摘要
目的比较与验证经食管超声心动图（TEE）经二尖瓣（MV）测定的二尖瓣置换术（MVR）患者心脏指数（ClMV）与肺动脉导管（PAC）热稀释法测定的心脏指数（CIPAC）问的一致性。方法选择择期在心肺转流（CPB）下行MVR或者双瓣置换术（DVR）患者25例，其中男性12例，女性13例，年龄25～78岁。将患者分为机械瓣膜组（M组，n=16）和生物瓣膜组（B组，n=9）。麻醉诱导气管插管后放置TEE探头，于CPB停止后15min（T1）、30min（T2）、45min（T3）、60min（T4），关胸后5min（T5）、10min（T6）、15min（T7）时测定经MV的CI（CIMV），同时在各时间点记录经Swan-Ganz导管测定的CI（CIPAC）。CIMV与CIPAC的一致性分析采用Bland-AltmanPLOT和MountainPLOT一致性检验，以及相关关系。结果M组105对测量值，CIPAC测量值为1.50～3.60L（min·m2）（2.42±0.43），CIMv值为1.44～5.98L／（min·m2）（2.94±0.87）；平均偏差为-0.50L／（min·m2），95％的一致性界限为-1.97～0.97L/（min·m2）；回归方程Ym=1.72＋0.24Xm（r=0.47，P〈0.0001）。B组63对测量值，CIPAC值为1.90～4.00l/（min·m2）（2.58±0.49），CIMv值为1.83～7.71L／（min·m2）（3.93±1.13）；平均偏差为-1.30L／（min·m2）,95％的一致性界限为-3.10～0.50L/（min·m2）。回归方程yb=1.564＋0.26xb（r=0.60，P〈0.0001）。结论在MVR中。由TEE经人工二尖瓣测量的CIMV与经肺动脉导管热稀释法测量的CIPAC有较好的相关性，但不能相互替代，需要回归方程校正。
Objective To verify consistency between cardiac index （C1） measured by transesophageal echocardiography （TEE） through mitral valve（MV） and CI measured by thermodilution method through Swan-Ganz catheter. Methods A total of 25 patients with scheduled for mitral valve replacement （MVR） or double valve replacement requiring cardiopulmonary bypass （CPB） were enrolled, which included 12 males and 13 females, aged 25 - 78 years old. They were divided into 2 groups： mechanical prosthesis valve group（group M, n = 16） and bioprosthesis valve group（group B, n = 9）. The TEE probe was inserted after anesthesia induction and tracheal intubations. The values of TEE CI and thermal CI were determined at 7 periods： approximately 15-minute （Tl）, 30- minute（T2）, 45- minute（T3）, 60-minute （T4） after termination of CPB, and approximately 5-minute（T5）, 10-minute（T6）, 15-minute（T7） after closure of incision. The statistical analysis was made with Bland-Altman method and Mountain plot method, the linear regression analysis was used to obtain correlation coefficients between TEE CI and thermal CI. Results The 105 pairs of values in group M： CIPAC was 1.50 - 3.60 L/（min·m2） with 2.42 ± 0.43, CIMV was 1.44 - 5.98 L（min·m2） with 2.94 ± 0.87, the mean deviation was - 0.50 L/（min·m2） and consistency limits of 95 % was - 1.97 - 0.97L/（min·m2）. The regression equation was Ym = 1.72 ＋ 0.24Xm（r = 0.47, P〈 0.000 1）. The 63 pairs of values in group B： CIPAC was 1.90 - 4.00L/（min·m2） with mean of 2.58 ± 0.49, CIMV was 1.83 - 7.71L/（min·m2） with 3.93±1.13, the mean deviation was - 1.30L/（min·m2） and consistency limits of 95 % was - 3.10 - 0.50 L/（min·m2）. The regression equation was Yb = 1.56 ＋ 0.26xb（r = 0.60, P 〈 0.000 1）. Conclusion It is demonstrated that CI values by TEE through artificial MV is correlate well with those by thermodilution method through Swan-Ganz thermodilution catheter in mitral valve replacement surgery,
出处
《生物医学工程与临床》
CAS
2014年第5期448-453,共6页
Biomedical Engineering and Clinical Medicine
