Effect of Systemic Vascular Resistance on the Reliability of Noninvasive Hemodynamic Monitoring in Cardiac Surgery
Effect of Systemic Vascular Resistance on the Reliability of Noninvasive Hemodynamic Monitoring in Cardiac Surgery
复制标题
DOI：
10.1053/j.jvca.2020.11.011
复制
发表时间：
2021-04-22
影响因子：
2.8
通讯作者：
Nishikawa, Kiyonobu
中科院分区：
文献类型：
--
作者：
Mukai, Akira;Suehiro, Koichi;Nishikawa, Kiyonobu
目的：评估全身血管阻力（SVR）对ClearSight系统（Edwards Lifesciences, Irvine， CA）测量血压（BP）和心输出量（CO）可靠性的影响。设计：观察性研究。单位：大学医院。参与者：25例接受心脏手术的患者。干预措施:没有。测量和主要结果：记录使用ClearSight和动脉线测量的血压，使用ClearSight和肺动脉导管测量的一氧化碳，分别在给药前（T1）和给药后2分钟。使用Bland-Altman分析比较T1时的BP和CO测量值。极坐标图用于评估趋势能力。根据T1时SVRI指数（SVRI）将患者分为以下三组：低组(2500达因s/ cm（5)/m(2)）。BP和CO偏差分别为-4.8 +/- 8.9 mmHg和0.10 +/- 0.81 L/min，与SVRI显著相关（p < 0.05）。CO误差百分比为40.6%，正常SVRI组（33.3%）低于低SVRI组（46.3%）和高SVRI组（47.7%）。苯甲肾上腺素和麻黄素对BP和CO的角一致性率分别为96.3%和95.4%和87.0%和92.5%。低svri组对使用苯肾上腺素后CO变化的跟踪能力较低（角一致性率为33.3%）。结论：ClearSight系统在不同SVR状态下测量血压和跟踪血压变化具有可接受的准确性；然而，在各种SVR状态下，CO测量的精度和趋势能力较差。(C) 2020爱思唯尔公司版权所有。
Objective: To assess the effect of systemic vascular resistance (SVR) on the reliability of the ClearSight system (Edwards Lifesciences, Irvine, CA) for measuring blood pressure (BP) and cardiac output (CO).Design: Observational study.Setting: University hospital.Participants: Twenty-five patients undergoing cardiac surgery.Interventions: None.Measurements and Main Results: BP, measured using ClearSight and an arterial line, and CO, measured using ClearSight and a pulmonary artery catheter, were recorded before (T1) and two minutes after phenylephrine or ephedrine administration. Bland-Altman analysis was used to compare BP and CO measurements at T1. A polar plot was used to assess trending abilities. Patients were divided into the following three groups according to the SVR index (SVRI) at T1: low (2,500 dyne s/ cm(5)/m(2)). The bias in BP and CO was -4.8 +/- 8.9 mmHg and 0.10 +/- 0.81 L/min, respectively, which was correlated significantly with SVRI (p < 0.05). The percentage error in CO was 40.6%, which was lower in the normal SVRI group (33.3%) than the low and high groups (46.3% and 47.7%, respectively). The angular concordance rate was 96.3% and 95.4% for BP and 87.0% and 92.5% for CO after phenylephrine and ephedrine administration, respectively. There was a low tracking ability for CO changes after phenylephrine administration in the low-SVRI group (angular concordance rate 33.3%).Conclusion: The ClearSight system showed an acceptable accuracy in measuring BP and tracking BP changes in various SVR states; however, the accuracy of CO measurement and its trending ability in various SVR states was poor. (C) 2020 Elsevier Inc. All rights reserved.