目的 探讨容量状态改变对犬脉搏轮廓持续心排血量(PCCO)监测准确性的影响.方法 对20只杂种犬制备失血性休克模型,并进行容量复苏.每一个模型同时放置两根脉搏轮廓心排血量(PiCCO)导管进行心排血量(CO)监测,1根用于经肺热稀释法问断监测心排血量(COTp)(定标组),另1根用于PCCO监测(非定标组).失血相血容量每下降5％定标组监测一次,直至失血量达40％血容量,非定标组持续监测.随后两根导管均采用经肺热稀释进行定标并进入容量复苏相,复苏容量每增加5％当量的血容量,定标组监测一次,非定标组持续监测,直至补回100％血容量.各时间点均记录COTp、PCCO、平均动脉压(MAP)、体循环阻力(SVR)、全心舒张末期容积(GEDV).结果 (1)在基线,定标组COTP与非定标组PCCO的差异无统计学意义(P＞0.05).(2)在失血相,定标组COTp与GEDV均逐渐下降,TH8时分别降至最低值(1.06±0.57) L/min和(238±93) ml,SVR逐渐上升,TH6时升至最高值(5 074 ±2 342)dyn·s·cm-5,而非定标组PCCO、SVR下降,TH8时分别降至最低值(2.42±1.37) L/min和(2 285 ±1 033)dyn·s·cm-5;定标组COTp与非定标组PCCO在各时间点的差异均有统计学意义(TH1～TH8的t值分别为-5.218、-5.495、-4.639、-6.588、-6.029、-5.510、-5.763、-5.755,P值均＜0.01),且从TH1至TH8两组差值百分比逐渐增大,两组SVR的差异有统计学意义(TH1、TH4的t值分别为2.866、2.429,P值均＜0.05,TH2～ TH3、TH5～ TH8的t值分别为3.073、3.590、6.847、8.425、6.910、8.799,P值均＜0.01),两组MAP的差异无统计学意义(P＞0.05).(3)在容量复苏相,定标组COTp与GEDV均逐渐上升,TR7时GEDV升至最高值[(394±133) ml],TR8时COTp升至最高值[(3.15±1.42) L/min],SVR逐渐下降,TR8时降至最低值[(3 284±1 271)dyn·s· cm-5],而非定标组PCCO、SVR波动上升,TR7时SVR升至最高值[(8 589±4771)dyn·s·cm-5],TR8时PCCO升至最高值[(1.35±0.70) L/min];定标组COTP与非定标组PCCO在各时间点的差异均有统计学意义(TR1～ TR8的t值分别为8.195、8.703、7.903、8.266、9.600、8.340、8.938、8.332,P值均＜0.01),从TR1至TR8两组差值百分比逐渐增大,两组SVR的差异有统计学意义(TR1的t值为-2.810,P＜0.05,TR2～ TR8的t值分别为-6.026、-6.026、-5.375、-6.008、-5.406、-5.613、-5.609,P值均＜0.01),两组MAP的差异无统计学意义(P＞0.05).结论 容量快速改变时,PCCO不能反映真实CO,此时应通过提高定标的频率来保持PCCO的准确性.
