目的 評(píng)價(jià)脈搏指示連續(xù)心排出量( PiCCO) 技術(shù)在肺移植術(shù)中血流動(dòng)力學(xué)監(jiān)測(cè)的作用。方法 20 例終末期肺病患者行肺移植術(shù), 同時(shí)運(yùn)用PiCCO 和Swan-Ganz 肺動(dòng)脈漂浮導(dǎo)管( PAC)對(duì)術(shù)中6 個(gè)時(shí)間點(diǎn)的血流動(dòng)力學(xué)指標(biāo)進(jìn)行監(jiān)測(cè)。分別比較胸腔內(nèi)血容量指數(shù)( ITBVI) 、肺動(dòng)脈嵌頓壓( PAWP) 與每搏量指數(shù)( SVIpa) 的相關(guān)性, 以及相鄰時(shí)間點(diǎn)變化值間( 分別用Δ1 ～Δ5 表示) 的相關(guān)性, 并運(yùn)用Bland-Altman 法對(duì)兩種方法測(cè)得的心排指數(shù)( CI) 進(jìn)行一致性檢驗(yàn)。結(jié)果 ITBVI 與SVIpa呈正相關(guān)( r=0. 654, P lt;0. 05) , 而PAWP與SVIpa 無(wú)顯著相關(guān)性( P gt;0. 05) 。術(shù)中相鄰時(shí)間點(diǎn)ITBVI的變化也與SVIpa 變化成正相關(guān)( Δ1 , r = 0. 621; Δ2 , r = 0. 784; Δ3 , r = 0. 713; Δ4 , r = 0. 740; Δ5 , r =0. 747; P 均 lt;0. 05) , PAWP 的變化與SVIpa 變化無(wú)明顯相關(guān)性( P gt;0. 05) 。兩種方法測(cè)得的CI 平均偏離度為( 0. 09 ±0. 5) L·min-1·m-2 , 一致性界限為( - 0. 89 ～1. 07) L·min- 1 ·m-2。結(jié)論 在肺移植手術(shù)中PiCCO 和PAC 監(jiān)測(cè)心臟前負(fù)荷的變化具有較好的相關(guān)性, PiCCO 能夠反映肺移植中血流動(dòng)力學(xué)的變化。
引用本文： 嚴(yán)潔,許紅陽(yáng),朱艷紅,王雁娟,梁鋒鳴,楊挺,陳靜瑜. PiCCO血流動(dòng)力學(xué)監(jiān)測(cè)在肺移植患者中的應(yīng)用. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2010, 9(2): 184-187. doi: 復(fù)制
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| 2. | Gil Antón J, Cecchetti C, Menéndez S, et al. Preliminary clinical experience with PiCCO system in children with shock. An Pediatr ( Barc) , 2009, 71 : 135-140. |
| 3. | López-Herce J, Bustinza A, Sancho L, et al. Cardiac output and blood volume parameters using femoral arterial thermodilution.Pediatr Int, 2009, 51: 59-65. |
| 4. | Bein B, Meybohm P, Cavus E, et al. The reliability of pulse contourderived cardiac output during hemorrhage and after vasopressor administration. Anesth Analg, 2007, 105: 107-113 . |
| 5. | Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1986, 1: 307-310. |
| 6. | Werawatganon T, Punyatavorn S, Chatkaew P, et al. Validity and reliability of cardiac output by arterial thermodilution and arterial pulse contour analysis compared with pulmonary artery thermodilution in intensive care unit. J Med Assoc Thai, 2003, 86( Suppl 2) : S323-S330 . |
| 7. | Della Rocca G, Costa MG, Pompei L, et al. Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique. Br J Anaesth, 2002 , 88 :350-356. |
| 8. | Chatterjee K. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation, 2009, 119: 147 -152. |
| 9. | Rubenfeld GD, McNamara-Aslin E, Rubinson L. The pulmonary artery catheter, 1967 -2007 : rest in peace? JAMA, 2007, 298: 458 -461. |
| 10. | Kumar A, Anel R, Bunnell E, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med, 2004, 32 : 691-699. |
| 11. | Katzenelson R, Perel A, Berkenstadt H, et al. Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water. Crit Care Med, 2004, 32: 1550-1554. |
| 12. | Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge.Crit Care Med, 2007, 35 : 64-68. |
| 13. | Luecke T, Roth H, Herrmann P, et al. Assessment of cardiac preload and left ventricular function under increasing levels of positive endexpiratory pressure. Intensive Care Med, 2004, 30: 119 -126. |
| 14. | Reuter DA, Felbinger TW, Schmidt C, et al. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med, 2002, 28: 392-398 . |
| 15. | Rex S, Brose S, Metzelder S, et al. Prediction of fluid responsiveness in patients during cardiac surgery. Br JAnaesth, 2004, 93: 782-788 . |
| 16. | Hofer CK, Furrer L, Matter-Ensner S, et al. Volumetric preload measurement by thermodilution: a comparison with transoesophageal echocardiography. Br J Anaesth, 2005, 94: 748-755. |
- 1. Sander M, von Heymann C, Foer A, et al. Pulse contour analysis after normothermic cardiopulmonary bypass in cardiac surgery patients. Crit Care, 2005, 9: R729-734 .
- 2. Gil Antón J, Cecchetti C, Menéndez S, et al. Preliminary clinical experience with PiCCO system in children with shock. An Pediatr ( Barc) , 2009, 71 : 135-140.
- 3. López-Herce J, Bustinza A, Sancho L, et al. Cardiac output and blood volume parameters using femoral arterial thermodilution.Pediatr Int, 2009, 51: 59-65.
- 4. Bein B, Meybohm P, Cavus E, et al. The reliability of pulse contourderived cardiac output during hemorrhage and after vasopressor administration. Anesth Analg, 2007, 105: 107-113 .
- 5. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1986, 1: 307-310.
- 6. Werawatganon T, Punyatavorn S, Chatkaew P, et al. Validity and reliability of cardiac output by arterial thermodilution and arterial pulse contour analysis compared with pulmonary artery thermodilution in intensive care unit. J Med Assoc Thai, 2003, 86( Suppl 2) : S323-S330 .
- 7. Della Rocca G, Costa MG, Pompei L, et al. Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique. Br J Anaesth, 2002 , 88 :350-356.
- 8. Chatterjee K. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation, 2009, 119: 147 -152.
- 9. Rubenfeld GD, McNamara-Aslin E, Rubinson L. The pulmonary artery catheter, 1967 -2007 : rest in peace? JAMA, 2007, 298: 458 -461.
- 10. Kumar A, Anel R, Bunnell E, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med, 2004, 32 : 691-699.
- 11. Katzenelson R, Perel A, Berkenstadt H, et al. Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water. Crit Care Med, 2004, 32: 1550-1554.
- 12. Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge.Crit Care Med, 2007, 35 : 64-68.
- 13. Luecke T, Roth H, Herrmann P, et al. Assessment of cardiac preload and left ventricular function under increasing levels of positive endexpiratory pressure. Intensive Care Med, 2004, 30: 119 -126.
- 14. Reuter DA, Felbinger TW, Schmidt C, et al. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med, 2002, 28: 392-398 .
- 15. Rex S, Brose S, Metzelder S, et al. Prediction of fluid responsiveness in patients during cardiac surgery. Br JAnaesth, 2004, 93: 782-788 .
- 16. Hofer CK, Furrer L, Matter-Ensner S, et al. Volumetric preload measurement by thermodilution: a comparison with transoesophageal echocardiography. Br J Anaesth, 2005, 94: 748-755.