超声心排血量与PICCO监测重症患者血流动力学的对比研究

目的 探讨超声心排血量与连续心排血量(PICCO)监测重症患者血流动力学的差异。方法 选取佛山市高明区人民医院2018年3月至2020年1月收治的重症患者88例,先予以PICCO监测,后予以超声心排血量监测。比较2种不同监测方法得出的血流动力学参数[每搏量(SV)、每搏量指数(SI)、心排血量(CO)、心排血指数(CI)],并分析2种监测方法得出的各血流动力学参数的相关性。结果 在监测0～24 h时间段,2种不同监测方法测得的SV、SI、CO、CI均呈显著升高趋势,且与PICCO相比,超声心排血量监测24 h的上述各项血流动力学参数升高更为明显,差异有统计学意义(均P<0.05);2种监测方法测得的SV、SI、CO、CI之间为正相关关系(r=0.813、0.856、0.792、0.901,均P<0.05);2种监测方法在2 h时CO值的一致性较差[1.96 SD=1.44,95%CIJP(0.15～1.27)],在6 h[1.96 SD=0.24,95%CI(-0.14～0.30)]、12 h[1.96 SD=0.28,95%CI(-0.21～0.33)]、24 h[1.96 SD=0.24,95%CI(-0.14～0.36)]、48 h[1.96 SD=0.34,95%CI(-0.71～0.78)]时CO值的一致性较好。结论 超声心排血量、PICCO在监测重症患者血流动力学参数方面存在差异,但具有良好的相关性。     

血流动力学监测——动脉轮廓法和肺动脉导管法的对比性研究

目的探讨动脉轮廓法(PiCCO)在血流动力学监测中的准确性。方法30例危重患者因不同病因入住ICU,每例患者均同时行PiCCO和肺动脉导管法(PAC)对血流动力学进行监测,于同一时间点采集两种方法的血流动力学数据,比较两种方法的相关性。结果两种方法所测心输出量(CO)、心脏指数(CI)、每搏输出量(SV)、体循环阻力(SVR)有很好的相关性,r值分别是0.865、0.879、0.824、0.833,差异有统计学意义(P<0.001)。结论PiCCO可以及时、快捷、连续地反映血流动力学状态。     

USCOM与二维超声心动图测量心排血量的相关性分析

目的：探讨USCOM1A监测心排血量（CO）、每搏量（SV）的准确性及其可行性。方法：利用USCOM1A测量41例患者的CO、SV，以常规超声心动图双平面Simpson′s法为对照。结果：USCOM1A监测的CO、SV较二维超声心动图监测的CO、SV略大，但差异无统计学意义（P均〉0.05），Bland-Altman分析显示一对配对CO之差在偏差95%的可信区间外。结论：USCOM1A可以取代常规超声心动图双平面Simpson′s法快速监测CO。     

大面积烧伤休克期心功能变化监测的研究

目的观察大面积烧伤休克期心功能监测对复苏的指导意义。方法对入院后置人Swan-Ganz漂浮导管的15例大面积烧伤病人，采用血流动力学监测仪，于入院时及伤后8、16、24、36、48h连续监测患者的心排量（CO）、心排指数（CI）、每搏量（SV）、每搏指数（SI）、右房压（RAP）、肺动脉压（PAP），中心静脉压（CVP）、心率（Hr）。结果休克期实施有创心功能监测是安全的，无一例发生并发症，15例病人均平衡渡过休克期。结论大面积烧伤休克期实施有创心功能监测对指导复苏具有重要意义。     

