摘要
背景外周动脉波形分析（PWA）是经肺动脉热稀释法校正后的一种测定心排出量（CO）的方法。PWA系统．Flo—Trac／Vigileo（FTV）法，不需要在使用前定标。我们同时比较了用FTV法和经食管超声心动图（TEE）法测定心排出量的结果。方法选择10例ASAⅠ-Ⅱ，择期行腹腔镜结直肠手术的患者做为研究对象。20G套管针桡动脉置管，与血流动力学监测仪及FTV系统连接，进行PWA分析并测定心排出量（COPWA）。据以往方法进行TEE测定心排出量（COTEE）。记录气管插管后、截石位后5分钟、气腹后5分钟、每30分钟或者每次平均动脉压低于基础值20％的测量值。统计分析用Bland-Altman法。结果比较88个测量值，COTEE值为3．23—12Lt／min（平均6．21±1．85），COPWA值为2．9—8．5Lt/min（平均4．84±1．14），偏差1．17，可信区间-2．02～4．37。所有COTEE和COPWA测定值之间的误差百分率平均为40％，范围27％～50％。结论腹腔镜结肠手术中用TEE和FTV法测定心排出量有明显的临床差异。
BACKGROUND： Pulse wave analysis （PWA） allows cardiac output （CO） measurement after calibration by transpulmonary thermodilution. A PWA system that does not require previous calibration, the FloTrac/Vigileo （FTV）, has been recently developed. We compared determinations of CO made with the FTV to simultaneous measurements using transesophageal echocardiography （TEE）. METHODS： Ten ASA Ⅰ-Ⅱ patients scheduled for laparoscopic colorectal surgery were studied. A radial 20-gauge cannula was inserted and connected to a hemodynamic monitor and a FTV systena for PWA and determination of CO （COPWA）. TEE CO （COTEE） was determined as previously described. Measurements were made after intubation, 5 min after establishing the lithotomy position, 5 min after establishing pneumoperitoneum, every 30 min, or each time mean arterial blood pressure decreased below basal values. Statistical analysis was made with the Bland and Altman method. RESULTS： Eighty-eight measurements were compared. The COTEE values ranged from 3.23 to 12 Lt/rnin （mean 6. 21 ± 1. 85）. Values for COPWA ranged from2.9 to 8.5 Lt/min （mean 4.84 ± 1.14）. Bias was i. 17 and limits of agreement -2.02 and 4.37. The percentage error between all COTEE and COPWA measurements was 40% （27% -50%） mean （range）. CONCLUSIONS： During laparoscopic colon surgery, clinically important differences were observed between CO determinations made with TEE and FTV.
出处
《麻醉与镇痛》
2010年第4期66-70,共5页
Anesthesia & Analgesia
