阵发性房颤对经肺热稀释法所监测参数的影响

Effect of Paroxysmal Atrial Fibrillation on Parameters Monitored by Transpulmonary Thermodilution Method

目的探讨阵发性房颤对经肺热稀释法所监测参数准确性的影响。方法观察12例急诊EICU阵发性房颤患者在房颤前及房颤过程中所监测的血流动力学参数(心率、平均动脉压、心脏指数、系统血管阻力指数、胸腔内血容量指数、血管外肺水指数、肺部超声测定的B线数目)的变化。结果患者发生房颤时,心率较基线状态下明显上升[(123.3±20.0)次/min比(98.9±12.3)次/min,P=0.006];平均动脉压[(86.9±10.2)mm Hg(1 mm Hg=0.133 k Pa)比(93.0±12.5)mm Hg,P=0.058]、心脏指数[(2.82±0.62)L/(min·m2)比(3.31±1.02)L/(min·m2),P=0.058]及系统血管阻力指数[(2 254±947)dyn·s·cm-5·m2比(2 302±828)dyn·s·cm-5·m2,P=0.351]无变化;胸腔内血容量指数明显升高[(1 333±90)ml/m2比(937±111)ml/m2,P<0.001];血管外肺水指数明显升高[(16.1±1.1)ml/kg比(6.5±1.9)ml/kg,P<0.001];肺部超声测定的B线数目无变化(10.0±4.2比9.4±4.4,P=0.180)。结论发生房颤后经肺热稀释法会高估胸腔内血容量指数和血管外肺水指数,在临床工作中需要结合实际情况及其他监测手段如查体、肺超声检查等,进行综合判断及决策。

Objective To investigate the effect of atrial fibrillation on the accuracy of parameters monitored by transpulmonary thermodilution method. Methods Totally 12 patients from emergency intensive care unit with paroxysmal atrial fibrillation were enrolled. The hemodynamic parameters such as heart rate,mean arterial pressure,cardiac index,systemic vascular resistance index,intrathoracic blood volume index,and extravascular lung water index were monitored by transpulmonary thermodilution method before paroxysmal atrial fibrillation and during atrial fibrillation,the number of B-lines was detected by lung ultrasonography before and during paroxysmal atrial fibrillation. The changes of all the parameters were analyzed. Results When the paroxysmal atrial fibrillation happened,the heart rate increased significantly [（ 123. 3 ± 20. 0） beat / min vs.（ 98. 9 ± 12. 3）beat / min,P = 0. 006]; the mean arterial pressure [（ 86. 9 ± 10. 2） mm Hg vs.（ 93. 0 ± 12. 5） mm Hg,P =0. 058],cardiac index [（ 2. 82 ± 0. 62） L /（ min·m2） vs.（ 3. 31 ± 1. 02） L/（ min·m2）,P = 0. 058]and systemic vascular resistance index [（ 2 254 ± 947） dyn·s·cm- 5·m2vs.（ 2 302 ± 828） dyn·s·cm- 5·m2,P = 0. 351] had no obvious change; however, the intrathoracic blood volume index significantly increased[（ 1 333 ±90） ml /m2 vs.（ 937 ± 111） ml / m2,P 〈0. 001]; extravascular lung water index also increased significantly [（ 16. 1 ± 1. 1） ml / kg vs.（ 6. 5 ± 1. 9） ml / kg,P〈 0. 001]. No significant difference was found in the number of B-lines detected by lung ultrasonography before and during atrial fibrillation（ 10. 0 ± 4. 2 vs. 9. 4 ± 4. 4,P = 0. 180）. Conclusion Both intrathoracic blood volume and extravascular lung water monitored by transpulmonary thermodilution method were overvalued during paroxysmal atrial fibrillation,which may mislead the clinical judgment and decision-making.