床旁超声心动图监测重症患者血容量及心脏功能的临床研究

目的探讨床旁超声心动图监测重症患者血容量及心脏功能的临床价值。方法选择我院重症医学科感染性休克患者52例,脉搏指示连续心输出量(PiCCO)导管法检测全心舒张末期容积指数(GEDI)、每搏量指数(SVI)、心排指数(CI)、全心射血分数(GEF)评估血容量及心功能;同时行床旁超声心动图监测左室舒张末期容积(LVEDV)、每搏量(SV)、心输出量(CO)、下腔静脉管径(IVC)、左室射血分数(LVEF);在PiCCO指导下经扩容治疗及应用血管活性药物治疗第2天,再次行床旁超声监测评估血容量及心功能,比较床旁超声心动图监测重症患者血容量及心脏功能与PiCCO导管方法测量的准确性。结果扩容治疗后床旁超声心动图所测LVEDV、SV、IVC、CO及LVEF均增高,与扩容治疗前比较差异均有统计学意义(均P0.05);床旁超声心动图监测指标LVEDV、SV、CO、LVEF分别与PiCCO导管监测指标GEDI、SVI、CI及GEF呈正相关(r=0.614、0.703、0.536、0.573、0.527、0.514、0.498、0.487,均P0.01)。结论床旁超声心动图监测重症患者血容量及心脏功能结果可信,弥补了PiCCO导管法诸多不足。     

24例危重病人行经肺温度稀释法监测的护理

[目的]探讨经肺温度稀释法（PiCCO）与肺动脉热稀释法（Swart—Ganz）的相关性。[方法]对24例危重病人同时行Swart—Ganz、PiCCO连续监测，并记录心排血量（CO）、每搏量（SV）、心排血指数（CI）、外周血管阻力（SVR），PiCCO监护仪还可监测胸腔内血容量（ITBV）和血管外肺水（EVLW）。于同一时间点采集血流动力学参数，比较两种监测技术的相关性。[结果]相关分析显示，心排血指数PiCCO与Swan—Ganz相关系数为0．885（P〈0．05）。应用PiCCO技术可准确测量心排出量，其所测量的全心舒张末期容积与胸腔内血容积较中心静脉压（CVP）更能反映心脏前负荷变化。[结论]PiCCO连续血流动力学监测可作为危重病人可靠的监测手段。     

1,6—二磷酸果糖对冠心病心力衰竭患者血流动力学的影响

采用随机分组、双盲、交叉、对照研究观察国产果糖二磷酸钠（FDP）对冠心病心力衰竭患者的血流动力学参数的影响，结果显示，对心力衰竭患者，FDP可使心排血量（CO）、每搏量（SV）、心排指数（CI）和每搏指数（SI）明显上升，而对平均右心房压（MRAP）、平均肺动脉压（MPAP）、肺毛细血管楔嵌压（PCWP）、心率、动脉收缩压和舒张庄无明显影响，本研究结果表明，FDP作为一种重要的细胞内中间代谢供能物质，静脉滴注后可在一定程度上改善充血性心力衰竭患者的心脏功能。     

无创血流动力学监测系统在急诊科的综合应用分析

目的：探讨无创血流动力学监测系统在急诊科的综合应用价值。方法以房颤患者、心力衰竭患者、冠心病及其合并症患者、机械通气患者和正常对照患者共230例为研究对象,总结分析ANALOGIC无创血流动力学监测系统应用情况,研究选择相关血流动力学参数作统计学分析。结果（1）房颤组与正常对照组比较显示,房颤组心排量（CO）、心脏指数（CI）、搏排量（SV）、心搏指数（SI）、速度指数（VI）、加速指数（ACI）、射血分数（EF）均低于正常对照组,射血前期（PEP）明显延长,左室射血时间（LVET）明显缩短,收缩时间比（STR）增大（P<0.05）;（2）49例心力衰竭患者在监测治疗前后各参数差异有统计学意义（P<0.05）;（3）冠心病组与正常对照组血流动力学参数比较显示,冠心病组系统血管阻力（SVR）、系统血管阻力指数（SVRI）明显增高（P<0.05）,其余指标如CI、CO、SV、VI等有下降趋势,但差异无统计学意义（P>0.05）;冠心病合并症患者亦伴随有CO明显降低,SVR、SVRI明显升高（P<0.05）;（4）机械通气组不同压力支持通气（PSV）对各参数的影响不明显（P>0.05）,不同呼气末正压（PEEP）值对各参数的影响有统计学意义（P<0.05）。结论 ANALOGIC无创血流动力学检测仪操作简单、方便,能进行持续的血流动力学监测,在心衰、冠心病、房颤及机械通气患者中得到了较好应用,值得急诊科进一步推广。     

