a limited agreement： the bias was 0.17 L＇min-m-2, the precision was 0.82 L＇min-m-2, and 95%CI was 1.79-1.44. Conclusion In critically ill patients in the intensive care unit, the FloTrac/Vigileo system can reflects the patients hemodynamics variation timely when the SVR was normal. However. more studies about the accuracy of the FloTrac/Vivileo svstem was needed, when the SVR was abnormal.