目的 探討容量狀態改變對犬脈搏輪廓持續心排血量(PCCO)鑑測準確性的影響.方法 對20隻雜種犬製備失血性休剋模型,併進行容量複囌.每一箇模型同時放置兩根脈搏輪廓心排血量(PiCCO)導管進行心排血量(CO)鑑測,1根用于經肺熱稀釋法問斷鑑測心排血量(COTp)(定標組),另1根用于PCCO鑑測(非定標組).失血相血容量每下降5％定標組鑑測一次,直至失血量達40％血容量,非定標組持續鑑測.隨後兩根導管均採用經肺熱稀釋進行定標併進入容量複囌相,複囌容量每增加5％噹量的血容量,定標組鑑測一次,非定標組持續鑑測,直至補迴100％血容量.各時間點均記錄COTp、PCCO、平均動脈壓(MAP)、體循環阻力(SVR)、全心舒張末期容積(GEDV).結果 (1)在基線,定標組COTP與非定標組PCCO的差異無統計學意義(P＞0.05).(2)在失血相,定標組COTp與GEDV均逐漸下降,TH8時分彆降至最低值(1.06±0.57) L/min和(238±93) ml,SVR逐漸上升,TH6時升至最高值(5 074 ±2 342)dyn·s·cm-5,而非定標組PCCO、SVR下降,TH8時分彆降至最低值(2.42±1.37) L/min和(2 285 ±1 033)dyn·s·cm-5;定標組COTp與非定標組PCCO在各時間點的差異均有統計學意義(TH1～TH8的t值分彆為-5.218、-5.495、-4.639、-6.588、-6.029、-5.510、-5.763、-5.755,P值均＜0.01),且從TH1至TH8兩組差值百分比逐漸增大,兩組SVR的差異有統計學意義(TH1、TH4的t值分彆為2.866、2.429,P值均＜0.05,TH2～ TH3、TH5～ TH8的t值分彆為3.073、3.590、6.847、8.425、6.910、8.799,P值均＜0.01),兩組MAP的差異無統計學意義(P＞0.05).(3)在容量複囌相,定標組COTp與GEDV均逐漸上升,TR7時GEDV升至最高值[(394±133) ml],TR8時COTp升至最高值[(3.15±1.42) L/min],SVR逐漸下降,TR8時降至最低值[(3 284±1 271)dyn·s· cm-5],而非定標組PCCO、SVR波動上升,TR7時SVR升至最高值[(8 589±4771)dyn·s·cm-5],TR8時PCCO升至最高值[(1.35±0.70) L/min];定標組COTP與非定標組PCCO在各時間點的差異均有統計學意義(TR1～ TR8的t值分彆為8.195、8.703、7.903、8.266、9.600、8.340、8.938、8.332,P值均＜0.01),從TR1至TR8兩組差值百分比逐漸增大,兩組SVR的差異有統計學意義(TR1的t值為-2.810,P＜0.05,TR2～ TR8的t值分彆為-6.026、-6.026、-5.375、-6.008、-5.406、-5.613、-5.609,P值均＜0.01),兩組MAP的差異無統計學意義(P＞0.05).結論 容量快速改變時,PCCO不能反映真實CO,此時應通過提高定標的頻率來保持PCCO的準確性.
목적 탐토용량상태개변대견맥박륜곽지속심배혈량(PCCO)감측준학성적영향.방법 대20지잡충견제비실혈성휴극모형,병진행용량복소.매일개모형동시방치량근맥박륜곽심배혈량(PiCCO)도관진행심배혈량(CO)감측,1근용우경폐열희석법문단감측심배혈량(COTp)(정표조),령1근용우PCCO감측(비정표조).실혈상혈용량매하강5％정표조감측일차,직지실혈량체40％혈용량,비정표조지속감측.수후량근도관균채용경폐열희석진행정표병진입용량복소상,복소용량매증가5％당량적혈용량,정표조감측일차,비정표조지속감측,직지보회100％혈용량.각시간점균기록COTp、PCCO、평균동맥압(MAP)、체순배조력(SVR)、전심서장말기용적(GEDV).결과 (1)재기선,정표조COTP여비정표조PCCO적차이무통계학의의(P＞0.05).(2)재실혈상,정표조COTp여GEDV균축점하강,TH8시분별강지최저치(1.06±0.57) L/min화(238±93) ml,SVR축점상승,TH6시승지최고치(5 074 ±2 342)dyn·s·cm-5,이비정표조PCCO、SVR하강,TH8시분별강지최저치(2.42±1.37) L/min화(2 285 ±1 033)dyn·s·cm-5;정표조COTp여비정표조PCCO재각시간점적차이균유통계학의의(TH1～TH8적t치분별위-5.218、-5.495、-4.639、-6.588、-6.029、-5.510、-5.763、-5.755,P치균＜0.01),차종TH1지TH8량조차치백분비축점증대,량조SVR적차이유통계학의의(TH1、TH4적t치분별위2.866、2.429,P치균＜0.05,TH2～ TH3、TH5～ TH8적t치분별위3.073、3.590、6.847、8.425、6.910、8.799,P치균＜0.01),량조MAP적차이무통계학의의(P＞0.05).(3)재용량복소상,정표조COTp여GEDV균축점상승,TR7시GEDV승지최고치[(394±133) ml],TR8시COTp승지최고치[(3.15±1.42) L/min],SVR축점하강,TR8시강지최저치[(3 284±1 271)dyn·s· cm-5],이비정표조PCCO、SVR파동상승,TR7시SVR승지최고치[(8 589±4771)dyn·s·cm-5],TR8시PCCO승지최고치[(1.35±0.70) L/min];정표조COTP여비정표조PCCO재각시간점적차이균유통계학의의(TR1～ TR8적t치분별위8.195、8.703、7.903、8.266、9.600、8.340、8.938、8.332,P치균＜0.01),종TR1지TR8량조차치백분비축점증대,량조SVR적차이유통계학의의(TR1적t치위-2.810,P＜0.05,TR2～ TR8적t치분별위-6.026、-6.026、-5.375、-6.008、-5.406、-5.613、-5.609,P치균＜0.01),량조MAP적차이무통계학의의(P＞0.05).결론 용량쾌속개변시,PCCO불능반영진실CO,차시응통과제고정표적빈솔래보지PCCO적준학성.