盐酸法舒地尔治疗急性心力衰竭的无创血流动力学监测

目的用无创血流动力学监测系统评价法舒地尔治疗急性心力衰竭的疗效。方法选取60例急性心力衰竭住院患者,随机分为两组各30例,对照组给予常规基础治疗,治疗组给予常规基础治疗加盐酸法舒地尔治疗,观察其治疗前后临床症状,记录治疗前及治疗3 d后血流动力学监测参数,并选取其中8项:收缩压(SBP)、舒张压(DBP)、心率(HR)、心排出量(CO)、心脏指数(CI)、每搏排出量(SV)、射血分数(LVEF)、胸腔液体量(TFC)进行血流动力学定量评估。结果两组治疗后SBP、DBP、HR、CO、CI、SV、LVEF、TFC与治疗前比较差异均有统计学意义(P<0.05),两组治疗后CO、CI、SV、LVEF、TFC相比差异有统计学意义(P<0.05)。结论法舒地尔能提高急性心衰的治疗效果,无创血流动力学监测临床使用方便,能及时反映患者用药过程中的病情变化,具有较强的使用价值。     

大面积烧伤休克期心功能变化监测的研究

目的观察大面积烧伤休克期心功能监测对复苏的指导意义。方法对入院后置入Swan-Ganz漂浮导管的15例大面积烧伤病人,采用血流动力学监测仪,于入院时及伤后8、16、24、36、48 h连续监测患者的心排量(CO)、心排指数(CI)、每搏量(SV)、每搏指数(SI)、右房压(RAP)、肺动脉压(PAP)、中心静脉压(CVP)、心率(Hr)。结果休克期实施有创心功能监测是安全的,无一例发生并发症,15例病人均平衡渡过休克期。结论大面积烧伤休克期实施有创心功能监测对指导复苏具有重要意义。     

血液透析对慢性肾功能衰竭患者心功能和肺弥散功能的影响及其意义

测定２０例慢性肾功能衰竭患者血液透析（血透）前一天下午和血透后１～２小时的心功能及肺弥散功能的变化。发现血透后心排血量（ＣＯ）、心脏指数（ＣＩ）、每搏心排血量（ＳＶ）及每搏指数（ＳＩ）均显著降低，肺一氧化碳弥散量（ＤＬｃｏ）也显著降低，其中ＳＶ和ＳＩ对超滤反应敏感。结果表明，慢性肾功能衰竭患者血透后可由于左室充盈压降低而导致心功能指标出现下降，并有肺弥散功能的损害     

Non-invasive in vivo measurement of cardiac output in C57BL/6 mice using high frequency transthoracic ultrasound: evaluation of gender and body weight effects

Even though mice are being increasingly used as models for human cardiovascular diseases, non-invasive monitoring of cardiovascular parameters such as cardiac output (CO) in this species is challenging. In most cases, the effects of gender and body weight (BW) on these parameters have not been studied. The objective of this study was to provide normal reference values for CO in C57BL/6 mice, and to describe possible gender and/or BW associated differences between them. We used 30-MHz transthoracic Doppler ultrasound to measure hemodynamic parameters in the ascending aorta [heart rate (HR), stroke volume (SV), stroke index (SI), CO, and cardiac index (CI)] in ten anesthetized mice of either sex. No differences were found for HR, SV, and CO. Both SI and CI were statistically lower in males. However, after normalization for BW, these differences disappeared. These results suggest that if comparisons of cardiovascular parameters are to be made between male and female mice, values should be standardized for BW.     

