CAJ | 학술논문

目的探讨感染性休克患者采用不同定标间隔时间对脉搏轮廓分析法持续心排血量(PCCO)监测准确性的影响.方法回顾性分析2011年2月至2013年2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血量(PiCCO)监测的25例感染性休克患者的临床资料.记录每次经肺热稀释测量定标前1 min的PCCO值和该次经肺热稀释测量的心排血量(COTPTD),并除以理想体表面积,计算心排血量指数(CI),组成配对数据PCCI和CITPTD.按照定标间隔时间分为0～1h(含1h)、1～8h(含8h)、8～ 16h(含16h)、＞16h组.使用线性同归、相关一致性的界限值(以bias±2SD表示)及百分误差值(2SD/CITPTD均值)对PCCI和CITPTD进行一致性分析.结果 25例感染性休克患者共采集162组配对数据.相关分析显示,PCCI与CITPTD显著相关(r2=0.494,P＜0.001),bias±2SD为-(0.06±1.41) L·min-1·m-2,百分误差值为37％;除1～8h组的百分误差值小于30％外,其余各组的百分误差值均大于30％.对162组配对数据PCCI和CITPTD的变化量(ΔPCCI和ΔCITTPTD)进行线性回归分析显示,两者显著相关(r2=0.217,P＜0.001);定标间隔时间1～8h组和8～16h组ΔPCCI与ACITPTD均显著相关(r2=0.327、P＜ 0.001,r2=0.303、P＜0.001).结论在感染性休克患者中,随着定标间隔时间的延长,PCCO的可信度会下降,应在循环有变化或与临床表现不符时重新定标;建议经肺热稀释法的定标间隔时间不要超过8h.
목적 탐토감염성휴극환자채용불동정표간격시간대맥박륜곽분석법지속심배혈량(PCCO)감측준학성적영향.방법 회고성분석2011년2월지2013년2월엄주의과대학부속제일의원중증의학과접수맥박지시련속심배혈량(PiCCO)감측적25례감염성휴극환자적림상자료.기록매차경폐열희석측량정표전1 min적PCCO치화해차경폐열희석측량적심배혈량(COTPTD),병제이이상체표면적,계산심배혈량지수(CI),조성배대수거PCCI화CITPTD.안조정표간격시간분위0～1h(함1h)、1～8h(함8h)、8～ 16h(함16h)、＞16h조.사용선성동귀、상관일치성적계한치(이bias±2SD표시)급백분오차치(2SD/CITPTD균치)대PCCI화CITPTD진행일치성분석.결과 25례감염성휴극환자공채집162조배대수거.상관분석현시,PCCI여CITPTD현저상관(r2=0.494,P＜0.001),bias±2SD위-(0.06±1.41) L·min-1·m-2,백분오차치위37％;제1～8h조적백분오차치소우30％외,기여각조적백분오차치균대우30％.대162조배대수거PCCI화CITPTD적변화량(ΔPCCI화ΔCITTPTD)진행선성회귀분석현시,량자현저상관(r2=0.217,P＜0.001);정표간격시간1～8h조화8～16h조ΔPCCI여ACITPTD균현저상관(r2=0.327、P＜ 0.001,r2=0.303、P＜0.001).결론 재감염성휴극환자중,수착정표간격시간적연장,PCCO적가신도회하강,응재순배유변화혹여림상표현불부시중신정표;건의경폐열희석법적정표간격시간불요초과8h.
Objective To evaluate the effect of time elapsed on continuous pulse contour cardiac output (PCCO) measurement in septic shock patients.Methods Data during February 2011 to February 2013 from 25 septic shock patients equipped with a pulse indicator continuous cardiac output (PiCCO) device in Department of Critical Care Medicine of Guangzhou Medical University were retrospectively analyzed.PCCO was recorded immediately before transpulmonary thermodilution (COTPTD) calibration.After divided by ideal body surface area,cardiac index (CI) was calculated,and PCCI/CITPTD pairs were analyzed.Four subsets of CI pairs were defined according to intervals of time elapsed from the previous calibration [within the first hour (including 1 hour),between 1 and 8 hours (including 8 hours),between 8 and 16 hours (including 16 hours),and more than 16 hours].Linear regression,the threshold value of concordance (as indicated by bias ± 2SD) and percentage error (2SD/the mean of CITPTD) were used to compare agreement between PCCI and CIrPTTD.Results A total of 162 data pairs from 25 patients were analyzed.For all data pairs,PCCI correlated significantly with CITPTD (r2=0.494,P＜0.001),the bias ± 2SD was-(0.06 ± 1.41) L· min-1· m-2 and the percentage error was 37％.Among the four time-interval subsets,the percentage error was ＜30％ only in subset between 1 and 8 hours,and the percentage error in other subsets was over 30％.Linear regression analysis between ΔPCCI and ΔCITPTD showed a r2 of 0.217(P＜0.001) for the whole 162 data pairs.A r2 of 0.327 (P＜0.001) and a r2 of 0.303 (P＜0.001) were calculated for the subset of between 1 and 8 hours and between 8 and 16 hours respectively.Conclusions Our study in septic shock patients suggests that the accuracy of PCCO will be decreased as the increase of the time interval for calibration.Transpulmonary thermodilution calibration should be performed again if hemodynamic changes or was inconsistent with the clinical presentation.It is suggested that re-calibration should be done within 8 hours.