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目的:与传统热稀释法测量心排血量(CO)结果进行对比,评价基于动脉压力波形的心排血量监测(APCO)方法监测结果的准确性;观察液体负荷下血流动力学各监测指标的敏感性。方法:选择ASAⅠ～Ⅱ级的骶骨肿瘤、后腹膜巨大肿瘤手术患者12例,常规麻醉诱导后,桡动脉穿刺置管,连接FloTrac传感器和Viglieo监测仪,放置肺动脉导管鞘及六腔Swan-Ganz导管。以上操作完毕后,每间隔30min行间断心排血量(ICO)测定,同时记录APCO和CCO(经Swan-Ganz导管测得的连续CO)。采用Bland-Altman分析比较各监测方法测得CO间的差异,评价APCO监测结果的准确性。手术开始前无刺激时,七氟烷维持0.8MAC下,按理想体质量给予10ml/kg羟乙基淀粉130/0.4氯化钠注射液(万汶),30min内输注完毕。对比输液前后心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、肺小动脉楔压(PAWP)、每搏量变异度(SVV)、APCO、每搏量(SV)、每搏指数(SVI)等指标的变化,筛选敏感监测指标。结果:APCO-ICO为(-0.11±0.51)L/min,95%CI为-1.12～0.89;APCO-CCO为(0.15±0.50)L/min,95%CI为-0.84～1.13。APCO与ICO、CCO间的一致性好。快速输液前后,HR、MAP差异无统计学意义;CVP(P<0.05)、PAWP、SVV、APCO、SV、SVI差异有统计学意义(P<0.01)。结论:APCO与热稀释法ICO、CCO相关性好,PAWP、SVV、APCO、SV、SVI是敏感的液体负荷后血流动力学观察指标。
OBJECTIVE: To compare the results of conventional thermodilution to measure cardiac output (CO) and to evaluate the accuracy of monitoring results based on arterial pressure waveform (APCO). To observe the changes of hemodynamics Indicator sensitivity. Methods: Twelve ASA grade Ⅰ ~ Ⅱ sacral tumors were enrolled in this study. Twelve patients underwent retroperitoneal giant tumor surgery. After conventional anesthesia induction, radial artery puncture catheterization was performed. FloTrac sensor and Viglieo monitor were placed. Pulmonary catheter sheath and six-chamber Swan-Ganz catheter . After the above operation, intermittent cardiac output (ICO) was measured at intervals of 30 min. APCO and CCO (continuous CO measured by Swan-Ganz catheter) were recorded. Bland-Altman analysis was used to compare the differences between CO detected by each monitoring method, and the accuracy of APCO monitoring results was evaluated. Sevoflurane maintained at 0.8MAC, 10ml / kg of hydroxyethyl starch 130 / 0.4 sodium chloride injection (Van Wen), according to the ideal body weight, infusion was completed within 30min. The heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), pulmonary arterial wedge pressure (PAWP), stroke volume variation (SVV), APCO and stroke volume Stroke index (SVI) and other indicators of change, screening sensitive indicators. Results: APCO-ICO was (-0.11 ± 0.51) L / min, 95% CI was -1.12 ~ 0.89, APCO-CCO was 0.15 ± 0.50 L / min and 95% CI was -0.84 ~ 1.13. APCO and ICO, CCO good consistency. There was no significant difference in HR and MAP before and after rapid infusion. There were significant differences in CVP (P <0.05), PAWP, SVV, APCO, SV, SVI between before and after rapid infusion (P <0.01). CONCLUSION: The correlation between APCO and thermo-dilution ICO and CCO is good. PAWP, SVV, APCO, SV and SVI are sensitive indicators of hemodynamic response after fluid load.