Modified head-up tilt test for orthostatic challenge of critically ill patients

The purpose of this study was to assess the cardiovascular response to a modified head-up tilt test for use with the bedridden, critically ill patient. The cardiovascular responses of seven normals and ten critically ill patients to 45 degrees head-up tilt with the legs horizontal (0 degrees) were analyzed. Stroke volume index (SI) and cardiac index (CI) were measured with thoracic electric bioimpedance (TEB). The baseline TEB (Z0) was measured to monitor fluid shift out of the thorax during tilt. BP was measured and systemic vascular resistance index (SVRI) was calculated. Normals responded to the modified head-up tilt with a decreased SI (59 to 44 ml/m2 and CI (3.7 to 2.8 L/min.m2), and an increased SVRI and Z0 (25.5 to 27.9). As a group, the patients showed no significant change with tilt. However, individual analysis revealed a heterogeneous response by the patients. Those patients who demonstrated a caudal shift of blood (increased Z0) had decreased SI. Those with no indication of a caudal shift of blood, presumably due to decreased venous compliance, did not change SI. Thus, this type of modified head-up tilt can be used in the ICU to study more intensely cardiovascular function and control in the bedridden subject.     

Noninvasive Cardiac Output Measurement by Transthoracic Electrical Bioimpedence: Influence of Age and Gender

Background  Thoracic electrical bioimpedance (TEB) as a method of measuring cardiac output (CO) is being explored increasingly over the last two decades, as a non-invasive alternative to the pulmonary artery catheter. The objective of this study was to establish normative data for measurement of CO by TEB and define the effect of age and gender on CO. Method  Stroke volume (SV) of 397 normal individuals (203 men, 194 women) in the age range of 10–77 years was determined using Kubisek and Bernstein formulae by TEB method. Derived cardiac parameters including CO, cardiac index (CI), systemic vascular resistance and resistance index were calculated and analyzed. Results  We found significant difference in CO among age groups and between gender. CO between Kubicek formula and Bernstein formula correlated well, but their means differed significantly. Cardiac indices peak in the third and seventh decade and were comparable between genders. Conclusion  A comprehensive data set of normalized values expressed as 95% confidence interval and mean ± SD in different age groups and different gender was possible for cardiac parameters using TEB. Sathyaprabha TN, Pradhan C, Rashmi G, Thennarasu K, Raju TR. Noninvasive cardiac output measurement by transthoracic electrical bioimpedence: influence of age and gender.     

Hemodynamic monitoring in obese patients: the impact of body mass index on cardiac output and stroke volume

OBJECTIVE: Interpreting hemodynamic parameters in critically ill obese patients can be difficult as the effects of body mass index (BMI) on cardiac output (CO) and stroke volume (SV) at the extremes of body size remains unknown. We examined the relationship between BMI and both CO and SV for patients with varying body sizes. DESIGN: Retrospective cohort analysis. SETTING: A large tertiary care academic medical center. PATIENTS: A total of 700 consecutive adults who were found to have disease-free coronary arteries and a cardiac output measurement (thermodilution or Fick method) during coronary angiography between July 1, 2000, and July 31, 2004. MEASUREMENTS AND RESULTS: We examined the relationship between BMI (mean, 28 kg/m(2); range, 10.6-91.6 kg/m(2)) and cardiac hemodynamics after adjusting for demographic (age, sex) and clinical (diabetes, smoking status, valvular heart disease, medications, indications for catheterization) characteristics using multivariable regression. Body mass index was positively correlated with CO and SV. Each 1 kg/m increase in BMI was associated with a 0.08 L/min (95% confidence interval [CI], 0.06-0.10; p < .001) increase in CO and 1.35 mL (95% CI, 0.96-1.74; p < .001) increase in SV. There was no significant association between BMI and both cardiac index (0.003 L/min/m(2); 95% CI, -0.008-0.014; p = .571) and stroke volume index (0.17 mL/m(2); 95% CI, -0.03-0.37; p = .094). CONCLUSION: Variations in BMI translate into predictable but only modest differences in CO and SV, even at the extremes of body size. Indexing hemodynamic measurements to body surface area attenuates the effects of BMI. Body habitus should not appreciably complicate the interpretation of hemodynamic measurements.     

