两种中心静脉压测量途径在老年重症患者中应用比较

CVP in elderly patients with severe diseases： a comparative study of two different measurement approaches

目的 比较在老年重症患者中经中央静脉置入中心静脉导管（CICC）和PICC两种不同途径测量的中心静脉压值是否一致.方法 本研究为自身配对设计,通过对同时留置有CICC和PICC的患者测量中心静脉压时,经两种不同途径测量中心静脉压的值进行比较研究;通过对定量测量结果一致性评价的精度估算,应用枚举法算得当所需的样本量为70例时,精度即可满足要求.结果 70例样本数据显示,PICC法检测的CVP值为（7.995〈3.435）cmH2O,CICC法检测的CVP值为（7.743〈3.277）cmH2O,差异无统计学意义（t=1.622,P=0.109）.经两种不同途径测得的中心静脉压值的Pearson线性相关系数为0.926（P〈0.0001）.拟合经过原点的线性回归方程可得CVPPICC=1.023 CVPCICC,其R2值为0.978,预测线的95%CI包含了参考线.作Bland-Altman图可见64个样本落在一致性界限以内（-2.300-2.804）,一致率为91.43%,所有在LoA外的点均未超出LoA的95%CI范围.结论 经中央静脉置入中心静脉导管和PICC两种不同途径测量的中心静脉压值具有高度的一致性,可以使用PICC代替经中央静脉置入中心静脉导管进行中心静脉压的监测.

Objective To compare the value of central venous pressure （CVP） measured by peripherally inserted central catheters （PICC） and centrally inserted central catheters （CICC） in elderly patients with severe diseases.Methods Paired design and self-controlled was applied in the research. CVP was measured by 2 different measurement approaches in patients with PICC and CICC simultaneously. The sample size was calculated by the enumeration method through the accuracy estimation of consistency evaluation of quantitative measurement, and the required number was 70.Results Among the 70 collected samples, the mean values of the measured CVP by PICC and CICC were （7.995〈3.435） cmH2O and （7.743〈3.277） cmH2O; no statistically significant difference was observed （t=1.622,P=0.109）. The pearson＇s linear correlation coefficient of the CVP measured by 2 different measurement approaches was 0.926 （P〈0.0001）. A linear regression model through the origin of the CVP measured by 2 different measurement approaches was fitted with the linear regression equation of CVPPICC=1.023 CVPCICC （R2=0.978）; and the 95%CI of the prediction line contained the reference line. The Bland-Altman plot showed that 64 samples fell within limits of agreement （LoA）, LoA was -2.300-2.804, with a consistent rate of 91.43%. All the plots out of the LoA did not exceeded the 95%CI.Conclusions The CVP measured by CICC and PICC exhibit high consistency. Therefore, PICC can be used to replace the CICC in the CVP monitoring.