PiCCO血流動力學監測在肺移植患者中的應用_《中國呼吸與危重監護雜志》

作者：

嚴潔 ¹ , 許紅陽 ¹ , 朱艷紅 ¹ , 王雁娟 ² , 梁鋒鳴 ¹ , 楊挺 ¹ , 陳靜瑜 ³

1 無錫市人民醫院危重病醫學科( 江蘇無錫 214002) ;;
2 無錫市人民醫院麻醉科( 江蘇無錫214002) ;;
3 無錫市人民醫院肺移植科( 江蘇無錫214002)通訊作者: 嚴潔, E-mail: yjeast@ 163. com;

關鍵詞：

脈搏指示連續心排出量肺移植血流動力學

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目的評價脈搏指示連續心排出量( PiCCO) 技術在肺移植術中血流動力學監測的作用。方法 20 例終末期肺病患者行肺移植術, 同時運用PiCCO 和Swan-Ganz 肺動脈漂浮導管( PAC)對術中6 個時間點的血流動力學指標進行監測。分別比較胸腔內血容量指數( ITBVI) 、肺動脈嵌頓壓( PAWP) 與每搏量指數( SVIpa) 的相關性, 以及相鄰時間點變化值間( 分別用Δ1 ～Δ5 表示) 的相關性, 并運用Bland-Altman 法對兩種方法測得的心排指數( CI) 進行一致性檢驗。結果 ITBVI 與SVIpa呈正相關( r=0. 654, P lt;0. 05) , 而PAWP與SVIpa 無顯著相關性( P gt;0. 05) 。術中相鄰時間點ITBVI的變化也與SVIpa 變化成正相關( 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 變化無明顯相關性( P gt;0. 05) 。兩種方法測得的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。結論在肺移植手術中PiCCO 和PAC 監測心臟前負荷的變化具有較好的相關性, PiCCO 能夠反映肺移植中血流動力學的變化。

引用本文： 嚴潔,許紅陽,朱艷紅,王雁娟,梁鋒鳴,楊挺,陳靜瑜. PiCCO血流動力學監測在肺移植患者中的應用. 中國呼吸與危重監護雜志, 2010, 9(2): 184-187. doi: 復制

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.

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.

《中國呼吸與危重監護雜志》

PiCCO血流動力學監測在肺移植患者中的應用

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《中國呼吸與危重監護雜志》

PiCCO血流動力學監測在肺移植患者中的應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料