Reproducibility and comparison of cardiac output measurement by transthoracic bioimpedance and thermodilution methods in critically ill patients.

The short-term reproducibility in cardiac output (CO) and stroke volume (SV) measurements by transthoracic electrical bioimpedance (TEB) and thermodilution (TH) and their agreement were studied in 31 consecutive patients in the Intensive Care Unit (ICU). For comparison of changes in CO and SV, six patients were studied separately. TEB data were not obtainable in four patients due to interference with impedance signals or heart rate detection. Both methods were reproducible. For TEB, the mean difference of duplicate measurements was 0.03 (SD 0.3) l/min for CO and 0.3 (SD 3.2) ml for SV. For TH, it was -0.04 (SD 0.5) l/min for CO and 0.6 (SD 6.6) ml for SV. The coefficient of reproducibility for CO was thus 0.6 l/min for TEB and 1.0 l/min for TH and that for SV was 6.4 ml for TEB and 13.2 ml for TH. There was no agreement in absolute CO or SV between the methods; TEB giving lower absolute readings. The mean difference (TH-TEB) was 1.4 (SD 1.4) l/min for CO and 14 (SD 13.4) ml for SV. There was, however, good correlation between the two methods. For CO, the regression equation was TEB=0.623+0.739 (TH); (p less than 0.0005, r=0.87). For SV, the regression equation was TEB=-0.23+0.823 (TH); (p less than 0.0005, r=0.86). When only changes were considered, the mean difference (TH-TEB) was -0.5 (SD 0.9) l/min for CO and -4 (SD 8) ml for SV. There was significant correlation in the changes detected by each method.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bioimpedance-derived differences in cardiac physiology during exercise stress testing in low-risk chest pain patients

BACKGROUND: Little has been written about the utility of thoracic electrical bioimpedance (TEB)-derived cardiac physiologic variables in evaluating patients with low-risk chest pain syndromes. Noninvasive bioimpedance can monitor cardiac physiology while a patient is performing an exercise stress test. In addition, the demographics of patients with chest pain, the incidence of coronary artery disease (CAD), and the methods used for evaluation have well-documented sex differences. OBJECTIVE: The objectives are to show that there are different cardiac physiologic responses to exercise stress test in Chest Pain Evaluation Unit patients with and without true CAD that could be used to stratify patients and that there is a sex difference in TEB results. METHODS: Patients 18 to 65 years of age with low-risk chest pain were eligible. Patients were attached to the TEB throughout the exercise stress test procedure. Heart rate (HR) was monitored. Primary dependent variables were TEB-measured cardiac output (CO, L/min) and stroke volume (SV, ml) at peak exercise. Secondary variables were TEB-measured ejection fraction (%), end-diastolic volume (EDV, ml), ventricular ejection time (ms), and thoracic fluid index (omega) at peak exercise. Outcome variables were either proved CAD or patient sex. CAD was proved by angiography, stress scintigraphy, or stress echocardiogram. Results were compared using a Student's t test assuming equal variances, with significance considered at a P < 0.05, and 95% confidence intervals were calculated for significant results. RESULTS: Nine patients had proved CAD, 82 patients did not. Forty-three women and 48 men were included in the study. At peak exercise, patients with CAD had a significantly smaller increase in EDV than patients without CAD (32.8 +/- 59.5 ml versus 89.3 +/- 101.8 ml) without a significant change in CO, SV, or HR. At peak exercise, women had a significantly smaller increase in CO and SV without a significant change in HR. In addition, women had a significantly smaller increase in EDV. CONCLUSION: When compared with patients without CAD, patients with CAD have a significantly smaller increase in EDV and a trend toward the same effect in CO and SV. Women have significantly smaller increases CO, SV, and EDV compared with men. Because there were no differences in HR, using HR as the sole end point would miss these differences. TEB is a practical means of measuring these variables.     

