2种心排量监测方法在重症感染性休克患者中的应用

Application of 2 cardiac output monitoring in patients with severe septic shock

目的比较无创心排量监测(non-invasive cardiac output monitoring,NICOM)与脉搏指示连续心排量(pulseindicated continuous cardiac output,Pi CCO)监测2种方法测定重症感染性休克患者血流动力学参数的差异及相关性,为护士参与开展重症患者床旁无创心排量监测提供依据。方法选取2017年4月—12月收入北京某三级甲等医院ICU需进行血流动力学监测的感染性休克患者作为研究对象,分别对同一患者采用NICOM和Pi CCO 2种方式监测患者心输出量和每搏量变异度,比较2种方法的差异和相关性。结果共纳入感染性休克患者31例,男19例,女12例,其中NICOM测得心输出量为5.10(4.35,6.50)L/min,Pi CCO测得心输出量为4.89(4.34,6.23)L/min,两种方法比较,差异无统计学意义(Z=-0.786,P=0.430);NICOM测得每搏量变异度为13.00(11.00,16.00),Pi CCO测得每搏量变异度为12.00(9.00,15.00),两种方法比较,差异有统计学意义(Z=-2.607,P=0.009)。两种方法测定心输出量的Spearman相关系数为0.904(P<0.001,95%CI为0.932~1.135),每搏量变异度相关系数为0.841(P<0.001,95%CI为0.601~0.786),均显著正相关。Bland-Altman分析显示,2种方法测定心输出量平均差值为0.21 L/min(P=0.032,95%CI为-1.12~1.54),每搏量变异度平均差值为1.56(P<0.001,95%CI为-2.56~5.68)。结论NICOM和Pi CCO 2种监测方法的结果有差异,但相关性和一致性良好。NICOM可以应用于临床,为护士参与测量的床旁血流动力学监测提供了新方法。

Objective To investigate the performance of bioelectrical impedance without innovation by non-invasive cardiac output measurement(NICOM)and pulse indicated continuous cardiac output(Pi CCO)methods in measuring the hemodynamic parameters among patients with severe septic shock,so as to provide references for clinical practice to lead non-invasive hemodynamic monitoring of patients with severe septic shock.Methods Patients with septic shock admitted to the ICU of a tertiary hospital in Beijing for hemodynamic monitoring from April to De-cember 2017 were selected.Cardiac output(CO)and stroke volume variation(SVV)were monitored by NICOM and Pi CCO respectively in the same patient,and the differences,correlation and consistency of 2 methods were compared.Results A total of 31 patients with septic shock were included,including 19 males and 12 females.No statistically significant difference was found between NICOM’s measurement of CO with 5.10(4.35,6.50)L/min and Pi CCO’s measurement of CO with 4.89(4.34,6.23)L/min(Z=-0.786,P=0.430).The difference of SVV with 13.00(11.00,16.00)detected by NICOM and SVV with 12.00(9.00,15.00)by Pi CCO was statistically significant(Z=-2.607,P=0.009).Correlation analysis showed that the Spearman correlation coefficient of CO determined by the 2 methods was 0.904(P<0.001,95%CI:0.932~1.135),and the SVV correlation coefficient was 0.841(P<0.001,95%CI:0.601~0.786),both of which have a significantly positive correlation.Blast-Altman analysis showed that the mean CO bias was 0.21 L/min(P=0.032,95%CI:-1.12~1.54)and the mean SVV bias was 1.56(P<0.001,95%CI:-2.56,5.68).Conclusion The hemodynamic pa rameters of patients with severe septic shock monitored by NICOM were different from those monitored by Pi CCO,but the correlation and consistency were satisfactory.Therefore,NICOM can be applied in clinical practice,which provides a new idea for the development of subspecialty of critical care.