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題名 | Cardiac Output Measurement During Cardiac Surgery-- Esonphageal Doppler Versus Pulmonary Artery Catheter=開心手術期間之心搏量的測量--食道超音波及肺動脈導管測量之比較 |
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作者 | 蘇煖燕; 黃俊仁; 蔡佩珊; 徐永偉; 洪育均; 鄭清榮; | 書刊名 | 麻醉學雜誌 |
卷期 | 40:3 2002.09[民91.09] |
頁次 | 頁127-133 |
分類號 | 415.3024 |
關鍵詞 | 心博量; 溫度稀釋法; Swan-Ganz導管術; 都卜勒心臟超音波; 冠狀動脈繞道術; Cardiac output; Thermodilution; Catheterization; Swan-ganz; Echocardiography; Doppler; Coronary artery bypass; |
語文 | 英文(English) |
中文摘要 | 背景:以單次灌注輸液之血溫變化所得心搏量(BCD),被視爲心搏量的標准測量方法。此法需要配合肺動脈導管的置入。然而施行此一侵入性技術之利弊權衡,仍莫衷一是。再者,重複測量數值結果亦可見極大。往昔論文報告曾指出:持續監測血溫變化所得心搏量(CCO),因其重複測量結果差異較小,被視爲爓精確的測量方式。經食道杜蔔勒超音波監測器(ED-CD)能提供另一非侵入性心搏量持續測量的方法。本研究乃立意於,比較由超音波監測器及血溫變化測量所得之心搏量的異同。方法:十十四名接受開心手術的病人,隨機接受肺動脈導管置入以利BCO叵CCO之測量,而此24名病患亦同時接受食道超音波的置入。第一組患者(n=12)於開刀全程(體外期間除外)當中,每15分鍾測量一次BCO,在同一時間亦記錄ED-CO的測量值;而第二組患者(n=12)亦於相同時間間隔,同時記錄CCO及ED-CO的測量值。對所得數值之相似性,使用Bland-Altman分析法加以分析,而差異值定義爲0.05。結果:測昨心搏量的數值範圍各爲2.1-9.41/min(BCO),2.4-9.21/min(CCO),以及2.3-8.91/min(ED-CO)。ED-CO以CCO所得數值有很了的相似性,其線性回歸係數r^2爲0.846,而變異系數及標准差爲0.05±0.49l/min;相對地,BCO與ED-CO所測得數值相關性較小,回歸系數r^2爲0.406,而其變異系數及標准差爲0.11±0.12l/min。尤有甚者,BCO的測量結果其重複性較差,而ED-CO及CCO兩者的測量值重複性較好。結論:對於轎行動力變化的監測,經食道超音波監測器不失爲一良好變通方法,且與CCO所得數值亦有良好之相似性。而由於其測量結果之明顯差異,BCO的正確性及精確度仍待存疑,故而不應視其爲測量心搏出量的標准方法。 |
英文摘要 | Background: Bolus thermodilution cardiac output (BCO) measurement has been considered as the “gold standard” for cardiac output (CO) measurement. However, it requires placement of a pulmonary artery (PA) catheter, and questions have been raised regarding the risk/benefit ratio of this invasive technique. Furthermore, great variations between measurements have been reported. Continuous thermodilution CO (CCO) measurement is reported to be a better alternative, but it still requires the placement of a PA catheter. Esophageal echo- Doppler ultrasonography (ED) provides non-invasive continuous measurement of CO (ED-CO). This study was thus designed to compare the agreement between ED-CO and both thermodilution techniques (BCO and CCO). Methods: Twenty-four patients undergoing primary coronary artery bypass graft surgery were randomized to have a PA catheter placed for measurement of either BCO or CCO. All patients also had an ED probe placed. In Group I patients (n=12), BCO measurement was carried out every 15 minutes throughout the surgery except during cardiopulmonary bypass, with concurrent ED-CO reading recorded at the same time point. In Group II patients (n=12), CCO and ED-CO measurements were recorded at the same designated points of time as in Group L The agreement between methods (BCO vs. ED-CO or CCO vs. ED-CO) was assessed using Bland-Altman method. Results: The range of measured CO of each method was 2.1 to 9.41/mm for BCO, 2.4 to 9.21/mm for CCO and 2.3 to 8.91/min for ED-CO. ED-CO and CCO had excellent agreement with a linear regression coefficient (r^2 value) of 0.846, and a bias (mean difference) and SD of bias of 0.05±0.491/mm. In contrast, the agreement between BCO and ED-CO was poorer; correlation was low (r^2 value 0.406) and both the bias and SD of bias were high (0.11±1.121/min). Furthermore, BCO measurements had poor reproducibility, whereas both ED-CO and CCO measurements had good reproducibility. Conclusions: Esophageal echo-Doppler ultrasonography is a satisfactory alternative for cardiac output measurement because it gives a value in good agreement with CCO measurement. With significant between-measurement variations, the accuracy and precision of BCO are uncertain, and it should not be considered as the “gold standard”. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。