Bioimpedance Cardiac Output Measurements in Patients with Presumed Congestive Heart Failure

Objective: To describe preliminary ED experience with thoracic electrical bioimpedance (TEB) for evaluation of patients with complaints suggestive of congestive heart failure (CHF).
Methods: A 6-month, prospective, observational study was performed using a convenience sample of patients with signs and symptoms consistent with CHF. Patients were excluded if they had received medication prior to arrival in the ED, if they were obese, and if they had unstable vital signs. They also were excluded if they were combative, refused to sign consent, or had invasive lines that did not allow for TEB lead placement. Patients also were excluded if the study could not be completed because the patient was taken from the department for a diagnostic test, or if there were no good follow-up records available 6–12 months after the patient's visit. The patient's physician was blinded to the output of the TEB monitor. Cardiac output (CO), stroke volume (SV), end-diastolic volume (EDV), thoracic fluid index (TFI), and acceleration index (ACI) were recorded at 5-minute intervals. Results were evaluated for the time intervals 0–5 minutes, 30–35 minutes, and 60–65 minutes.
Results: Seven patients were included in the study. The echocardiographic diagnoses were hypertrophic car-diomyopathy (2 cases), dilated cardiomyopathy (2 cases), ischemic cardiomyopathy (1 case), right ventricular hypertrophy (1 case), and pericardial effusion (1 case). Significant changes were seen in all cardiac parameters, with variance from individual to individual.
Conclusions: Significant differences in TEB variables exist between patients who appear similar on initial examination in the ED. Changes noted on TEB may help to further elucidate physiologic differences. The clinical use of TEB-based hemodynamic measurements to guide presumed CHF patient management remains speculative.     

米力农与硝普钠合用治疗难治性心力衰竭的临床价值

目的:观察米力农与硝普钠合用治疗难治性心力衰竭患者的疗效。方法:选择90例难治性心力衰竭患者,随机分为A、B、C三组各30例,分别用米力农(对照组)、多巴酚丁胺(对照组)和米力农+硝普钠组(实验组)治疗,观察患者治疗前后心功能级别和心脏超声心功能指标(EF、CO、SV、CI和VA/VE)的变化情况。结果:A、B、C组总有效率分别为57%、47%和87%,差异有显著性(P<0.05)。结论:米力农适用治疗难治性心衰,尤其是不能耐受洋地黄药物治疗者,与硝普钠合用,临床疗效显著增加。     

彩色多普勒超声心动图、Swan-Ganz导管和脉波指示剂连续心排血量监测仪血流动力学检测的同步比较研究

目的对比研究彩色多普勒超声心动图(CDE)、Swan-Ganz导管和脉波指示剂连续心排血量(PiCCO)监测仪在血流动力学检测中的相关性。方法选取2006年3月至2008年10月入苏州市立医院东区ICU的心功能不全的危重病患者共8例,男5例,女3例,平均(51.4±21.1)岁。记录患者一般情况,并置入PiCCO导管和Swan-Ganz导管,通过CDE、Swan-Ganz导管法和PiCCO导管法同步测量每搏输出量(SV)和每分输出量(CO),比较三种方法所测数据的相关性。结果运用CDE、Swan-Ganz导管法和PiCCO导管法测量所得的SV依次为(62.4±29.3)ml、(53.1±14.0)ml和(49.9±14.7)ml。组间差异无统计学意义(P均0.05),组间均具有相关性,相关系数值分别为0.78、0.91和0.76;测量所得的CO分别为(5.9±2.2)L/min、(5.1±1.4)L/min和(5.0±1.4)L/min。组间差异无统计学意义(P均0.05),组间均具有相关性,相关系数值值分别为0.75、0.96和0.72。结论 CDE、Swan-Ganz导管和PiCCO监测仪检测的SV、CO具有相关性。