Objective To study the accuracy of pulse contour cardiac output(PCCO) during blood volume change.Methods Hemorrhagic shock model was made in twenty dogs followed by volume resuscitation.Two PiCCO catheters were placed into each model to monitor the cardiac output (CO).One of catheters was used to calibrate CO by transpulmonary thermodilution technique (COTp) (calibration group),and the other one was used to calibrate PCCO (none-calibration group).In the hemorrhage phase,calibration was carried out each time when the blood volume dropped by 5 percents in the calibration group until the hemorrhage volume reached to 40 percent of the basic blood volume.Continuous monitor was done in the none-calibration group.Volume resuscitation phase started after re-calibration in the two groups.Calibration was carried out each time when the blood equivalent rose by 5 percents in calibration group until the percentage of blood equivalent volume returned back to 100.Continuous monitor was done in none-calibration group.COTP,PCCO,mean arterial pressure (MAP),systemic circulation resistance (SVR),global enddiastolic volume(GEDV) were recorded respectively in each time point.Results (1)At the baseline,COTP in calibration group showed no statistic difference compared with PCCO in none-calibration group (P ＞ 0.05).(2) In the hemorrhage phase,COTP and GEDV in calibration group decreased gradually,and reached to the minimum value (1.06 ± 0.57) L/min,(238 ± 93) ml respectively at TH8.SVR in calibration group increased gradually,and reached to the maximum value (5 074 ± 2 342)dyn · s · cm-5 at TH6.However,PCCO and SVR in none-calibration group decreased in a fluctuating manner,and reached to the minimum value (2.42 ± 1.37)L/min,(2 285 ± 1 033)dyn · s · cm-5 respectively at TH8.COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TH1-8,t values were respectively-5.218,-5.495,-4.639,-6.588,-6.029,-5.510,-5.763and-5.755,all P ＜ 0.01).From TH1 to TH8,the difference in percentage increased gradually.There were statistic differences in SVR at each time point between the two groups (At TH1 and TH4,t values were respectively 2.866 and 2.429,both P ＜ 0.05,at TH2-TH3 and TH5-TH8,t values were respectively 3.073,3.590,6.847,8.425,6.910 and 8.799,all P ＜0.01).There was no statistic difference in MAP between the two groups (P ＞ 0.05).(3) In the volume resuscitation phase,COTP and GEDV in the calibration group increased gradually.GEDV reached to the maximum value ((394 ± 133)ml) at TR7,and COTP reached to the maximum value (3.15 ± 1.42)L/min at TR8.SVR in the calibration group decreased gradually,and reached to the minimum value (3 284 ± 1 271) dyn · s · cm-5 at TR8.However,PCCO and SVR in the none-calibration group increased in a fluctuating manner.SVR reached to the maximum value (8 589 ± 4 771) dyn · s · cm-5 at TR7,and PCCO reached to the maximum value (1.35 ±0.70) L/min at TR8.COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TR1-8,t values were respectively 8.195,8.703,7.903,8.266,9.600,8.340,8.938,8.332,all P ＜ 0.01).From TR1 to TR8,the difference in percentage increased gradually.There were statistic differences in SVR at each time point between the two groups (At TR1,t value was-2.810,P ＜ 0.05,at TR2-8,t values were respectively-6.026,-6.026,-5.375,-6.008,-5.406,-5.613 and -5.609,all P ＜ 0.05).There was no statistic difference in MAP between the two groups (P ＞ 0.05).Conclusion PCCO could not reflect the real CO in case of rapid blood volume change,which resulting in the misjudgment of patient's condition.In clinical practice,more frequent calibrations should be done to maintain the accuracy of PCCO in rapid blood volume change cases.
