中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
35期
41-44
,共4页
心脏缺损,先天性%高血压,肺性%监测,手术中%剖宫产术
心髒缺損,先天性%高血壓,肺性%鑑測,手術中%剖宮產術
심장결손,선천성%고혈압,폐성%감측,수술중%부궁산술
Heart defects,congenital%Hypertension,pulmonary%Monitoring,intraoperative%Cesarean section
目的 评价动脉波形分析心输出量法(APCO)及肺动脉导管法(PAC)监测先天性心脏病并重度肺动脉高压孕妇行剖宫产围手术期心指数(CI)的一致性.方法 选取择期行剖宫产术的先天性心脏病并重度肺动脉高压孕妇45例,术中均同时采用APCO及PAC监测.采取连续硬膜外麻醉,于硬膜外给药前即刻(T1)、硬膜外给药后5 min(T2)、硬膜外给药后10 min(T3)、胎儿娩出前即刻(T4)、胎儿娩出后2 min(T5)、胎儿娩出后5 min(T6)记录CI.APCO及PAC监测的CI(分别为A-CI和P-CI)进行Pearson相关性分析和一致性检验.结果 各时点P-CI均高于A-CI,差异有统计学意义(P＜0.05);与T1时比较,T2～T4、T6时A-CI和P-CI差异均无统计学意义(P＞0.05),T5时A-CI[(4.5±1.1) L/(min ·m2)比(4.2±0.8)L/(min ·m2)]和P-CI [(6.2±1.5) L/(min ·m2)比(5.4±1.2)L/(min·m2)]均升高,差异有统计学意义(P＜ 0.05);T1～T6时两种方法监测的CI均呈正相关(r值分别为0.931,0.955,0.945,0.892,0.960,0.913;P＜ 0.05).Bland-Atlman一致性分析结果显示两种监测方法的一致性较差.结论 APCO与PAC监测先天性心脏病并重度肺动脉高压孕妇剖宫产围手术期CI的一致性较差,但在监测CI变化趋势上是相同的.
目的 評價動脈波形分析心輸齣量法(APCO)及肺動脈導管法(PAC)鑑測先天性心髒病併重度肺動脈高壓孕婦行剖宮產圍手術期心指數(CI)的一緻性.方法 選取擇期行剖宮產術的先天性心髒病併重度肺動脈高壓孕婦45例,術中均同時採用APCO及PAC鑑測.採取連續硬膜外痳醉,于硬膜外給藥前即刻(T1)、硬膜外給藥後5 min(T2)、硬膜外給藥後10 min(T3)、胎兒娩齣前即刻(T4)、胎兒娩齣後2 min(T5)、胎兒娩齣後5 min(T6)記錄CI.APCO及PAC鑑測的CI(分彆為A-CI和P-CI)進行Pearson相關性分析和一緻性檢驗.結果 各時點P-CI均高于A-CI,差異有統計學意義(P＜0.05);與T1時比較,T2～T4、T6時A-CI和P-CI差異均無統計學意義(P＞0.05),T5時A-CI[(4.5±1.1) L/(min ·m2)比(4.2±0.8)L/(min ·m2)]和P-CI [(6.2±1.5) L/(min ·m2)比(5.4±1.2)L/(min·m2)]均升高,差異有統計學意義(P＜ 0.05);T1～T6時兩種方法鑑測的CI均呈正相關(r值分彆為0.931,0.955,0.945,0.892,0.960,0.913;P＜ 0.05).Bland-Atlman一緻性分析結果顯示兩種鑑測方法的一緻性較差.結論 APCO與PAC鑑測先天性心髒病併重度肺動脈高壓孕婦剖宮產圍手術期CI的一緻性較差,但在鑑測CI變化趨勢上是相同的.
목적 평개동맥파형분석심수출량법(APCO)급폐동맥도관법(PAC)감측선천성심장병병중도폐동맥고압잉부행부궁산위수술기심지수(CI)적일치성.방법 선취택기행부궁산술적선천성심장병병중도폐동맥고압잉부45례,술중균동시채용APCO급PAC감측.채취련속경막외마취,우경막외급약전즉각(T1)、경막외급약후5 min(T2)、경막외급약후10 min(T3)、태인면출전즉각(T4)、태인면출후2 min(T5)、태인면출후5 min(T6)기록CI.APCO급PAC감측적CI(분별위A-CI화P-CI)진행Pearson상관성분석화일치성검험.결과 각시점P-CI균고우A-CI,차이유통계학의의(P＜0.05);여T1시비교,T2～T4、T6시A-CI화P-CI차이균무통계학의의(P＞0.05),T5시A-CI[(4.5±1.1) L/(min ·m2)비(4.2±0.8)L/(min ·m2)]화P-CI [(6.2±1.5) L/(min ·m2)비(5.4±1.2)L/(min·m2)]균승고,차이유통계학의의(P＜ 0.05);T1～T6시량충방법감측적CI균정정상관(r치분별위0.931,0.955,0.945,0.892,0.960,0.913;P＜ 0.05).Bland-Atlman일치성분석결과현시량충감측방법적일치성교차.결론 APCO여PAC감측선천성심장병병중도폐동맥고압잉부부궁산위수술기CI적일치성교차,단재감측CI변화추세상시상동적.
Objective To evaluate the concordance on cardiac index (CI) measured with arterial pressure based cardiac output (APCO) and pulmonary artery catheter (PAC) during cesarean section in parturients with congenital heart disease combined with severe pulmonary hypertension.Methods Forty-five congenital heart disease combined with severe pulmonary hypertension parturient who scheduled for cesarean section were selected,APCO and PAC were used for cardiac output and other parameters of hemodynamics monitoring during operation in all patients.Continuous epidural anesthesia was performed.CI was recorded immediately before epidural administration (T1),at 5 and 10 min after epidural administration (T2,T3),immediately before delivery (T4),and at 2 and 5 min after delivery (T5,T6).The correlation of CI between APCO and PAC (A-CI and P-CI,respectively) was tested by Pearson correlation analysis and agreement test.Results The P-CI was significantly higher than A-CI,there was statistical difference (P ＜ 0.05).Compared with T1,no significant differences between A-CI and P-CI were found at T2-T4 and T6 (P ＞ 0.05),The A-CI at T5 [(4.5 ± 1.1) L/(min·m2) vs.(4.2 ± 0.8) L/(min ·m2)] and P-CI [(6.2 ± 1.5) L/(min·m2) vs.(5.4 ± 1.2) L/ (min· m2)] were significantly higher,there were statistical differences (P ＜ 0.05).The correlation analysis showed that there was positive correlation between A-CI and P-CI at T1-6 (r =0.931,0.955,0.945,0.892,0.960,0.913 ; P ＜ 0.05).Bland-Altman analysis showed poor agreement between CI measured with the two methods.Conclusion CI value obtained with APCO agrees poorly with that obtained with PAC during cesarean section in parents with congenital heart disease combined with severe pulmonary hypertension,but agrees well in monitoring the changing trend of CI.
