肺动脉导管与经胸心脏超声测量非体外循环冠搭桥术后心排量的对比研究

Validation of cardiac output assessed by pulmonary artery catheter against transthoracic echocardiography in patients after coronary bypass graft

目的 对比研究肺动脉导管（PAC）和经胸心脏超声（TTE）测量非体外循环冠状动脉搭桥术（OPCABG）后心排量（CO）的偏差和一致性.方法 应用PAC和TTE检测265例OPCABG后患者心功能及血流动力学相关参数,根据Bland-Altman法分析两方法测量CO结果的一致性,最后通过二元Logistic回归分析造成两方法测量CO结果偏差的原因.结果 两种方法在相同患者同一时间点下测量CO的相关系数为r=0.68,偏差值为（1.82±1.27） L/min,95％置信区间为（-0.67～4.31）.射血分数＜40％、外周血管阻力＜700或＞1400 dys·n^-1·cm^-5,可以直接影响两种方法测量CO的一致性,并且测量时若并发心房颤动、左室游离壁及室间隔节段运动异常、三尖瓣中重度关闭不全、二尖瓣中重度关闭不全和主动脉瓣中重度关闭不全,均可造成两方法测量CO结果的较大偏差.结论 综合分析PAC与TTE的检测结果,才能更好地评价OPCABG后心功能和血流动力学.

Objective To analyze the difference and agreement of cardiac output （CO） by pulmonary artery catheter and transthoracic echocardiography in patients after coronary bypass graft.Methods 256 patients after off-pump coronary bypass graft was recruited in this study.The heart functions and hemodynamic variations were measured by pulmonary artery catheter and transthoracic echocardiography at the same time from the same patients.According to the CO results,the difference and agreement of the both methods in measuring the heart functions and hemodynamic variations were evaluated by the logistic regression analysis.Results 484 measurement sets were obtained,the correlation index of both methods was 0.68.Bland-Altman plots showed good agreement：the bias was （1.82±1.27）L/min,95%CI was （-0.67-4.31）.Logistic regression analysis showed that ejection faction,systemic vascular resistance,regional wall motion abnormalities and valvular regurgitation could result in the difference of the two methods.Conclnsion We should integrate the measurements from both of two methods when we assessed the heart functions and hemodynamic variations.