CAJ | 학술논문

目的比较经锁骨下静脉导管和股静脉导管注入冰盐水两种方法对脉搏指示连续心排血量(PiCCO)监测心排血指数(CI)、血管外肺水指数(EVLWI)、全心舒张期末容积指数(GEDVI)的影响,了解经股静脉插管这一非常规方法所测数据的可靠性.方法应用PiCCO监测仪,对北京医院重症监护病房(ICU)2007年1月-2009年3月收治的13例重症患者进行血流动力学监测.对同一患者分3个时间点分别采用经锁骨下静脉导管及股静脉导管注入冰盐水两种方法检测,采用配对双侧t检验及Bland-Altman分析方法比较两组CI、EVLWI、GEDVI的差异.结果共收集数据39组,经股静脉与锁骨下静脉导管检测数据的差值分别为CI(0.28±0.46)L·min-1·m-2、EVLWI(1.05±1.89)ml/kg、GEDVI(195.2±105.7)ml/m2,差异均有统计学意义(P值分别为0.000 5、0.001 3、<0.000 1);Bland-Ahman分析显示两种方法检测GEDVI的一致性较差(一致性限度为-11.9,402.3);经股静脉注入冰盐水方法检测数值较经锁骨下静脉检测的明显偏高.结论与经锁骨下静脉注射相比,经股静脉注入冰盐水方法检测血流动力学,对CI、EVLWI、GEDVI的估计过高,其中对GEDVI影响最大,在临床应用中需注意重新评估.
목적 비교경쇄골하정맥도관화고정맥도관주입빙염수량충방법대맥박지시련속심배혈량(PiCCO)감측심배혈지수(CI)、혈관외폐수지수(EVLWI)、전심서장기말용적지수(GEDVI)적영향,료해경고정맥삽관저일비상규방법소측수거적가고성.방법 응용PiCCO감측의,대북경의원중증감호병방(ICU)2007년1월-2009년3월수치적13례중증환자진행혈류동역학감측.대동일환자분3개시간점분별채용경쇄골하정맥도관급고정맥도관주입빙염수량충방법검측,채용배대쌍측t검험급Bland-Altman분석방법비교량조CI、EVLWI、GEDVI적차이.결과 공수집수거39조,경고정맥여쇄골하정맥도관검측수거적차치분별위CI(0.28±0.46)L·min-1·m-2、EVLWI(1.05±1.89)ml/kg、GEDVI(195.2±105.7)ml/m2,차이균유통계학의의(P치분별위0.000 5、0.001 3、<0.000 1);Bland-Ahman분석현시량충방법검측GEDVI적일치성교차(일치성한도위-11.9,402.3);경고정맥주입빙염수방법검측수치교경쇄골하정맥검측적명현편고.결론 여경쇄골하정맥주사상비,경고정맥주입빙염수방법검측혈류동역학,대CI、EVLWI、GEDVI적고계과고,기중대GEDVI영향최대,재림상응용중수주의중신평고.
Objective To compare the use of subclavian vein catheter and femoral vein catheter,in monitoring pulse indicator continuous cardiac output(PiCCO)monitering data cardiac index(CI),extravascular lung water index(EVLWI),and global end-diastolic volume index(GEDVI)with central venous injection of the bolus cold saline injection,in order to determine whether the femoral vein access,which is not typically used,could be used to obtain reliable data.Methods Thirteen patients in Beijing Hospital intensive care unit(ICU)were involved,from Januany 2007 to March 2009.Each patient was monitored with PiCCOplus device,after an injection of cold saline bolus via both femoral and subclavian venous catheter.Pared t-test and Bland-Altman analysis were used to compare CI,EVLWI and GEDVI values.Results Data of 39 measurements were collected.The bias between femoral injection and subclavian 105.7)ml/m2,and they were statistically significant(P values was 0.000 5,0.001 3,<0.0001,respectively).The Bland-Altman analysis showed an clinically overestimation of GEDVI after femoral injection(limit of concordance was-11.9,402.3),compared with that after subclavian injection.Conclusion Measurements with a cold saline bolus via a femoral catheter,compared to those via a subclavian catheter,lead to overestimation of CI,EVLWI and GEDVI values,and a great bias of GEDVI should be taken into account in clinical work.