Transoesophageal echocardiography accurately detects cardiac output variation:: a prospective comparison with thermodilution in cardiac surgery
Transoesophageal echocardiography accurately detects cardiac output variation:: a prospective comparison with thermodilution in cardiac surgery
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DOI：
10.1017/s0265021507001354
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发表时间：
2008-02-01
影响因子：
3.6
通讯作者：
Pare, C.
中科院分区：
文献类型：
--
作者：
Parra, V.;Fita, G.;Pare, C.
背景与目的：术中多普勒超声可通过经食管超声心动图测量心输出量。最近，与热稀释技术相比，其可靠性受到质疑。本研究的目的是比较心脏手术中超声多普勒和热稀释法测量的心输出量的术中变化。我们还评估了技术之间的协议。研究方法：经机构伦理委员会批准后，前瞻性纳入50例心脏手术患者（38例男性，12例女性，平均年龄63.4 ± 14.3岁）。心输出量通过10 mL生理盐水在12 ℃下热稀释法进行评估，同时通过超声多普勒在左心室流出道水平的经胃深度视图中使用脉冲波多普勒进行盲法评估。匹配的热稀释心输出量和超声多普勒心输出量测量在呼气末进行了三次，包括心肺转流术前后。结果：在44例患者（88916）中获得了回波多普勒测量。在3例患者中，无法充分获得多普勒记录，3例在旁路术后发生左心室流出道梗阻。Bland-Altman分析显示偏倚为0.015 L min（-1），一致性限较窄（-1.21至1.22 L min（-1）），误差为29.1%。对于检测热稀释心输出量10%以上的变化，超声多普勒是准确的（92%的灵敏度和71%的特异性，受试者工作特征曲线P = 0.008）。未发生与研究相关的并发症。结论：超声多普勒和热稀释法测定的心输出量之间的一致性在临床上是可接受的，经食管超声心动图是评估选定患者人群中显著心输出量变化的可靠工具。
Background and objective: Intraoperative Doppler ultrasound can be used to measure cardiac output by trans-oesophageal echocardiography. Recently, its reliability, when compared to the thermodilution technique, has been questioned. The purpose of this study was to compare intraoperative changes in cardiac output measured by echo-Doppler and by thermodilution in cardiac surgery. We also assessed the agreement between the techniques. Methods: Fifty cardiac surgical patients (38 male, 12 female, mean age of 63.4 +/- 14.3 yr) were prospectively included after approval by the Ethics Committee of the Institution. Cardiac output was assessed by thermodilution, with 10 mL saline at 12 degrees C, and simultaneously and blindly by echo-Doppler in deep transgastric view with pulsed wave Doppler at the level of the left ventricular outflow tract. Matched thermodilution cardiac output and echo-Doppler cardiac output measurements were taken three times at the end of expiration, both pre- and post-cardiopulmonary bypass. Results: Echo-Doppler measurements were obtained in 44 patients (88916). In three patients, Doppler recordings could not be obtained adequately, and three developed left ventricular outflow tract obstruction after bypass. Bland-Altman analysis revealed a bias of 0.015 L min(-1), with narrow limits of agreement (-1.21 to 1.22 L min(-1)) and 29.1% error. Echo-Doppler was accurate (92% sensitivity and 71% specificity, P = 0.008 by receiver operating characteristic curves) for detecting more than 10% of change in thermodilution cardiac output. There were no complications related to the study. Conclusions: The agreement between cardiac output by echo-Doppler and by thermodilution is clinically acceptable and transoesophageal echocardiography is a reliable tool to assess significant cardiac output changes in a population of selected patients.