INVERSE THERMODILUTION WITH CONVENTIONAL PULMONARY ARTERY CATHETERS FOR THE ASSESSMENT OF CEREBRAL, HEPATIC, RENAL, AND FEMORAL BLOOD FLOW
INVERSE THERMODILUTION WITH CONVENTIONAL PULMONARY ARTERY CATHETERS FOR THE ASSESSMENT OF CEREBRAL, HEPATIC, RENAL, AND FEMORAL BLOOD FLOW
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DOI：
10.1097/shk.0b013e318194c73a
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发表时间：
2009-08-01
期刊：
影响因子：
3.1
通讯作者：
Jakob, Stephan M.
中科院分区：
文献类型：
--
作者：
Ganter, Christoph C.;Buser, Christof;Jakob, Stephan M.
局部血流变化的评估在临床上是困难的。我们测试了传统肺动脉导管（PAC）是否可用于通过反向热稀释法（ITD）测量局部静脉血流量。使用血管周围超声多普勒（USD）流量探头作为参考，在体外和体内测试了反向热稀释法。在麻醉猪中，将PAC插入颈静脉、肝静脉、肾静脉和股静脉，并将其测量值与颈动脉、肝动脉、肾动脉和股动脉以及门静脉的同步USD流量测量值进行比较。通过PAC的远端端口注入液体推注，并通过近端热敏电阻记录温度变化。在22 ℃和4 ℃下使用2 mL和5 mL注射液。通过使用滚子泵（体外）、多巴酚丁胺输注和诱导心包填塞分别改变流量。体外试验：当血流量在400 mL.min（-1）和700 mL.min（-1）之间时（n = 50），ITD和USD相关性良好（r = 0.86，P < 0.0001），偏倚和一致性限为3 101 mL.min-1。体内：由于技术原因，必须从分析中排除514对测量值，并分析了976对测量值。最佳相关性为肾血流r = 0.87（P < 0.0001），肝血流r = 0.46（P < 0.0001）。脑血流和股血流之间无显著相关性。尽管在各种条件下具有良好的体外相关性，但使用传统PAC的反向热稀释法与USD在肾血流方面的效果相当好，但在其他血流方面则不然。此外，这种方法具有很大的技术局限性。
Assessment of regional blood flow changes is difficult in the clinical setting. We tested whether conventional pulmonary artery catheters (PACs) can be used to measure regional venous blood flows by inverse thermodilution (ITD). Inverse thermodilution was tested in vitro and in vivo using perivascular ultrasound Doppler (USD) flow probes as a reference. In anesthetized pigs, PACs were inserted in jugular, hepatic, renal, and femoral veins, and their measurements were compared with simultaneous USD flow measurements from carotid, hepatic, renal, and femoral arteries and from portal vein. Fluid boluses were injected through the PAC's distal port, and temperature changes were recorded from the proximally located thermistor. Injectates of 2 and 5 mL at 22 degrees C and 4 degrees C were used. Flows were altered by using a roller pump (in vitro), and infusion of dobutamine and induction of cardiac tamponade, respectively. In vitro: At blood flows between 400 mL.min(-1) and 700 mL.min(-1) (n = 50), ITD and USD correlated well (r = 0.86, P < 0.0001), with bias and limits of agreement of 3 101 mL.min-1. In vivo: 514 pairs of measurements had to be excluded from analysis for technical reasons, and 976 were analyzed. Best correlations were r = 0.87 (P < 0.0001) for renal flow and r = 0.46 (P < 0.0001) for hepatic flow. No significant correlation was found for cerebral and femoral flows. Inverse thermodilution using conventional PAC compared moderately well with USD for renal but not for other flows despite good in vitro correlation in various conditions. In addition, this method has significant technical limitations.