经桡动脉微创心功能监测临床应用

Clinical application of minimally invasive cardiac function monitoring via radial artery

目的探讨经桡动脉微创连续动脉心排量监测技术在危重患者中的应用。方法选择我院心脏外科和神经外科2013年12月至2014年12月收治的危重、心功能差的心脏手术或颅脑等手术患者30例,分别行经桡动脉微创Flo Trac/Vigileo法和常规NICO法监测。比较二种方法判断心排出量(cardiac output,CO)、心指数(cardiac index,CI)、每搏输出量(stroke volume,SV)。结果所有30例患者均顺利完成本研究,平均麻醉时间为242分钟(153-423分钟),接受CO测定期间循环状态稳定,共得到56组同时测量的数据。Flo Trac法得到的CO、SV和CI结果均明显低于NICO法,差异有统计学意义(P<0.05);Bland-Altman分析显示两种方法测量的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),5.36%(3/56)的测量点在误差的相关回归分析显示两种方法测得的CO相关系数为0.695,回归方程为COFlo=1.28+0.61CONICO。结论经桡动脉微创连续动脉心排量监测技术测量的CO低于NICO法,但两者之间具有良好的一致性和相关性,均可为危重、心功能差的心脏手术或颅脑等手术患者提供可靠的CO测定手段。以Flo Trac测得的血流动力学参数为"目标"指导危重患者术中液体治疗,同时避免液体过负荷。从而决定进一步的治疗策略。

Objective To study the application of minimally invasive continuous arterial cardiac output monitoring technology in critically ill patients. Methods 30 cases of patients who were critically ill or with poor heart function or received brain surgery, in Cardiac surgery and Department of Neurosurgery of our hospital during December 2013 and December 2014, were selected as research objects. They received minimally invasive FloTrac/Vigileo method via radial artery or conventional Nico monitoring respectively. Cardiac output （CO）, cardiac index （CI） and stroke volume （SV） monitored by the two methods were compared. Results All the 30 patients were successfully completed the study, average duration of anesthesia was 242 minutes （153 -423 minutes）. They performed steady cyclic state during they accepting co determination, and obtained 56 groups of measurement data. Co, SV and CI results came from FloTrac method were significantly lower than those from Nico method, the differences were statistically significant （ P 〈 0. 05 ）. Bland - Altman analysis showed that the deviation of two kinds of methods of co value was 0.57 L/min, the accuracy was 0.60 L / rain, 95% confidence interval was （ - 0.60, 1.73 ） , 5.36% （ 3/56 ） of the measurement points in error correlation and regression analysis showed the co correlation coefficient of the two methods was O. 695, the regression equation was COFlo = 1.28 ＋ 0.61CONICO. Conclusions The CO measured by radial artery minimally invasive continuous artery cardiac output monitoring technique is lower than that from Nico method, but the two methods has good consistency and relevance, both methods can provide reliable co determination means for patients critically ill or with poor heart function or received brain surgery. The hemodynamic parameters of the FloTrac were measured as the ＂objective＂ to guide the treatment of patients who critically ill and avoid the excessive load of liquid to decide the further treatment strategy.