摘要
目的探讨通过单指示剂经肺热稀释法获得的评估心脏收缩功能的参数——心功能指数(CFI)和全心射血分数(GEF)在评估危重患者左心收缩功能方面的临床应用价值。方法采用前瞻性临床观察研究,选取2012年1月至2013年12月广州医科大学附属第一医院重症医学科接受脉搏指示连续心排出量(Pi CCO)监测的39例患者,其中左心收缩功能不全组18例,对照组21例。两组患者在进行经肺热稀释法测量的同时行经胸心脏超声检查,并采集相关数据。相关性分析采用Pearson分析,为左心室射血分数(LVEF)、CFI、GEF建立受试者工作特征(ROC)曲线并比较曲线下面积,计算其预测左心功能不全的阈值。结果相关性分析显示LVEF与CFI、GEF有良好相关性(r=0.553,r=0.468,P<0.005)。CFI、GEF、LVEF的ROC曲线下面积分别为0.885、0.862、0.903,且LVEF与CFI、GEF的曲线下面积差异无统计学意义(P>0.05)。CFI<4.25/min预测左心功能不全的敏感性为77.8%,特异性为88.9%;GEF<19.5%预测左心功能不全的敏感性为88.9%,特异性为66.7%。结论单指示剂经肺热稀释法测量的CFI、GEF与经胸心脏超声测量的LVEF之间存在良好相关性,均可用于重症患者左心收缩功能的评估。
Objective To investigate the clinical significance of cardiac function index( CFI) and global ejection fraction( GEF),derived from single-indicator transpulmonary thermodilution technique,in assessment of cardiac function in critically ill patients. Methods A prospective clinical observational study was conducted in the Intensive Care Unit of the First Affiliated Hospital of Guangzhou Medical University.Between January 2012 and December 2012,39 patients who underwent Pi CCO monitoring were recruited,including 18 cases with left ventricular systolic dysfunction and 21 cases without left ventricular systolic dysfunction. Both groups underwent transpulmonary thermodilution measurements and transthoracic cardiac ultrasonography. Pearson correlation analysis was conduced to assess the correlation between left ventricular ejection fraction( LVEF) and CFI and GEF. ROC curve was established to calculate the predicted threshold of CFI and GEF for diagnosing cardiac insufficiency. Results LVEF was significantly correlated with CFI and GEF( r = 0. 553,P < 0. 005; r = 0. 468,P < 0. 005). The area under ROC curve of CFI,GEF and LVEF for diagnosing cardiac insufficiency was 0. 885,0. 862 and 0. 903,respectively( P > 0. 05 for comparison).The cut-off value of CFI for predicting cardiac insufficiency was 4. 25 / min,with a sensitivity of 77. 8% and a specificity of 88. 9%. The cut-off value of GEF for predicting cardiac dysfunction was 19. 5 / min,with a sensitivity of 88. 9% and a specificity of 66. 7%. Conclusion CFI and GEF measured by transpulmonary thermodilution correlate well with LVEF assessed by transthoracic echocardiography,both can be used for assessment of left ventricular systolic function.
出处
《中国呼吸与危重监护杂志》
CAS
北大核心
2015年第1期76-80,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
广州市医药卫生科技项目(编号:20141A001076)
关键词
经肺热稀释法
心功能指数
全心射血分数
左心室射血分数
左心收缩功能
Transpulmonary thermodilution technique
Cardiac function index
Global ejection fraction
Left ventricular ejection fraction
Left ventricular systolic function
